Abstract
Ranolazine is a new drug indicated for the treatment of chronic angina. Ranolazine has a novel mechanism of action of inhibiting the late sodium current during ventricular depolarization. A number of clinical trials have demonstrated the ability of ranolazine to increase exercise tolerance, decrease weekly anginal episodes, and effective in reducing angina symptoms. Ranolazine should be reserved for patients who have not achieved an adequate response with other antianginal drugs as ranolazine is identified to extend the QT interval. The therapeutic dose choice of 500 to 1000 mg twice daily is generally well tolerated, with constipation, nausea, asthenia, and dizziness being the most common adverse events reported. Ranolazine is extensively metabolized predominantly through the CYP3A4 pathway with a small amount excreted in the urine unchanged. Ranolazine is contraindicated in patients with hepatic impairment and have severe renal insufficiency should be more closely monitored for side effects. Ranolazine has been studied in wide range of clinical patient subgroups with chronic angina, is effective, and is usually well tolerated. There are few data in blacks, Hispanics, and Asians. The reduction in HbA1c levels in diabetic subjects that were observed in the CARISA trial requires prospective validation.