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Home Formulary 2.0 Cardiovascular System 2.6 Nitrates, calcium-channel blockers and other antianginal drugs 2.6.3 Other antianginal drugs 2.6.3 Ranolazine

2.6.3 Ranolazine

ChoiceDrugDosage

Reserve

 

Ranolazine tablets m/r 375mg,

500mg, 750mg

Dose: Initially 375mg twice daily, increased if necessary after 2-4 weeks to 500mg twice daily Please note, in practice, 375mg twice daily is often used as a maintenance dose.

Higher doses may lead to QT prolongation (exercise caution with doses greater than 500mg twice daily)

Prescribing Notes

  • Ranolazine is indicated for treatment of stable angina in patients inadequately controlled or intolerant of first-line antianginal therapies
  • Ranolazine inhibits myocardial late sodium current (hence reduces calcium influx) but does not affect heart rate or BP, thus may be particularly useful in patients with low BP and/or low heart rate

Caution

  • Caution in patients with body weight <60kg or borderline renal function (avoid if eGFR less than 30mL/minute/1.73m2)
  • Ranolazine is largely metabolised by the CYP3A4 system thus there is a potential for serious drug interactions, especially at higher doses (see BNF)
 

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