ranolazine (acycloguanosine)

Drug Name

Generic Name : ranolazine (acycloguanosine)

Brand Name: Ranexa

Classification: Piperazineacetamide, Antianginal

Pregnancy Category C

Dosage & Route

Available forms :ER tablets—500 mg

ADULTS
  • 500 mg PO bid; may be increased to maximum of 1,000 mg bid.
PEDIATRIC PATIENTS
  • Safety and efficacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
  • Not recommended with mild, moderate, or severe hepatic impairment.
Therapeutic actions
  • Antianginal, anti-ischemic. Mechanism of action is not known. Prolongs the QT interval; does not decrease heart rate or blood pressure; decreases myocardial workload.
Indications
  • Treatment of chronic angina in patients who have not responded adequately to other antianginal drugs; used with amlodipine, beta-blockers, nitrates
Adverse effects
  • CNS: Dizziness, headache, tinnitus, vertigo
  • CV: Palpitations, peripheral edema, prolonged QT interval
  • GI: Nausea, constipation, dry mouth, vomiting, abdominal pain
  • Respiratory: Dyspnea
Contraindications
  • Contraindicated with hypersensitivity to any component of the drug; pre-existing QT prolongation, concurrent use of QT-interval prolonging drugs; hepatic impairment; concurrent use of potent or moderately potent CYP3A inhibitors, including diltiazem; lactation.
  • Use caution in severe renal impairment, history of ventricular tachycardia, pregnancy.
Nursing considerations
Assessment
  • History: Allergy to any component of the tablet, pre-existing QT-interval prolongation, concurrent use of QT-interval prolonging drugs, hepatic impairment, concurrent use of potent or moderately potent CYP3A inhibitors, renal failure, pregnancy, lactation.
  • Physical: Orientation, reflexes; BP; respiratory evaluation; baseline ECG, LFTs, and renal function tests
Interventions
  • Obtain baseline ECG, LFTs, and renal function tests before starting therapy.
  • Ensure that patient swallows tablets whole; do not cut, crush, or let patient chew the tablets.
  • Ensure that patient continues to use other prescribed antianginal medications.
  • Advise patient to avoid grapefruit juice and grapefruit products while using this drug.
  • Suggest use of contraceptive measures while taking this drug; potential effects on a fetus are not known.
  • Advise nursing mothers that another method of feeding the baby will be needed while taking this drug.
  • Provide safety measures if dizziness and lightheadedness occur.
Teaching points
  • Take this drug twice a day. Swallow the tablet whole; do not cut, crush, or chew it.
  • If you miss a dose of the daily medication, take it as soon as you remember and then return to your usual routine. Do not take more than two doses in one day.
  • Do not take this drug for an acute anginal attack; this drug helps chronic chest pain. Continue to use your other angina drugs as prescribed.
  • You may be asked to have periodic ECGs and blood tests to monitor the effects of this drug on your body.
  • Do not consume grapefruit juice or grapefruit products while taking this drug.
  • It is not known how this drug could affect a nursing baby. If you are nursing a baby, you should select another method of feeding the baby.
  • It is not known how this drug could affect a fetus. If you are pregnant or decide to become pregnant while on this drug, consult your health care provider.
  • You may experience these side effects: dizziness, lightheadedness (if this occurs, avoid driving a car or operating dangerous machinery); headache, constipation (consult your health care provider because medications may be available to help).
  • Report palpitations, fainting spells, severe constipation.