Ranexa

Ranexa,

a trademark for ranolazine.

---

ranolazine

Ranexa

Pharmacologic class: Piperazine derivative

Therapeutic class: Antianginal

Pregnancy risk category C

Action

Unclear. Appears to modulate myocardial metabolism by partially inhibiting fatty acid oxidation, thereby increasing glucose oxidation and generating more adenosine triphosphate.

Availability

Tablets (extended-release): 500 mg

⊘Indications and dosages

➣ Chronic angina

Adults: Initially, 500 mg P.O. twice daily, increased to maximum recommended dosage of 1,000 mg P.O. twice daily if needed

Contraindications

• Hypersensitivity to drug or its components
• Hepatic impairment
• Preexisting QT interval prolongation
• Concurrent use of drugs that cause QT interval prolongation or inhibit CYP3A (including diltiazem)

Precautions

Use cautiously in:
• patients receiving concurrent digoxin therapy
• patients age 75 and older
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Administer without regard to meals.
• Don't give with grapefruit juice.

Route	Onset	Peak	Duration
P.O.	Unknown	2-5 hr	Unknown

Adverse reactions

CNS: dizziness, headache, vertigo

CV: palpitations

EENT: tinnitus, dry mouth

GI: nausea, vomiting, constipation, abdominal pain

Respiratory: dyspnea

Other: peripheral edema

Interactions

Drug-drug. CYP3A inhibitors such as diltiazem, ketoconazole, macrolide antibiotics, paroxetine, protease inhibitors, verapamil: increased ranolazine blood level

Digoxin, simvastatin: increased blood levels of these drugs

Drug-food. Grapefruit juice: increased ranolazine blood level

Patient monitoring

• Obtain baseline and follow-up ECGs to evaluate drug effects on QT interval.
• Monitor blood pressure regularly in patients with severe renal impairment.

Patient teaching

• Inform patient that drug can be taken with or without food, but not with grapefruit juice.
• Advise patient not to chew or crush tablets.
• Instruct patient to consult prescriber before taking other prescription or over-the-counter drugs.
• Inform patient that drug isn't intended for acute angina episodes.
• Caution patient to avoiding driving and other hazardous activities until drug effects are known.
• Advise female with childbearing potential to tell prescriber if she is pregnant or plans to become pregnant.
• Advise female not to breastfeed during therapy.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and foods mentioned above.