Ranolazine

About Ranolazine

How ranolazine relieves angina has not been determined. At treatment levels it can block the late sodium current in heart muscle, and its effects do not depend on lowering the heart rate or blood pressure. The label covers chronic angina, and it can be taken with beta blockers, nitrates, calcium channel blockers, antiplatelet and lipid-lowering medicines, ACE inhibitors and ARBs. It starts at 500 mg twice daily and is raised to 1000 mg twice daily, the maximum, as symptoms require. Safety and effectiveness in children have not been established.

There is no boxed warning. Ranolazine lengthens the QT interval on the ECG in proportion to the dose, and experience above 1000 mg twice daily is limited. Acute kidney failure has occurred in some people with severe kidney impairment (creatinine clearance under 30 mL/min), so kidney function is checked after starting and periodically when clearance is below 60 mL/min, and it is stopped if acute kidney failure develops. Dizziness, headache, constipation and nausea are the most common side effects, and fainting should be reported. Since approval, abnormal coordination, muscle jerks, tingling, tremor, hallucinations, painful urination or urinary retention, rash, swelling of the face or throat, and low blood sugar in people taking diabetes medicines have been reported.

It must not be taken with strong CYP3A inhibitors such as ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir or saquinavir; with CYP3A inducers such as rifampin, rifabutin, rifapentine, phenobarbital, phenytoin, carbamazepine or St. John’s wort; or by anyone with cirrhosis of the liver. Diltiazem, verapamil, erythromycin, fluconazole and grapefruit products cap it at 500 mg twice daily. It raises other drugs’ levels too: simvastatin is limited to 20 mg a day, metformin to 1700 mg a day with ranolazine at 1000 mg twice daily, and lovastatin, cyclosporine, tacrolimus, sirolimus, digoxin, tricyclic antidepressants and antipsychotics may need lower doses. Aspruzyo Sprinkle, granules approved in 2022 that could be sprinkled on soft food or given through a feeding tube, is now listed as discontinued along with Ranexa.

Taking Ranolazine

How to take it

Twice a day, with or without food, swallowed whole; do not crush, break or chew the tablets. Keep taking it even if you feel well, and keep your fast-acting angina medicine for attacks. It can cause dizziness, so learn how it affects you before driving.

If you miss a dose

Skip the missed dose and take the next one at the usual time; do not double the next dose.

Storage

At room temperature, away from heat and moisture, out of reach of children. Use a take-back program for unused tablets rather than flushing them.

Interactions to know about

Ketoconazole, clarithromycin, ritonavir, rifampin, carbamazepine, phenytoin, phenobarbital and St. John’s wort must not be taken with it. Diltiazem, verapamil, erythromycin and fluconazole limit its dose, and grapefruit juice and grapefruit products should be limited. It can raise levels of simvastatin, lovastatin, digoxin, cyclosporine, tacrolimus, sirolimus and metformin; tell the prescriber about any other medicine that affects heart rhythm.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Ranolazine differs from pharmacy to pharmacy

With Ranexa and Aspruzyo Sprinkle discontinued, every fill is a generic tablet, and generic ranolazine has many makers, so quotes differ with each pharmacy’s cost, markup and dispensing fee rather than with the brand. A month at two doses a day is at least sixty tablets, and twice that when each 1000 mg dose is two 500 mg tablets. A prescription written for Ranexa with substitution blocked, or for the discontinued granules, may need to be rewritten by the prescriber before it can be filled.

Ways to pay less for Ranolazine without insurance

• Ask whether ranolazine is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Ask for a ninety-day supply once your dose is settled.
• If your dose is 1000 mg twice a day, ask the pharmacy to quote one 1000 mg tablet per dose as well as two 500 mg tablets; your prescriber decides how it is written.
• If an older prescription names Ranexa and blocks substitution, ask the prescriber for one that allows the generic, since the brand is discontinued.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Ranolazine

1. 1.Do any of my medicines interact with it or need a lower dose?
2. 2.How much simvastatin or metformin can I take with it?
3. 3.What should I use for an angina attack, since this does not stop one?
4. 4.Will my kidney function or ECG be checked while I take it?

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