Ranexa

ranolazine

(ra-nole-a-zeen) ,

Ranexa

(trade name)

Classification

Therapeutic: antianginals
Pregnancy Category: C

Indications

Chronic angina pectoris.

Action

Does not ↓ BP or heart rate; remainder of mechanism is not known.

Therapeutic effects

Decreased frequency of angina.

Pharmacokinetics

Absorption: Highly variable.
Distribution: Unknown.
Metabolism and Excretion: Metabolized in the gut (P-glycoprotein) and by the liver (primarily CYP3A and less by CYP2D6); <5% excreted unchanged in urine and feces.
Half-life: 7 hr.

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
POunknown2–5 hr12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Concurrent use of potent inhibitors of CYP3A;Concurrent use of inducers of CYP3A;Hepatic impairment; Lactation: Lactation.
Use Cautiously in: Renal impairment; Obstetric: Use only when potential benefit outweighs risk to fetus; Pediatric: Safety not established; Geriatric: ↑ risk of adverse reactions in patients >75 yr.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Ear, Eye, Nose, Throat

  • tinnitus

Cardiovascular

  • torsades de pointes (life-threatening)
  • palpitations
  • QTc prolongation

Gastrointestinal

  • abdominal pain
  • constipation
  • dry mouth
  • nausea
  • vomiting

Interactions

Drug-Drug interaction

Ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir, and saquinavir significantly ↑ levels; concurrent use contraindicated.Rifampin, rifabutin, rifapentin, phenobarbital, phenytoin, and carbamazepine significantly ↓ levels; concurrent use contraindicated.Verapamil, diltiazem, aprepitant, erythromycin, and fluconazole ↑ levels (do not exceed ranolazine dose of 500 mg twice daily).Cyclosporine may ↑ levels.Paroxetine may ↑ levels.May ↑ levels of simvastatin.May ↓ metabolism and ↑ effects of metoprolol, tricyclic antidepressants, and antipsychotics ; dosage adjustments may be necessary.May ↑ digoxin levels; dose adjustment may be required.St. John's wort significantly ↓ levels (contraindicated).Grapefruit juice↑ levels (do not exceed ranolazine dose of 500 mg twice daily).

Route/Dosage

Oral (Adults) 500 mg twice daily initially, may be ↑ to 1000 mg twice daily.

Availability (generic available)

Extended-release tablet: 500 mg

Nursing implications

Nursing assessment

  • Assess location, duration, intensity, and precipitating factors of anginal pain.
  • Monitor ECG at baseline and periodically during therapy to evaluate effects on QT interval.
  • Lab Test Considerations: Monitor renal function after starting and periodically during therapy in patients with moderate to severe renal impairment (CCr < 60 mL/min) for ↑ serum creatinine accompanied by ↑ BUN. Usually has a rapid onset, but does not progress during therapy and is reversible with discontinuation of ranolazine.
    • May cause transient eosinophilia.
    • May cause small mean ↓ in hematocrit.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)
Activity intolerance (Indications)

Implementation

  • Ranolazine should be used in combination with amlodipine, beta blockers, or nitrates.
    • Do not administer with grapefruit juice or grapefruit products.
  • Oral: May be administered without regard to food. Tablets should be swallowed whole; do not break, crush, or chew.

Patient/Family Teaching

  • Instruct patient to take ranolazine as directed. If a dose is missed, take the usual dose at the next scheduled time; do not double doses. Explain to patient that ranolazine is used for chronic therapy and will not help an acute angina episode.
  • Advise patient to avoid grapefruit juice and grapefruit products when taking ranolazine.
  • May cause dizziness and light-headedness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
  • Advise patient to notify health care professional if fainting occurs.
  • Inform patient that ranolazine may cause changes in the ECG. Patient should inform health care professional if they have a personal or family history of QTc prolongation, congenital long QT syndrome, or proarrhythmic conditions such as hypokalemia.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.

Evaluation/Desired Outcomes

  • Decrease in frequency of angina attacks.

Ranexa

a trademark for ranolazine.
Mentioned in ?
References in periodicals archive ?
Sales of its cardiovascular drugs Letairis and Ranexa are north of $1 billion a year together.
Gilead Sciences recently presented results from a new study indicating that its angina drug Ranexa was able to reduce the frequency of chest pain of patients with diabetes.
CV Therapeutics' approved products include Ranexa (ranolazine extended-release tablets) and ACEON (perindopril erbumine) Tablets.
The anti-anginal and anti-ischemic drug Ranexa is for the treatment of chronic angina in patients failing first-line therapy.
Ranexa is the first new type of drug approved for angina in the United States since calcium channel blockers were introduced more than 20 years ago.
The findings also reveal that the absence of efficacious antiarrhythmic agents with strong safety profiles is likely to continue as Gilead/Menarini's anti-anginal agent Ranexa (ranolazine) is the only antiarrhythmic drug forecasted to launch through 2021.
Nasdaq: GILD) recently presented encouraging data on its chronic angina drug Ranexa (ranolazine) from a phase IV study (TERISA: n=927).
That's the same price the board of CV Therapeutics, maker of the Ranexa chest-pain treatment, rejected as too low on Feb.
Ranexa may be used in combination with beta blockers, nitrates, calcium channel blockers, anti-platelet therapy, lipid-lowering therapy, ACE inhibitors and angiotensin receptor blockers.
CV Therapeutics and Menarini Group Sign Deal for Ranexa II-81
Palo Alto CA) said the FDA will review its chest-pain drug Ranexa as an initial treatment for angina.