Formulary
Ranolazine: Indications, Dosing, Side Effects and Interactions
Ranolazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Ranolazine: Indications, Dosing, Side Effects and Interactions
Ranolazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**As adjunctive therapy in the treatment of stable angina in patients inadequately controlled or intolerant of first-line antianginal therapies**
- **Adult** (By Mouth): Initially 375 mg twice daily for 2-4 weeks, then increased to 500 mg twice daily, then adjusted according to response to 750 mg twice daily; reduced if not tolerated to 375-500 mg twice daily.
Cautions
Body-weight less than 60 kg; elderly; moderate to severe congestive heart failure; QT interval prolongation
Side effects
Common or very common Asthenia; constipation; headache; vomiting Uncommon Anxiety; appetite decreased; confusion; cough; dehydration; dizziness postural; drowsiness; dry mouth; gastrointestinal discomfort; gastrointestinal disorders; haemorrhage; hallucination; hot flush; hypotension; insomnia; joint swelling; muscle cramps; muscle weakness; pain in extremity; peripheral oedema; QT interval prolongation; sensation abnormal; skin reactions; syncope; tinnitus; tremor; urinary disorders; urine discolouration; vertigo; vision disorders; weight decreased Rare or very rare Acute kidney injury; altered smell sensation; angioedema; consciousness impaired; coordination abnormal; erectile dysfunction; gait abnormal; hearing impairment; hyponatraemia; memory loss; oral hypoaesthesia; pancreatitis; peripheral coldness
Interactions
**Other interactions (37):**
- Effects of other medicinal products on ranolazine CYP3A4 or P-gp inhibitors : Ranolazine is a substrate of cytochrome CYP3A4.
- Inhibitors of CYP3A4 increase plasma concentrations of ranolazine.
- Concomitant treatment with ketoconazole 200 mg twice daily increased the AUC of ranolazine by 3.0- to 3.9-fold during ranolazine treatment.
- Grapefruit juice is also a potent CYP3A4 inhibitor.
- Diltiazem (180 to 360 mg once daily), a moderately potent CYP3A4 inhibitor, causes dose-dependent increases in average ranolazine steady-state concentrations of 1.5- to 2.4-fold.
- Careful dose titration of ranolazine is recommended in patients treated with diltiazem and other moderately potent CYP3A4 inhibitors (e.g.
Pregnancy
Manufacturer advises avoid unless essential-no information available.
Breast feeding
Manufacturer advises avoid-no information available.
Hepatic impairment
Manufacturer advises caution in mild impairment; avoid in moderate to severe impairment (risk of increased exposure). Dose adjustments Manufacturer advises careful dose titration in mild impairment.
Renal impairment
Use with caution if creatinine clearance 30-80 mL/minute (risk of increased exposure); avoid if creatinine clearance less than 30 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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