Ranexa for Angina

Ranexa (ranolazine) is a relatively new drug with a unique mechanism of action that is primarily used to treat chronic stable angina. It is also sometimes used for other cardiovascular conditions that produce chest pain.

Ranexa has been shown to significantly improve the amount of time people with stable angina can exercise before symptoms develop. It was approved by the U.S. Food and Drug Administration (FDA) in 2008 as a first-line treatment for angina pectoris.

What is angina pectoris?

Angina is chest pain or discomfort caused by a lack of oxygen-rich blood in the heart muscle. Some people describe the feeling as pressure or squeezing, and in addition to the chest, discomfort can also be felt in the shoulders, arms, neck, jaw or back. Angina may even feel like indigestion.

Angina pectoris itself is a symptom, not a disease. Usually, it indicates that a person has atherosclerotic coronary artery disease (CAD), which causes one or more coronary arteries to narrow. When the hearts of people with CAD are stressed (for example, when they exert force), the area of ​​the heart muscle that is supplied by the narrowed arteries can become ischemic, meaning it will be starved of oxygen. Angina pectoris often occurs when myocardial ischemia occurs.

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How does Ranexa benefit angina?

Ranexa has a unique mechanism of action, so it can be added to other angina medications, such as beta-blockers and nitrates, to improve control of this symptom.

It was originally thought that Ranexa caused the heart muscle to switch from fatty acids to glucose for energy production. This process reduces the amount of oxygen that the heart muscle needs to function, thereby reducing ischemia.

Recently, however, researchers learned that Ranexa’s main action is actually blocking what’s called “late inward sodium channels” in heart cells. This sodium channel increases the calcium concentration within the heart muscle cells and increases the muscle contraction and energy use of the heart muscle.

By blocking this sodium channel (which works only in ischemic cells, not healthy heart cells), Ranexa improves the metabolism of ischemic heart cells, reduces damage to the heart muscle, and reduces angina symptoms .

When is Ranexa useful?

The primary use of Ranexa is to treat people with chronic stable angina. Ranexa can significantly reduce the frequency of angina attacks and increase the amount of exercise that can be done without angina. It is often combined with standard medical treatment for angina.

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In addition to standard treatment, some research suggests that Ranexa may also help treat unstable angina when the heart is not getting enough blood flow or oxygen.

Ranexa also shows promise in the treatment of microvascular angina, chest pain caused by abnormalities in the small arteries of the heart.

How is Ranexa taken?

Ranexa is available in 500 mg and 1,000 mg extended-release tablets, as well as a generic form of ranolazine. The usual dose is 500 mg twice a day, but may be increased to 1,000 mg twice a day.

Ranexa is one of those medicines that should not be taken with grapefruit or grapefruit juice, as it can increase blood levels of Ranexa, making side effects more likely.

Ranexa side effects

The most common side effects of Ranexa are headache, constipation, and nausea. Other less serious side effects may include:

  • Dizziness or spinning sensation
  • headache
  • dry mouth
  • weakness
  • ringing in the ear

Also, while taking Ranexa, it is important to be aware of any of the following serious side effects and to call your doctor right away if they occur:

  • Feeling as if you might pass out
  • swelling of the hands, ankles, or feet
  • slow, fast, or pounding heartbeat
  • tremor
  • blood in the urine
  • Urinating less often or not urinating at all
  • shortness of breath
  • rash, bruising, tingling, numbness, pain, or muscle weakness
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Initially, the main concern about Ranexa was that it could prolong the QT interval (a measure of electrical activity within the heart) on an ECG (electrocardiogram). Some drugs with this effect can increase the risk of dangerous arrhythmias.

However, careful study shows that this risk is small or non-existent with Ranexa. In fact, Ranexa has now been shown to actually reduce the risk of developing ventricular arrhythmias and atrial fibrillation (diseases that cause abnormal heart rhythms), and is sometimes used as an antiarrhythmic drug.

In addition, people with cirrhosis (scarring) should not take Ranexa, nor should people taking St. John’s wort and certain other medicines:

  • fungal infection
  • frustrated
  • HIV
  • Tuberculosis (TB)
  • Seizures

Studies have shown that side effects are more common in people over the age of 75, so this drug should be used with caution in older adults. Pregnant women are advised not to take Ranexa.

VigorTip words

Ranexa is a unique drug that has been shown to treat chronic stable angina. It is also useful for patients with other chest pain syndromes.