This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Ranolazine oral

Updated 2 Feb 2023 | Other antianginal drugs


Prolonged release oral formulation of ranolazine

Drugs List

  • RANEXA 375mg prolonged release tablet
  • RANEXA 500mg prolonged release tablet
  • RANEXA 750mg prolonged release tablet
  • ranolazine 375mg prolonged release tablet
  • ranolazine 500mg prolonged release tablet
  • ranolazine 750mg prolonged release tablet
  • Therapeutic Indications


    Stable angina pectoris: Adjunctive treatment

    Use in combination for the symptomatic treatment of patients with stable angina pectoris who are intolerant to or not adequately controlled by first line antianginal treatments (such as beta-blockers and/or calcium antagonists).



    Treatment should be initiated at 375 mg ranolazine twice a day, after 2 to 4 weeks the dose can be titrated to 500 mg ranolazine twice a day. Depending on the patients response the dose may be further titrated to 750 mg twice a day.

    Titration down to 500 mg or 375 mg twice a day may be required if the patient experiences treatment-related side effects (e.g. dizziness, nausea or vomiting). Ranolazine should be discontinued if the side effects do not resolve after decreasing the dose.


    Ranolazine should be used with caution in the elderly due to age related decrease in renal function. The incidents of side effects was higher in the elderly. The dose should be carefully titrated.

    Patients with Renal Impairment

    Mild to moderate renal impairment (creatinine clearance 30 to 80 ml/minute)
    Careful titration of dose is recommended in these patients.

    Patients with Hepatic Impairment

    Mild hepatic impairment
    Careful titration of dose is recommended in these patients.

    Additional Dosage Information

    Patients with low weight (less than or equal to 60 kg)
    The incidents of side effects was higher in patients with low weight, dose should be carefully titrated in these patients.

    Patients with moderate to severe congestive heart failure (NYHA class III to IV)
    Careful titration of dose is recommended in these patients.


    Children under 18 years
    Long QT syndrome
    Moderate hepatic impairment
    Renal impairment - creatinine clearance below 30 ml/minute
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Weight below 60kg
    CYP2D6 poor metaboliser genotype
    Electrolyte imbalance
    Glucose-galactose malabsorption syndrome
    History of torsade de pointes
    Lactose intolerance
    Mild hepatic impairment
    New York Heart Association class III failure
    New York Heart Association class IV failure
    Renal impairment - creatinine clearance 30-80ml/minute

    Correct electrolyte disorders before treatment
    Advise ability to drive/operate machinery may be affected by side effects
    Some formulations contain lactose
    Some formulations contain tartrazine
    Consider monitoring ECG in patients at risk of QT prolongation
    Monitor renal function regularly
    Monitor serum electrolytes
    Advise patient not to take St John's wort concurrently
    Advise patient grapefruit products may increase plasma level
    Remind patient of importance of carrying Alert Card with them at all times

    If ranolazine is used in a patient with a combination of risk factors frequent monitoring of side effects and reduced dose are recommended. Discontinuation of treatment may be required.

    Patient who are known to have low CYP2D6 metabolising capacity may be treated with ranolazine but caution should be exercised when they have a combination of several risk factors.

    Pregnancy and Lactation


    Ranolazine is contraindicated in pregnancy.

    At the time of writing, there is no published experience concerning exposed human pregnancies and their outcomes. The manufacturer reports that there are insufficient animal studies with respect to the effects on pregnancy and embryo development. As the potential risk is unknown the use of ranolazine is contraindicated during pregnancy, and other antianginal agents with more data on their use during pregnancy should be considered first.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Ranolazine is contraindicated in breastfeeding.

    It is unknown whether ranolazine is excreted into human breast milk. Therefore, ranolazine should not be used by nursing mothers.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal discomfort
    Abdominal pain
    Acute renal failure
    Allergic dermatitis
    Blood urea increased
    Blurred vision
    Cold sweat
    Decreased appetite
    Dry mouth
    Erectile dysfunction
    Erosive duodenitis
    Gait abnormality
    Hearing disturbances
    Hot flushes
    Impaired co-ordination
    Impaired consciousness
    Increased platelet count
    Increased sweating
    Increases in hepatic enzymes
    Joint swelling
    Muscle weakness
    Muscular cramps
    Oral hypoaesthesia
    Orthostatic hypotension
    Painful extremities
    Peripheral coldness
    Peripheral oedema
    Postural dizziness
    Prolongation of QT interval
    Serum creatinine increased
    Throat tightness
    Urinary retention
    Visual disturbances
    Weight loss


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: July 2016

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 5 July 2016.

    Summary of Product Characteristics: Ranexa prolonged-release tablets. A.Menarini Farmaceutica Internazionale SRL. Revised November 2015.

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.