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 ?
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