Home Drug Guide Ranolazine

Drug Guide

Generic Name

Ranolazine

Brand Names Ranexa, Aspruzyo Sprinkle

Classification

Therapeutic: Antianginal agent

Pharmacological: Late sodium current inhibitor

FDA Approved Indications

  • Chronic angina pectoris

Mechanism of Action

Ranolazine selectively inhibits the late phase of the sodium current in myocardial cells, which reduces intracellular calcium overload, thereby improving myocardial relaxation and reducing ischemia.

Dosage and Administration

Adult: Initially 500 mg twice daily; may be increased to 1000 mg twice daily based on response and tolerability.

Pediatric: Not established for pediatric use.

Geriatric: Use with caution; start at lower dose due to potential with reduced renal or hepatic function.

Renal Impairment: Adjust dose based on renal function; contraindicated in severe renal impairment (CrCl <30 mL/min).

Hepatic Impairment: Use caution; dose adjustment recommended in hepatic impairment.

Pharmacokinetics

Absorption: Well absorbed, with oral bioavailability of approximately 37%.

Distribution: Extensive tissue distribution; plasma protein binding approximately 62%.

Metabolism: Metabolized primarily via CYP3A4 and CYP2D6 enzymes.

Excretion: Excreted mainly via urine (about 75%), with some fecal excretion.

Half Life: Approximately 7 hours.

Contraindications

  • Concurrent use with strong CYP3A inhibitors or inducers.
  • Severe hepatic impairment.

Precautions

  • Use with caution in hepatic impairment, renal impairment, or electrolyte imbalance. Monitor for QT prolongation.
  • Pregnancy Category C; benefits must outweigh risks.

Adverse Reactions - Common

  • Dizziness (Common)
  • Headache (Common)
  • Constipation (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • QT prolongation (Less common)
  • Serious arrhythmias (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) may increase ranolazine levels.
  • CYP3A4 inducers (e.g., rifampin) may decrease efficacy.
  • Other QT prolonging agents.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of angina, arrhythmias, and adverse effects such as dizziness or QT prolongation.

Diagnoses:

  • Risk for decreased cardiac perfusion
  • Risk for arrhythmias

Implementation: Administer as prescribed, monitor ECG, blood pressure, and symptom relief.

Evaluation: Assess for reduction in anginal episodes, adverse effects, and laboratory abnormalities.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report symptoms like dizziness, chest pain, or irregular heartbeat.
  • Avoid alcohol and CYP3A4 inhibitors or inducers unless directed by healthcare provider.

Special Considerations

Black Box Warnings:

  • QT interval prolongation leading to torsades de pointes.

Genetic Factors: Consider individual variability in CYP2D6 metabolizer status.

Lab Test Interference: May cause falsely elevated serum digoxin or other drug levels.

Overdose Management

Signs/Symptoms: Dizziness, hypotension, bradycardia, signs of arrhythmia.

Treatment: Supportive care, electrolyte correction, ECG monitoring, and in case of severe overdose, consider activated charcoal or hospitalization for advanced care.

Storage and Handling

Storage: Store at room temperature away from moisture, heat, and light.

Stability: Stable for 24 months when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.