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Ranolazine Medication: Uses, Dosage, Side Effects & Interactions
Summary of Key Points
Ranolazine is a prescription medication used to manage chronic stable angina and other heart-related conditions. It works by improving blood flow to the heart, which helps reduce chest pain and discomfort. Ranolazine is often prescribed when other treatments have not been effective. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist with any questions or concerns you may have.
Names of Medication
US Brand Name: Ranexa
Generic Name: Ranolazine
The generic name refers to the active ingredient in the medication. It is the same as the brand-name version but may be available at a lower cost.
Pharmacologic Category
Antianginal Agent
Ranolazine Dosage
Ranolazine is prescribed to treat various heart-related conditions in adults. It is essential to follow the dosage and schedule provided by your healthcare provider. Do not change your dose without consulting your doctor. If you have any questions or concerns, our telemedicine providers are here to help.
Angina Pectoris (Chronic Stable Angina)
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Ischemic Heart Disease
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Coronary Artery Disease
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Heart Failure
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Myocardial Ischemia
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Atrial Fibrillation
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Hypertension
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Diabetes Mellitus
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Peripheral Artery Disease
Initial dose: 500 mg orally twice daily
Maintenance dose: May increase to 1,000 mg twice daily based on response and tolerance
Dosage Forms and Strengths
Extended-release tablets: 500 mg, 1,000 mg
Administration Instructions for Ranolazine
Ranolazine should be taken orally, with or without food. Swallow the tablet whole—do not crush, chew, or break it. To maintain consistent levels of the medication in your body, take Ranolazine at the same time each day. If you miss a dose, take it as soon as you remember, unless it’s almost time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Do not take two doses at once. If you have any questions about how to take this medication, consult your healthcare provider.
Ranolazine Side Effects and Adverse Reactions
As with all medications, Ranolazine may cause side effects. Some are more common, while others are rare but potentially serious. If you experience any side effects, contact your healthcare provider immediately. You can also schedule a telemedicine appointment with one of our providers for further guidance.
Common Ranolazine Side Effects
Dizziness: Feeling lightheaded or unsteady.
Nausea: A sensation of discomfort in the stomach, often accompanied by the urge to vomit.
Constipation: Difficulty or infrequent bowel movements.
Headache: Mild to moderate pain in the head.
Serious Side Effects of Ranolazine
QT Prolongation: A potentially dangerous heart rhythm condition that can lead to irregular heartbeats.
Severe Allergic Reaction: Symptoms may include swelling of the face, lips, or throat, difficulty breathing, or a rash.
Low Blood Pressure: Feeling faint or lightheaded, especially when standing up.
Contraindications for Ranolazine
A contraindication is a specific condition or situation where a medication should not be used because it may cause harm. Several contraindications should be considered before starting Ranolazine:
Severe liver disease: Ranolazine is processed by the liver. If you have severe liver disease, the medication may not be metabolized properly, leading to higher levels in the blood and an increased risk of side effects.
QT prolongation: Ranolazine can extend the QT interval on an electrocardiogram (ECG), which may increase the risk of a dangerous heart rhythm called torsades de pointes. If you have a history of QT prolongation or are taking other medications that affect the QT interval, Ranolazine may not be safe for you.
Use of strong CYP3A inhibitors: Medications that strongly inhibit the CYP3A enzyme (such as ketoconazole or clarithromycin) can raise Ranolazine levels in your body, increasing the risk of toxicity. If you are taking these medications, Ranolazine is contraindicated.
Allergy to Ranolazine: If you have had an allergic reaction to Ranolazine in the past, you should not take this medication.
Ranolazine Drug Interactions
Ranolazine can interact with several other medications, which may increase the risk of side effects or reduce the effectiveness of your treatment. It is important to inform your healthcare provider about all the medications you are taking. Some known drug interactions include:
Ketoconazole (Nizoral): A strong CYP3A inhibitor that can increase Ranolazine levels in the blood.
Clarithromycin (Biaxin): Another strong CYP3A inhibitor that can raise Ranolazine levels, increasing the risk of side effects.
Rifampin (Rifadin): A strong CYP3A inducer that can reduce the effectiveness of Ranolazine by lowering its levels in the blood.
Simvastatin (Zocor): Ranolazine can increase the levels of simvastatin, which may raise the risk of muscle-related side effects.
Digoxin (Lanoxin): Ranolazine can increase the levels of digoxin, which may lead to toxicity if not monitored closely.
Ranolazine in Pregnancy
Is it safe to take Ranolazine during pregnancy? The safety of Ranolazine during pregnancy has not been thoroughly studied. While animal studies have indicated some potential risks, there is not enough data from human studies to determine its safety. If you are pregnant or planning to become pregnant, it is essential to discuss the possible risks and benefits of taking Ranolazine with your healthcare provider. They may recommend alternative treatments that are considered safer during pregnancy.
Ranolazine while Breastfeeding
Is it safe to take Ranolazine while breastfeeding? It is currently unclear whether Ranolazine passes into breast milk. Due to the potential for serious side effects in a nursing infant, it is generally advised to avoid taking Ranolazine while breastfeeding. If you are breastfeeding, consult your healthcare provider to discuss alternative treatments or whether it may be necessary to stop breastfeeding while using Ranolazine.
Estimated Cost of Ranolazine Medication
The estimated cost of a 30-day supply of Ranolazine extended-release tablets (500 mg, taken twice daily) without insurance ranges from $50 to $150, depending on the pharmacy and available discounts. By using a GoodRx coupon, you may be able to reduce the cost to approximately $40 to $60. Prices can vary, so it’s a good idea to check with your pharmacy or use a discount service like GoodRx to find the best price.
Possible Alternatives to Ranolazine
If Ranolazine is not suitable for you, or if you are exploring other treatment options, there are alternative medications and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss your options.
Angina Pectoris/Chronic Stable Angina
Alternative treatments include beta-blockers (e.g., metoprolol), calcium channel blockers (e.g., amlodipine), and nitrates (e.g., nitroglycerin). In addition, lifestyle changes such as regular exercise, a heart-healthy diet, and quitting smoking can help manage symptoms.
Ischemic Heart Disease/Coronary Artery Disease
Common treatments include aspirin, statins (e.g., atorvastatin), and ACE inhibitors (e.g., lisinopril). Lifestyle modifications, such as maintaining a healthy weight and controlling blood pressure, are also important.
Heart Failure
Medications like ACE inhibitors, beta-blockers, and diuretics (e.g., furosemide) are often prescribed. Reducing salt intake and managing fluid levels can also help improve symptoms.
Myocardial Ischemia
Treatment options include antiplatelet agents (e.g., clopidogrel), beta-blockers, and nitrates. Lifestyle changes, such as stress management and regular physical activity, can also be beneficial.
Atrial Fibrillation
Medications such as anticoagulants (e.g., warfarin), beta-blockers, and antiarrhythmics (e.g., amiodarone) are commonly used. In some cases, procedures like cardioversion or ablation may be recommended.
Hypertension
Alternatives include ACE inhibitors, ARBs (e.g., losartan), diuretics, and calcium channel blockers. Reducing sodium intake, exercising regularly, and managing stress can also help lower blood pressure.
Diabetes Mellitus
Medications such as metformin, insulin, and SGLT2 inhibitors (e.g., empagliflozin) are commonly prescribed. A balanced diet, regular exercise, and weight management are key lifestyle changes for managing diabetes.
Peripheral Artery Disease
Antiplatelet agents (e.g., aspirin), statins, and medications to improve blood flow (e.g., cilostazol) are often used. Regular exercise and quitting smoking are important lifestyle changes.
Recent Updates on Ranolazine Research
Recent studies have explored the potential of Ranolazine in treating conditions beyond chronic angina. For example, some research suggests that Ranolazine may help manage atrial fibrillation due to its ability to modulate sodium channels in the heart. However, more research is needed to confirm these findings and determine the most effective use of Ranolazine in this context.
Additionally, ongoing studies are investigating the potential benefits of Ranolazine in patients with heart failure and diabetes, as it may help improve glucose control and reduce the risk of cardiovascular events. While these findings are promising, they are still in the early stages, and more data is needed before Ranolazine can be recommended for these conditions.
As always, consult your healthcare provider before making any changes to your medication or treatment plan. You can schedule a telemedicine appointment with one of our providers to discuss the latest research and how it may apply to your condition.
