TM Owner Gilead Sciences
Ranexa 500mg Tablet
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Indications & Clinical Uses
- Ranexa 500 mg extended-release tablets contain ranolazine, an anti-anginal medicine used as add-on therapy in adults with chronic stable angina whose symptoms are not adequately controlled by, or who cannot tolerate, first-line treatments such as beta-blockers, calcium-channel blockers, nitrates or ACE inhibitors and ARBs.
- Ranexa may be combined with these other cardiovascular medicines.
- It is marketed in the US by Gilead Sciences and in the EU by Menarini under the same brand name, Ranexa.
- It does not work by lowering heart rate or blood pressure like traditional anti-anginal drugs; instead it reduces the heart's oxygen demand through a different mechanism.
- Ranexa is not approved for treating acute angina attacks and will not provide immediate relief of chest pain; it is intended for regular, ongoing use to reduce the frequency of angina episodes.
Side Effects
- The most common Ranexa side effects, occurring in more than 4% of patients, are dizziness, headache, constipation and nausea.
- Ranexa prolongs the QT interval on the heart's electrical tracing in a dose-related way, so patients with a personal or family history of long QT syndrome need close monitoring; report palpitations, fainting or an irregular heartbeat straight away.
- There is no boxed warning on the current Ranexa label.
- Acute kidney failure has occurred in some patients with pre-existing severe kidney impairment, so decreased urination or swelling should be reported.
- Less common but important reactions include low blood pressure on standing, confusion and, rarely, allergic skin reactions.
- Take Ranexa exactly as prescribed and do not stop it suddenly without medical advice; seek urgent care for fainting, worsening chest pain, or an irregular or racing heartbeat.
Precautions & Warnings
- Ranexa tablets must be swallowed whole; they must never be crushed, broken or chewed, because this destroys the extended-release action and can cause a rapid rise in ranolazine levels.
- Ranexa is contraindicated with liver cirrhosis and with strong CYP3A4 inhibitors, such as ketoconazole, clarithromycin or certain HIV medicines, because these markedly raise ranolazine levels and QT-prolongation risk.
- It should also be avoided with strong CYP3A4 inducers like rifampin, phenytoin or St John's Wort, which reduce its effect.
- Kidney function should be checked before starting and periodically during treatment, since dose adjustment or caution is needed in renal impairment.
- Ranexa can prolong the QT interval, so use caution in patients with a personal or family history of long QT syndrome or with other QT-prolonging medicines.
- There is limited data on use in pregnancy and breastfeeding, so Ranexa should be used only if clearly needed, after discussion with a healthcare provider.
Avoid Interactions
- Ranexa must not be combined with strong CYP3A4 inhibitors, including ketoconazole, itraconazole, clarithromycin and nelfinavir, because these substantially raise ranolazine levels and QT-prolongation risk; grapefruit juice should also be avoided for the same reason.
- Strong CYP3A4 inducers such as rifampin, carbamazepine, phenytoin, phenobarbital and St John's Wort reduce Ranexa's effectiveness and should not be used together.
- With moderate CYP3A4 inhibitors, the Ranexa dose is usually limited to 500 mg twice daily.
- Ranexa raises blood levels of metformin, digoxin and simvastatin, so metformin and simvastatin doses may need capping, and digoxin levels should be monitored.
- Combining Ranexa with other QT-prolonging medicines, such as certain antiarrhythmics, antipsychotics or antibiotics, increases the risk of dangerous heart rhythm changes and should be avoided unless a healthcare provider advises otherwise.
- Tell your healthcare provider and pharmacist about every medicine and supplement you take before starting Ranexa.
References
Frequently Asked Questions
Ranexa (ranolazine) 500 mg is an add-on medicine for adults with chronic angina whose chest pain isn't well controlled by beta-blockers, calcium-channel blockers or nitrates alone. It reduces how often angina episodes happen but does not treat a sudden attack. It's usually taken together with your other heart medicines.
Take Ranexa tablets by mouth, usually twice daily, with or without food, swallowing them whole. Never crush, break or chew Ranexa tablets, as this destroys the extended-release coating and can release too much ranolazine at once. Your doctor may raise the dose up to 1000 mg twice daily.
The most common Ranexa side effects are dizziness, headache, constipation and nausea. Ranexa can prolong the QT interval on your heart's rhythm tracing, so seek urgent care for fainting, palpitations or an irregular heartbeat. Reduced urination or swelling can signal kidney problems and should also be reported promptly.
Avoid grapefruit juice and strong CYP3A4 inhibitors like ketoconazole or clarithromycin, which raise ranolazine levels and QT risk; Ranexa is contraindicated with these and with liver cirrhosis. Avoid rifampin and St John's Wort, which reduce its effect, and check with your pharmacist before adding any new medicine.
If you miss a dose of Ranexa, take your next dose at the regular scheduled time; do not double up. Because it is taken on an ongoing twice-daily schedule to prevent angina, missing occasional doses can make chest pain harder to control, so try to take it consistently.
Yes, Ranexa is intended for long-term daily use to reduce angina frequency. It can occasionally cause acute kidney problems in people with pre-existing severe kidney impairment, so kidney function is checked before and during treatment. Report reduced urination, swelling or unusual tiredness to your healthcare provider.
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