Ranolazine is a medication used to treat chronic stable angina. It primarily works by modulating myocardial metabolic pathways to improve cardiac blood flow. This drug reduces myocardial ATP consumption and increases the supply of high-energy phosphate compounds, thereby alleviating chest pain symptoms. It is classified as a piperazine derivative and is mainly suitable for patients who respond poorly to other anti-anginal medications.
The generic name of this medication is Ranolazine, with the main brand name being Ranexa®. In Taiwan and Hong Kong, this drug is typically prescribed using either the generic or brand name, in specific formulations such as tablets, following the physician's instructions.
Ranolazine belongs to cardiac metabolic modulators, categorized as "Anti-Anginal Agents" and "Myocardial Metabolic Modulators." Its mechanism of action differs from traditional nitrates or beta-blockers, providing an alternative treatment option for patients.
Primarily used for the treatment of chronic stable angina, especially in patients whose symptoms are not adequately controlled with standard therapies such as beta-blockers, nitrates, or calcium channel blockers. In some cases, it may also be used in combination with other cardiovascular drugs.
Mild side effects include dizziness, headache, and diarrhea, which usually occur early in treatment and tend to diminish over time. More serious side effects may include arrhythmias, liver function abnormalities, or muscle pain. If these symptoms occur, immediate medical attention is required.
Contraindications: Severe hepatic impairment or hypersensitivity to components. Use during pregnancy or breastfeeding should be carefully evaluated due to unclear effects on the fetus.
This medication has a potential risk of QT interval prolongation. Cardiac patients should undergo regular ECG monitoring and avoid concomitant use with other QT-prolonging drugs.
Concurrent use with CYP3A4 enzyme inducers (e.g., carbamazepine) may reduce efficacy, while CYP3A4 inhibitors (e.g., clarithromycin) may increase blood concentrations.
When combined with statins (e.g., atorvastatin), there may be an increased risk of muscle-related side effects.
The usual starting dose is 1000 mg twice daily, taken with meals to enhance absorption. Tablets should be swallowed whole and not chewed. If a dose is missed, do not double the next dose. Elderly patients or those with hepatic impairment may require dose adjustments.
If a dose is missed and more than 6 hours remain before the next scheduled dose, take the missed dose immediately. If less than 6 hours remain, skip the missed dose and resume the regular schedule. Do not take extra to make up for missed doses.
If overdose is suspected, seek immediate medical attention and inform healthcare providers of the amount and timing of ingestion. Symptoms of overdose may include severe dizziness, irregular heartbeat, or fainting, which require gastric lavage or supportive care.
It is recommended to take Ranolazine with meals or immediately after eating to reduce gastrointestinal discomfort. A high-fat meal may slightly delay absorption but does not significantly affect efficacy. If gastrointestinal discomfort occurs, taking the medication with food may help alleviate symptoms.
Q: What should I do if I experience dizziness or changes in heartbeat while taking Ranolazine?Dizziness or abnormal heartbeat may be initial side effects. They usually improve within a few days. If symptoms are severe or persistent, discontinue use and consult a physician. Moving slowly when standing can help reduce dizziness. Patients with slow heart rate should monitor their pulse regularly and avoid concurrent use of other medications that lower heart rate.
Q: Can Ranolazine be used simultaneously with nitrates?Ranolazine and nitrates (e.g., nitroglycerin) must not be used together as this may cause severe hypotension or bradycardia. Patients who have used nitrates should stop the medication at least 24 hours before starting Ranolazine, and vice versa. Always inform your healthcare provider of all medications being used.
Q: Can I engage in vigorous exercise or drink alcohol while taking Ranolazine?It is advisable to avoid strenuous exercise, which can increase cardiac workload and cause discomfort. Alcohol may enhance side effects such as dizziness or headache. Limit alcohol intake and discuss personalized exercise recommendations with your doctor, especially if you have a history of heart disease.
Q: Is long-term use of Ranolazine safe with regard to liver function or electrolyte levels?Although Ranolazine has minimal impact on the liver, regular monitoring of liver function tests every 3-6 months is recommended during long-term use. Discontinue if symptoms such as fatigue or jaundice occur. Your doctor may also periodically monitor blood pressure, ECG, and serum electrolytes to ensure safe medication use.
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