Ranolazine is a medication used to treat chronic stable angina, primarily 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 do not respond well 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 by its generic or brand name, in formulations including tablets, following physician 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 effectively 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 consultation is necessary.
Contraindications: Severe hepatic impairment and hypersensitivity to components are contraindications. Pregnant or breastfeeding women should use with caution after risk assessment, as effects on the fetus are not fully established.
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.
Concomitant use with CYP3A4 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 food to enhance absorption. The tablets should be swallowed whole and not chewed. If a dose is missed, do not double the 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 it as soon as possible. If less than 6 hours remain, skip the missed dose and continue with the next dose at the scheduled time. Do not take extra medication to make up for a missed dose.
If overdose is suspected, seek immediate medical attention and inform healthcare providers of the dosage and timing. Symptoms of overdose may include severe dizziness, irregular heartbeat, or syncope, which require gastric lavage or supportive treatment.
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 stomach upset occurs, taking the medication with food may help alleviate symptoms.
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 medication and consult your doctor. Moving slowly when standing can help reduce dizziness. Patients with bradycardia should monitor their pulse regularly and avoid concurrent use of other medications that lower heart rate.
Can Ranolazine be used together with nitrates?Ranolazine and nitrates (e.g., nitroglycerin) should not be used together as this may induce severe hypotension or bradycardia. Patients who have used nitrates should stop at least 24 hours before starting Ranolazine, and vice versa. Always inform your healthcare provider of all medications you are taking.
Can I engage in vigorous exercise or drink alcohol while taking Ranolazine?It is advisable to avoid strenuous exercise as it may increase cardiac load and cause discomfort. Alcohol can enhance side effects such as dizziness or headache. Discuss personalized advice with your doctor before exercising, especially if you have a history of heart disease.
Is long-term use of Ranolazine safe with regard to liver function or electrolytes?Although Ranolazine has minimal impact on the liver, regular monitoring of liver function every 3-6 months is recommended during long-term use. If symptoms like fatigue or jaundice occur, discontinue medication and seek medical evaluation. Your doctor may also regularly monitor blood pressure, ECG, and blood electrolyte levels to ensure safe medication use.
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