Ranolazine
RANEXA
What it isLate sodium current inhibitor; chronic angina.
Why this oneIt reduces angina without lowering heart rate or blood pressure, so it can be added when beta blockade is already maximal or hypotension limits.
What limits itQT prolongation, and it is CYP3A4-dependent, so strong inhibitors are contraindicated. It has no mortality benefit.
FDA-approved for
- chronic angina (2006)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Chronic angina | Adults | 500 mg BID | 1000 mg BID | 1000 mg BID |
Renal Monitor renal function in moderate-severe impairment (CrCl <60); discontinue if acute renal failure develops
Hepatic Contraindicated in liver cirrhosis
Instructions
- Swallow whole; do not crush, break, or chew
- Take with or without meals
- Limit to 500 mg BID with moderate CYP3A inhibitors (diltiazem, verapamil, erythromycin)
- If a dose is missed, take next scheduled dose; do not double
Contraindications
- Strong CYP3A inhibitors (e.g., ketoconazole, clarithromycin, nelfinavir)
- CYP3A inducers (e.g., rifampin, phenobarbital, St. John's wort)
- Liver cirrhosis
Cautions
- QT interval prolongation (dose-related)
- Acute renal failure in severe renal impairment — monitor renal function
Adverse reactions
- Dizziness
- Headache
- Constipation
- Nausea
Pregnancy No human data; no fetal harm in animals at 4x MRHD
Lactation No human data; present in rat milk
NO BOXED WARNINGS
Principal riskQT prolongation; CYP3A4-dependent
Cost, est. cash$5–$150/month
Generic entry2013
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityQT prolongation and CYP3A interactions; dizziness and constipation are common.
Mechanism of action: Ranolazine ballicule
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