Ranolazine: Uses, How It Works, Medicines
Ranolazine is a prescription medicine used as an add-on for long-term angina when other medicines do not control it enough or cannot be tolerated. It is taken as a prolonged-release tablet swallowed whole. It can cause dizziness and constipation, may affect the heart's electrical trace (QT), and interacts with many medicines.
Also known as: Ranolazine tablet, Ranolazine 500 mg, Ranolazine ER, Ranolazine extended-release, Ranexa, Ranozex
Pharmacist review in progress. This page is based on the sources listed below and is being checked by our registered pharmacist.
How does Ranolazine work?
Ranolazine blocks a late sodium current in heart muscle cells. This limits the build-up of sodium and calcium in the cells when the heart is short of oxygen, so the heart muscle relaxes better and angina is reduced without a large change in heart rate or blood pressure.
How to take Ranolazine
Follow the label or your doctor's advice. The tablets are prolonged-release and are swallowed whole, not crushed, broken or chewed. Your doctor decides the dose and may check your kidney function.
Side effects of Ranolazine
Most people take it without serious problems. Some side effects are common and mild, but a few need medical help.
Uncommon or mild
- Dizziness
- Headache
- Constipation
- Nausea or vomiting
- Weakness
Rare but serious: get medical help
- Fainting, or a fast, pounding or irregular heartbeat
- Passing much less urine than usual, or sudden swelling (possible kidney problems)
- Confusion, hallucinations or severe dizziness
- Swelling of the face, lips, tongue or throat, or difficulty breathing (a severe allergic reaction). Get medical help immediately
Who should be careful
Some people need to check with a doctor before taking ranolazine, or need extra care while taking it.
When the label says not to use it
- Allergy to ranolazine or any ingredient
- Liver cirrhosis or moderate or severe liver problems
- Taking strong CYP3A inhibitors or CYP3A inducers
- Severe kidney problems, as set out in the EMA overview
- Liver disease: it must not be used in cirrhosis, and the EMA says not with moderate or severe liver problems
- Kidney disease: kidney function can worsen, so doctors check it
- Long QT or a family history of it, or other medicines that affect the heart rhythm
- Older people and people with low body weight may be more sensitive
- Pregnancy and breastfeeding: human data are limited; ask your doctor
- Dizziness: take care driving or operating machinery until you know how it affects you
Medicines and things that interact with Ranolazine
Ranolazine can change how other medicines work, and some medicines change its effect. Tell your doctor or pharmacist about everything you take, including herbal products and medicines bought over the counter.
- Strong CYP3A inhibitors such as ketoconazole, clarithromycin and ritonavir: must not be used together
- CYP3A inducers such as rifampicin, carbamazepine, phenobarbital and St. John's wort: lower the effect and must not be used
- Diltiazem, verapamil and erythromycin: the dose of ranolazine is limited
- Simvastatin and metformin: their doses may need to be limited
- Other medicines that affect the heart rhythm (QT): the risk adds up
- Grapefruit juice: can raise the level, so ask your doctor
If someone takes too much
Taking extra tablets can cause dizziness, vomiting, double vision, confusion and an irregular heartbeat. If someone has taken much more than prescribed, call 112 or go to the nearest hospital and take the medicine pack with you.
Regulatory status in India
Approved for sale in India as a prescription medicine. Ranolazine is not on the CDSCO list of medicines banned under section 26A of the Drugs and Cosmetics Act as a single ingredient. Fixed-dose combinations that contain it with other medicines may be treated differently, so check the ingredient list on the pack.
Type of medicine
Ranolazine belongs to this type of medicine.
Medicines that contain Ranolazine
These medicines sold in India contain Ranolazine. They are listed A to Z, not ranked.
- Ranozex 500 · 500 mg extended-release tablet
What is Ranolazine used for?
Medicines that contain Ranolazine are used for these conditions.
Common questions
What is ranolazine used for?
It is a prescription medicine for long-term angina. The EMA authorises it as an add-on when first-line medicines such as beta blockers or calcium channel blockers do not control symptoms enough or are not tolerated. A doctor decides whether it suits you.
Why must ranolazine tablets be swallowed whole?
They are prolonged-release tablets that release the medicine slowly. Crushing, breaking or chewing them would release it too fast and may cause side effects. Follow the label or your doctor's advice.
Does ranolazine affect heart rhythm?
It can lengthen the QT interval, a part of the heart's electrical trace, in a dose-related way. Tell your doctor about any long QT, a family history of it, or other medicines that affect rhythm, and report fainting or palpitations.
Which medicines should not be taken with ranolazine?
Some antifungal and antibiotic medicines, HIV medicines, and others such as rifampicin, carbamazepine and St. John's wort must not be combined, and simvastatin and metformin may need limits. Show your doctor and pharmacist the full list of what you take.
Does ranolazine lower heart rate or blood pressure?
Not by much, which is why it can be added to medicines that do. Dizziness can still occur. Do not start or stop it on your own.
Sources
- Ranexa (ranolazine): EPAR medicine overview. European Medicines Agency
- Ranolazine extended-release tablets: prescribing information (Zydus). DailyMed, US National Library of Medicine
- ATC/DDD Index: C01EB Other cardiac preparations. WHO Collaborating Centre for Drug Statistics Methodology
- List of drugs prohibited for manufacture and sale through gazette notifications under section 26A of the Drugs & Cosmetics Act 1940. Central Drugs Standard Control Organisation (CDSCO)