Extended-release
ranolazine (
ranolazine ER) [
Ranexa(®)] is an antianginal agent that achieves its effects via a novel mechanism of action (inhibition of the late phase of the inward
sodium current), without affecting heart rate or blood pressure (BP). This article reviews the efficacy, safety and tolerability of
ranolazine ER as add-on
therapy in patients with
chronic stable angina pectoris, as well as summarizing its pharmacological properties and its use in non-ST-elevation
acute coronary syndromes. In the CARISA and ERICA trials, add-on
therapy with
ranolazine ER improved exercise tolerance and/or reduced angina frequency and
nitroglycerin use in patients with
chronic stable angina; benefits were seen across a variety of patient subgroups. Although results of the
MERLIN-TIMI 36 trial do not support the use of
ranolazine ER in the acute management of non-ST-elevation
acute coronary syndromes, they do support its use as an antianginal
therapy.
Ranolazine ER was generally well tolerated, with the most commonly reported adverse events including
dizziness,
nausea,
asthenia and
constipation. Despite being associated with modest increases in the corrected QT interval,
ranolazine ER demonstrated antiarrhythmic effects in the
MERLIN-TIMI 36 trial. In conclusion,
ranolazine ER provides an important option for use as add-on
therapy to reduce symptoms in patients with
chronic stable angina.