Treatment considerations

Consider these key pieces of clinical information when adding Ranexa® to a patient's treatment plan.

Rate-pressure product
Anti-ischemic and antianginal effects of Ranexa do not depend upon reductions in the heart rate and blood pressure.1

The mechanism of action of ranolazine's antianginal effects has not been determined.

Rate-pressure product (RPP) at peak plasma concentrations (week 12)2

Based on a post-hoc analysis of patients in the CARISA trial

Ranexa does not affect the rate-pressure product, a measure of myocardial work, at maximal exercise

  • Patients with chronic angina treated with Ranexa in controlled clinical studies had minimal changes in mean heart rate (<2 bpm) and systolic blood pressure (<3 mm Hg)

BB=beta-blocker; bpm=beats per minute; CCB=calcium channel blocker; SE=standard error.

Please see full CARISA trial design, including baseline characteristics.
Tolerance to therapy

Exercise testing confirmed continuous effects throughout the 12-hour dosing interval maintained at weeks 2, 6, and 12 of treatment.3

Tolerance to Ranexa did not develop after 12 weeks of therapy

Change in treadmill exercise duration from baseline at trough ranolazine levels over time3

  • Ranexa 1000 mg BID*, when added to a beta-blocker (BB) or calcium channel blocker (CCB), was superior to those treatments plus placebo at improving exercise duration at 12 weeks3
  • At trough plasma concentrations at 12 weeks, Ranexa 1000 mg BID* produced a 24-second placebo-controlled increase in exercise duration (P<0.05)3
  • Statistically significant (P<0.05) increases in modified Bruce treadmill exercise duration and time to angina were observed for Ranexa vs placebo, at both trough (12 hours after dosing) and peak (4 hours after dosing) plasma levels1
Dose-free interval

Ranexa should be initiated at 500 mg BID and increased to 1000 mg BID as needed, based on clinical symptoms.1

  • Steady state is generally achieved within 3 days of BID dosing with Ranexa
Dosing information (24-hour)

For patients receiving long-acting nitrate therapy, guidelines recommend a nitrate-free interval of at least 10 to 14 hours every 24 hours to prevent nitrate tolerance.5

PDE-5 inhibitors
Ranexa is not contraindicated with PDE-5 inhibitors

Ranexa is contraindicated in patients1:

  • Taking strong inhibitors of CYP3A (e.g., ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir, and saquinavir)
  • Taking inducers of CYP3A (e.g., rifampin, rifabutin, rifapentine, phenobarbital, phenytoin, carbamazepine, and St. John's wort)
  • With liver cirrhosis

Limit the dose of Ranexa to 500 mg BID when coadministered with diltiazem, verapamil, or other moderate CYP3A inhibitors.

BID=twice a day.

Chronic Angina Burden on Patients icon of a heart

Chronic Angina Burden

Is the burden of angina under-recognized in your patients? Encourage open communication to help accurately assess the presence and frequency of your patients’ angina.

Learn more about prevalence, symptom reporting, and recurrence post-PCI.

Understand the Challenges
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Safety

Learn about safety data from the Ranexa clinical trials, including use in special populations.

Review Safety & Tolerability
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Financial Assistance

Ranexa Connect™ is a financial assistance resource for patients with a Ranexa prescription.

Ranexa Connect is pleased to announce iAssist, a program to help get your patients started on Ranexa faster. The program offers online patient enrollment, electronic signatures, as well as real-time pharmacy benefit check and eligibility for financial assistance.

Get Started Now
References:
  1. Ranexa [package insert]. Foster City, CA: Gilead Sciences, Inc.; January 2016.
  2. Stone PH, Chaitman B, Koren A, Crager M. Effects of ranolazine as monotherapy and combination therapy on rate pressure product at rest and during exercise: results from the MARISA and CARISA trials. Circulation. 2006;114:II_714. Abstract 3362.
  3. Chaitman BR, Pepine CJ, Parker JO, et al. Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. JAMA. 2004;291(3):309-316.
  4. Morrow DA, Gersh BJ. Chronic coronary artery disease. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald’s Heart Disease. 8th ed. Philadelphia, PA: Saunders/Elsevier;2008:1353-1405.
  5. Fihn SD, Gardin JM, Abrams J, et al; with American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines, American College of Physicians; American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons. 2012 guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126:e354-e471. 
Important Safety Information
Contraindications