Uses of Ranola: - Angina (heart-related chest pain) Chronic angina Taking strong inhibitors of CYP3A (e.g., ketoconazole, clarithromycin, nelfinavir) Taking inducers of CYP3A (e.g., phenobarbital, rifampicin)Significant hepatic impairment

Other Anti-anginal & Anti-ischaemic drugs

Ranolazine has anti-ischemlc and antlanginal effects that do not depend upon reductions in heart rate or blood pressure.The exact mechanism of action of ranolazine is unknown. Ranolazine at therapeutic levels can inhibit the cardiac late sodium current (INa). However, the relationship of this inhibition to angina symptoms is uncertain.The QT prolongation effect of ranolazine on the surface electrocardiogram is the result of inhibition of IKr which prolongs the ventricular action potential.

How to use Ranolazine: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Ranolazine is to be taken with food. Administration: May be taken with or without food. Adult Dose: Oral Chronic angina 500 mg PO BID initially; may increase to 1,000 mg PO BID, if needed Hepatic Impairment: Mild: Dose titration needed. Moderate to severe: Contraindicated. Renal Dose: Renal Impairment Mild to moderate (CrCl 30-80 mL/min): Dose titration needed. Severe (CrCl <30 mL/min): Contraindicated.

Increased plasma levels w/ moderate CYP3A4 inhibitors (e.g. diltiazem, fluconazole, erythromycin), P-glycoprotein inhibitors (e.g. verapamil, ciclosporin) and CYP2D6 inhibitors (e.g. paroxetine). May increase plasma digoxin concentrations. May increase risk of rhabdomyolysis w/ simvastatin. May increase plasma concentrations of atorvastatin, other statins (e.g. lovastatin) and CYP3A4 substrates w/ narrow therapeutic range (e.g. tacrolimus, sirolimus, everolimus). May increase plasma exposure of metformin. Increased risk of ventricular arrhythmias w/ other drugs that prolong QT interval (e.g. terfenadine, astemizole, mizolastine). Potentially Fatal: Increased plasma concentrations leading to increased adverse effects w/ CYP3A4 inhibitors (e.g. itraconazole, ketoconazole, HIV protease inhibitors, clarithromycin, telithromycin, nefazodone). Decreased plasma concentration w/ CYP3A4 inducers (e.g. rifampicin, phenytoin, phenobarbital, carbamazepine). Increased risk of QT interval prolongation w/ class 1A (e.g. quinidine) or class III (e.g. dofetilide, sotalol) antiarrhythmics other than amiodarone.

Taking strong inhibitors of CYP3A (e.g., ketoconazole, clarithromycin, nelfinavir) Taking inducers of CYP3A (e.g., phenobarbital, rifampicin)Significant hepatic impairment

Common - Nausea - Vomiting - Headache - Dizziness - Constipation - Weakness >10% Dizziness (5-13%) 1-10% Nausea (4-9%),Constipation (5-8%),Headache (3-6%),Syncope (3%) Frequency Not Defined Palpitations,Bradycardia,Peripheral edema,Prolonged QT interval,Abdominal pain,Dry mouth,Dyspepsia,Anorexia,Vomiting,Hematuria,Dyspnea,Tinnitus,Vertigo,Blurred vision,Vasovagal syncope,Confusional state,Hematuria,Hyperhidrosis

Pregnancy Category C. There are no adequate studies assessing the effect of ranolazine on the developing fetus. There are no adequate well-controlled studies in pregnant women. Ranolazine should be used during pregnancy only when the potential benefit to the patient justifies the potential risk to the fetus.lt is not known whether ranolazine is excreted in human milk. Because of the potentiality for serious adverse reactions from ranolazine in nursing infants, a decision should be made whether to discontinue nursing or to discontinue Ranolazine, taking into account the importance of the drug to the mother.

Precaution: Heart rhythm problems (e.g., bradycardia, QT prolongation, ventricular tachycardia), liver problems, certain uncorrected mineral imbalances (low potassium/magnesium levels), severe kidney problems. Lactation: Unknown if excreted in breast milk; discontinue or do not nurse

Symptoms: Dizziness, nausea, vomiting, diplopia, lethargy, syncope, severe tremor, incoordination, dysplasia, hallucination. Management: Symptomatic and supportive treatment.

Store Ranolazine tablets at 25°C with excursion permitted to 15° to 30°C. Protect from light and moisture.

Other Anti-anginal & Anti-ischaemic drugs

Ranolazine exert its antianginal and anti-ischaemic effects through concentration-, voltage-, and frequency-dependent inhibition of the late Na current and other cardiac ion channels and transporters. It may decrease the magnitude of the late Na current resulting in a net reduction in intracellular Na concentrations, reversal of Ca overload, restoration of ventricular pump function, and prevention of ischaemia-induced arrhythmias. Its antianginal effects are not dependent upon reductions in heart rate or BP and QT interval prolongation effect is caused by inhibition of rapid delayed rectifier K current (IKr), which prolongs the ventricular action potential.

Pregnancy Category C. There are no adequate studies assessing the effect of ranolazine on the developing fetus. There are no adequate well-controlled studies in pregnant women. Ranolazine should be used during pregnancy only when the potential benefit to the patient justifies the potential risk to the fetus.lt is not known whether ranolazine is excreted in human milk. Because of the potentiality for serious adverse reactions from ranolazine in nursing infants, a decision should be made whether to discontinue nursing or to discontinue Ranolazine, taking into account the importance of the drug to the mother.