Names and pronunciation
(ruh-no′luh-zeen) Ranexa
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Individual generic drug information
Extracted information for ranolazine only.
(ruh-no′luh-zeen) Ranexa
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Func. class.: Antianginal
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Chem. class.: Piperazine derivative
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ACTION: Antianginal, antiischemic; unknown, may work by inhibiting portal fatty-acid oxidation
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USES: Chronic stable angina pectoris; use in patients who have not responded to other treatment options; should be used in combination with other antian ginals such as amLODIPine, β-blockers, nitrates
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Unlabeled uses: Unstable angina
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Extracted information for ranolazine only.
CONTRAINDICATIONS: Preexist ing QT prolongation, hepatic disease (Child-Pugh class A, B, C), hypersensitivity, hypokalemia, renal failure, torsades de pointes, ventricular dysrhythmia, ventricular tachycardia, hepatic cirrhosis Precautions: Pregnancy, breastfeeding, children, geriatric patients, hypotension, renal disease, females at risk for torsades de pointes
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SIDE EFFECTS CNS: Headache, dizziness, hallucina tions CV: Palpitations, QT prolongation, ortho- static hypotension EENT: Tinnitus GI: Nausea, vomiting, constipation, dry mouth MISC: Peripheral edema RESP: Dyspnea
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INTERACTIONS Increase: ranolazine action—diltiaZEM, ketoconazole, macrolide antibiotics, dofeti- lide, PARoxetine, protease inhibitors, quiN- IDine, sotalol, thioridazine, verapamil, ziprasidone, avoid using together Increase: action of digoxin, simvastatin Increase: ranolazine absorption, toxicity— antiretroviral protease inhibitors Increase: QT prolongation and torsades de pointes—class IA/III antidysrhyth- mics, arsenic trioxide, chloroquine, dro- peridol, haloperidol, methadone, pent- amidine, chlorproMAZINE, mesoridazine, thioridazine, pimozide; CYP3A4 inhibitors (ketoconazole, fluconazole, itraconazole, IV miconazole, voriconazole, diltiaZEM, verapamil) Drug/Food • Do not use with grapefruit, grapefruit juice Drug/Herb Decrease: ranolazine level—St. John’s wort, don’t use together
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Extracted information for ranolazine only.
DOSAGE AND ROUTES Chronic angina • Adult: PO 500 mg bid, increased to 1000 mg bid based on response; max 1000 mg bid; limit to 500 mg bid in those taking moderate CYP3A4 inhibitors
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Available forms: Ext rel tabs 500, 1000 mg
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Administer: • Ext rel tabs: do not break, crush, chew tabs; take product as prescribed; do not double or skip dose • Use in combination with H2 blocker, metroNIDAZOLE, proton pump inhibitor, and clarithromycin for H. pylori R • Without regard to meals, bid; do not use with grapefruit juice or grapefruit
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Extracted information for ranolazine only.
Assess: • Angina: characteristics of pain (inten- sity, location, duration, alleviating/pre- cipitating factors) • QT prolongation: ECG for QT prolonga- tion, ejection fraction; assess for chest pain, palpitations, dyspnea; torsades de pointes may occur • Cardiac status: B/P, pulse, respirations • LFTs, serum creatinine/BUN (in those with CCr <60 mL/min), magnesium, po- tassium before treatment, periodically; if BUN and creatinine increase significantly, discontinue product • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; do not breastfeed, excretion unknown
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Evaluate: • Therapeutic response: decreased angi- nal pain, attacks
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid hazardous activities until sta- bilized on product, dizziness no longer a problem • To avoid OTC drugs, grapefruit juice, products prolonging QTc (quiNIDine, dofet- ilide, sotalol, erythromycin, thioridazine, ziprasidone or protease inhibitors, diltia- ZEM, ketoconazole, macrolide antibiotics, verapamil) unless directed by prescriber; to notify prescriber of palpitations, fainting • To comply with all areas of medical regimen • To take as directed; not to skip dose, double doses • Not to chew or crush; not to use with grapefruit juice • To notify all health care providers of product use • To notify prescriber of dizziness, edema, dyspnea • For acute angina, to take other prod- ucts prescribed; this product does not decrease acute attack
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Extracted information for ranolazine only.
PHARMACOKINETICS Absorption varied; peak 2-5 hr; half-life 7 hr; extensively metabolized by the liver (CYP3A and less by CYP2D6); excreted in urine (75%), feces (25%); protein bind- ing 62%
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Filter the extracted dose blocks for this individual drug.
Chronic angina
• Adult: PO 500 mg bid, increased to 1000 mg bid based on response; max 1000 mg bid; limit to 500 mg bid in those taking moderate CYP3A4 inhibitors
Candidate age grouping · source page 1133