USMLE

Ranolazine

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Cardiovascular Pharm
  1. Adenosine
  2. Magnesium
  3. Nitroprusside
  4. Nitrates
  5. Ivabradine
  6. Digoxin/Digitalis
  7. Class IA Antiarrhythmics
  8. Class IB Antiarrhythmics
  9. Class IC Antiarrhythmics
  10. Class II Antiarrhythmics
  11. Class III Antiarrhythmics - Amiodarone
  12. Class III Antiarrythmics - Sotalol
  13. Class III Antiarrhythmics - Ibutilide, Dofetilide
  14. Class IV Antiarrhythmics - Verapamil, Diltiazem
  15. HMG-CoA Reductase Inhibitors (Statins)
  16. Ezetimibe
  17. Fibrates
  18. PCSK9 Inhibitors (Alirocumab, Evolocumab)
  19. Fish Oil and Omega-3s
  20. Milrinone
  21. Aliskiren
  22. Hydralazine
  23. Ranolazine
  24. Sacubitril

Summary

Ranolazine is used to treat refractory angina when other therapies have proven ineffective. It does this by inhibiting the late phase of the inward sodium current, thus reducing intracellular concentrations of both sodium and calcium ions and effectively reducing myocardial wall tension and oxygen consumption. Adverse effects are nonspecific, and ones commonly seen include dizziness, constipation, nausea. Very rarely is QT interval prolongation observed.

Key Points

  • Ranolazine
    • Mechanism
      • Inhibits sodium (Na+) current
        • Inhibits late phase of sodium → reduced Na+ → reduced Na+/Ca+ exchange → reduced Ca+ inside cell → decreases diastolic wall tension and oxygen consumption
        • Does not affect heart rate or blood pressure
    • Clinical Use
      • Refractory angina
        • Used in angina not controlled by medication, stenting, or bypass surgery
    • Adverse Effects
      • Nonspecific findings: constipation, dizziness, headache, nausea
      • QT prolongation (Torsades de Pointes risk)
        • Rare finding caused by higher doses, where drug inhibits potassium repolarization current