Ranexa (Ranolazine) - Oral

What Is Ranexa?

Ranexa (ranolazine) is a prescription drug with a unique mechanism of action to treat stable angina, which is chest pain caused by an inadequate blood supply to the heart muscles.

Ranexa is an anti-ischemic and anti-anginal drug. It works by inhibiting what is known as the "late sodium current" to reduce sodium overload in the heart. The inhibition of this sodium channel causes a reduction of sodium in the heart cells and, therefore, decreases calcium. It is thought that this mechanism improves the metabolism in ischemic heart cells, reduces damage to the heart muscle, and helps angina.

Ranexa is available as prescription medicine in an oral dosage form as extended-release tablets. It should only be taken as directed.

Drug Facts

Generic Name: Ranolazine

Brand Name(s): Ranexa, Aspruzyo Sprinkle

Administration Route(s): Oral

Drug Availability: Prescription

Therapeutic Classification: Anti-anginal

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Ranolazine

Dosage Form(s): Extended-release tablet

What Is Ranexa Used For?

Ranexa is used alone or combined with other medicines to treat stable angina. It can be used with medicines, such as beta-blockers or calcium antagonists, to treat angina inadequately managed by first-line therapy. Ranexa can relieve symptoms and decrease the frequency of recurrent angina episodes. It increases the ability to perform strenuous work and exercise without experiencing symptoms of angina.

How to Take Ranexa

Ranexa is available as extended-release tablets to take by mouth. Take it twice daily at around the same time with or without food. Swallow the whole pill and do not crush, break or chew it. Once swallowed, the extended-release tablets deliver the drug in the body slowly. When you chew or crush the tablet, it can release the drug at once, which may increase the risk of side effects.

Do not drink grapefruit juice or eat grapefruit products when using Ranexa. Grapefruit can increase the amount of drug in the bloodstream, causing side effects.

Always follow the instructions on the label. Take Ranexa exactly as prescribed, and do not take more or less than the dose prescribed to you. Your healthcare provider may gradually increase your dose if necessary. Don't stop taking your medication without consulting your healthcare provider, as this can worsen your condition. If you need to stop your medication altogether, the dose may need to be gradually lowered by a healthcare provider.

Do not take Ranexa to treat a sudden attack of angina. Always follow the prescribed instructions to manage your condition.

Storage

Store the medicine in an adequately closed container at room temperature, away from excess heat, moisture, and direct light. Do not store it in a bathroom. Keep all medicines safe, out of sight, and reach of children.

Do not keep expired medicine. Take care to discard medications appropriately. Do not throw unwanted or outdated medicines in the waste bin or via wastewater. The best way to get rid of your unused or expired medication is to talk to your pharmacist about the medicine return program.

Off-Label Uses

Ranexa has been studied for off-label uses in medical conditions not approved by the Food and Drug Administration (FDA). It is sometimes used off-label to treat some arrhythmias, including ventricular tachycardia. However, the research is not supported by scientific evidence.

Ranexa has also been studied for off-label use to treat: 

  • Acute coronary syndrome 
  • Coronary microvascular dysfunction
  • People with coronary heart disease and diabetes or metabolic syndrome

How Long Does Ranexa Take to Work?

The peak plasma concentration of Ranexa is achieved after two to five hours of oral administration. However, the stable state requires three days of twice-daily dosing with Ranexa.

What Are the Side Effects of Ranexa?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Commonly reported side effects of Ranexa include:

You should consult your pharmacist or prescribing healthcare provider if these problems remain persistent or worsen. A healthcare provider prescribes a particular medicine when the benefits outweigh the minor side effects.

Severe Side Effects

Contact the healthcare provider right away if you have any severe side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Severe side effects can include:

  • Numbness
  • Tremor
  • Feeling bloated
  • Swelling of the feet
  • Unexpected weight gain 
  • Visual disturbance
  • Change in the amount of urine
  • Blood in the urine
  • Changes in sensation

Immediately get medical help if you have any of these severe side effects, including

  • Fainting
  • Severe dizziness
  • Irregular heartbeat
  • Chest discomfort or tightness of the chest
  • Feeling like you may pass out

A very severe allergic reaction to Ranexa is rare. However, call for immediate medical help if you notice any symptoms of a severe allergic reaction, such as rash, severe itching, swelling of the face, throat, or tongue, and trouble breathing.

Report Side Effects

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Dosage: How Much of Ranexa Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release tablets):
    • For chronic angina:
      • Adults—At first, 500 milligrams (mg) two times per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1000 mg two times per day.
      • Children—Use and dose must be determined by your doctor.

Modifications

Your healthcare provider may change your dose of Ranexa if you are using certain other drugs, including P-gp inhibitors, such as cyclosporine, and CYP3A inhibitors such as:

  • Diltiazem
  • Verapamil
  • Erythromycin

Consult your healthcare provider to make sure you are taking the right dose.

Missed Dose

If you forget to take a tablet of Ranexa, skip the missed dose and take the next one at the usual time. Never take a double dose to make up for the one you missed.

Overdose: What Happens If I Take Too Much Ranexa?

Immediately contact your healthcare provider or go to the nearest emergency department if you or someone you know has accidentally overdosed on Ranexa. Consider taking your medication with you so that the healthcare team knows what you have taken.

Symptoms of overdose may include:

What Happens If I Overdose on Ranexa?

If you think you or someone else may have overdosed on Ranexa, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Ranexa, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any problems or unwanted effects that may be caused by this medicine. Blood tests may be needed to check for unwanted effects.

Do not use ranolazine together with carbamazepine (Tegretol®), clarithromycin (Biaxin®), nefazodone (Serzone®), phenobarbital, phenytoin (Dilantin®), rifabutin (Mycobutin®), rifampin (Rifadin®, Rimactane®), rifapentine (Priftin®), medicine to treat fungus infections (eg, itraconazole, ketoconazole, Nizoral®, Sporanox®), medicine to treat HIV or AIDS (eg, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, Crixivan®, Fortovase®, Invirase®, Norvir®, Viracept®), or St. John's wort.

Do not use this medicine to treat a sudden onset of chest pain.

This medicine can cause a change in the heart rhythm called prolongation of the QT interval. This condition may change the way your heart beats and can cause palpitations or fainting spells. Check with your doctor right away if you start having any of these symptoms.

This medicine may cause acute kidney failure in some patients with severe kidney disease. Check with your doctor right away if you have the following symptoms: agitation, confusion, decreased urine output, depression, dizziness, headache, hostility, irritability, lethargy, muscle twitching, nausea, rapid weight gain, seizures, stupor, swelling of the face, ankles, or hands, or unusual tiredness or weakness.

This medicine may cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Grapefruit and grapefruit juice may increase the effects of ranolazine by increasing the amount of medicine in the body. You should not eat grapefruit or drink grapefruit juice while you are taking this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Ranexa?

You should not take Ranexa if you:

  • Are hypersensitive or allergic to ranolazine or any of the other ingredients
  • Have a severe kidney disorder or liver cirrhosis
  • Take other medications that break down or eliminate (such as inducers or inhibitors of CYP3A) the same way as ranolazine.

Consult with your healthcare provider if you are pregnant or breastfeeding before taking Ranexa. There is no available data on Ranexa use during pregnancy or breastfeeding.

What Other Medications Interact With Ranexa?

Consult your prescribing healthcare provider or pharmacist before taking Ranexa if you use the following medicines as they can have drug-drug Interactions with ranolazine.

Drugs that affect the heart rhythm (QT prolongation), including those used to treat:

  • Heart rhythm disorders, such as Norpace (disopyramide) and Pronestyl (procainamide)
  • Depression, such as Tofranil (imipramine), Silenor (doxepin), and Elavil or Vanatrip (amitriptyline)

Medicines that interfere with the elimination of Ranexa from the body and affect how it works. These medications may need a dose adjustment:

  • Certain medications to treat a bacterial infection, such as erythromycin, macrolide, and Biaxin (clarithromycin)
  • Azole antifungals, such as Omnel or Sporanox (itraconazole), Nizoral (ketoconazole), and Diflucan (fluconazole)
  • Medicine to prevent organ transplant rejection, such as tacrolimus, ciclosporin, Rapamune (sirolimus), Afinitor and Zortress (everolimus)
  • Heart medication, such as diltiazem or verapamil
  • HIV protease inhibitors, such as Viracept (nelfinavir) and Norvir (ritonavir)
  • Cancer medicines
  • Medications to treat epilepsy or neurologic disorder, such as Dilantin or Phenytek (phenytoin), carbamazepine, and phenobarbital
  • Rifamycins, such as Mycobutin (rifabutin) and Rifadin and Rimactane (rifampin)
  • Herbal remedy St. John's Wort

What Medications Are Similar?

Ranexa is a relatively new drug belonging to the anti-anginal class. It has a novel mechanism of action, making it a drug of choice in the treatment of angina. Ranexa can benefit people whose symptoms are not improved with commonly used treatments, such as beta-blockers, calcium channel blockers, and nitrates.

Frequently Asked Questions

  • What is Ranexa used for?

    Ranexa is a prescription medicine used alone or combined with other drugs to treat chest pains, also called angina.

  • How does Ranexa work?

    The active ingredient ranolazine blocks the sodium channel in the heart cells, causing the heart muscles to relax, improving blood supply to the heart, and alleviating angina symptoms.

  • What are the side effects of Ranexa?

    Common side effects of Ranexa include dizziness, headache, lightheadedness, tiredness, nausea, and constipation. Consult your healthcare provider if you have any severe side effects.

  • How to stop taking Ranexa?

    Never stop taking Ranexa on your own without consulting your healthcare provider. Abrupt discontinuation of this medication may result in worsening angina. Your healthcare provider reduces the dose gradually before stopping the treatment to reduce the withdrawal effects of the drug.

  • When should I take Ranexa?

    You can take Ranexa with or without food two times a day as prescribed. Do not eat grapefruit while being treated with ranolazine.

  • Can I drink alcohol with Ranexa?

    Drinking alcohol while being treated with Ranexa can make you feel dizzy. It is better to avoid alcohol with Renexa when you have to be alert, like driving or operating a piece of machinery.

How Can I Stay Healthy While Taking Ranexa?

Ranexa is proven beneficial to treat chest pain by improving oxygen supply to heart muscles. With a different mechanism of action from drugs commonly used to treat angina, Ranexa is a promising anti-anginal treatment. Always follow the guidelines of the healthcare provider regarding the dose and how to take your medication. Do not start, stop, or alter prescribed treatment regimens without consulting a pharmacist or healthcare provider.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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