How does it work?
Ranexa tablets contain the active ingredient ranolazine, which is a type of medicine called an antianginal medicine. It is used to treat angina.
The pain of angina is caused by too little oxygen reaching the heart when the heart rate increases and its workload increases, such as during exercise. This is usually a result of hardening of the arteries (atherosclerosis) that supply blood to the heart. This is also known as coronary heart disease. Ranolazine works by improving the blood flow to the heart and therefore oxygen supply to the heart.
The way in which ranolazine works is not fully understood, however, it does work in a slightly different way to other angina medicines.. It is thought to work by reducing the flow of sodium and calcium into the heart muscle cells. This allows the heart muscle to relax, which improves its blood and oxygen supply and helps prevent angina attacks. Ranolazine doesn’t alter heart rate or blood pressure.
Ranolazine is used as a second-line medicine in addition to other angina medicines.
Ranexa tablets are known as ‘prolonged-release’ tablets. They are designed to release the medicine slowly and continuously over several hours, to provide a steady amount of medicine in the blood.
What is it used for?
- Treatment of chronic stable angina pectoris.
This medicine is used when medicines such as beta-blockers and/or calcium antagonists have not successfully controlled the symptoms of angina, or have caused unacceptable side effects.
How do I take it?
- Ranexa tablets need to be taken on a regular basis to help prevent angina attacks. This medicine should not be used to treat an angina attack, as it won’t work for this purpose.
- Ranexa tablets should be taken twice a day (morning and evening), either with or without food.
- Ranexa tablets should be swallowed whole with a drink of water. The tablets should not be broken, chewed or crushed, as this can damage the prolonged-release action.
- You should avoid eating grapefruit or drinking grapefruit juice while taking this medicine, as grapefruit may affect the metabolism of ranolazine by your liver and could increase the risk of getting side effects.
- The dose prescribed depends on how well your angina is controlled, your liver and kidney function and how well you tolerate the medicine. Follow the instructions given by your doctor. These will be printed on the dispensing label that your pharmacist has put on the packet of medicine.
- You will be given a patient alert card with this medicine. This contains important information about this medicine that you should read, as well as details of your medicines and doses. You should show this card to any healthcare professional that is treating you.
- If you experience side effects such as feeling dizzy or sick, or being sick while taking this medicine, you should tell your doctor. Your dose may need reducing. If a lower dose doesn’t improve these side effects, you may need to stop taking this medicine.
- • This medicine may cause dizziness, blurred vision, confusion or hallucinations and so may affect your ability to drive or operate machinery. You should not drive or operate machinery until you know how this medicine affects you and are sure you can perform these activities safely.
- Ranexa 750mg tablets contain E102, which may cause allergic reactions.
Use with caution in
- Elderly people.
- People who weigh 60kg or less.
- Heart failure.
- People with a personal or family history of an abnormal heart rhythm seen on a heart monitoring trace (ECG) as a 'prolonged QT interval'.
- People taking medicines that can cause prolonged QT interval on an ECG (see end of factsheet for examples).
- Mildly decreased liver function.
- Mild to moderately decreased kidney function.
Not to be used in
- The safety and efficacy of this medicine in children has not been established and the manufacturer does not recommended it for children under 18 years of age.
- People with moderate to severely decreased liver function.
- People with severely decreased kidney function.
- Ranexa 750mg tablets contain lactose and should not be used by people with rare hereditary problems of galactose intolerance, the Lapp-lactase deficiency or glucose-galactose malabsorption.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine for use in pregnancy has not been established. For this reason, it should not be used during pregnancy unless considered essential by your doctor.
- It is not known if this medicine passes into breast milk. The manufacturer states that mothers who need to take this medicine should not breastfeed. Seek medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Common (affect between 1 in 10 and 1 in 100 people)
- Weakness or loss of strength (asthenia).
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Hot flushes.
- Low blood pressure.
- Difficulty breathing.
- Visual disturbances such as blurred vision.
- Disturbances of the gut such as abdominal pain, indigestion, wind, stomach discomfort and dry mouth.
- Excessive sweating.
- Swelling of feet or ankles (peripheral oedema).
- Spinning sensations (vertigo).
- Ringing in the ears (tinnitus).
- Swelling of the joints.
- Muscle cramps.
- Difficulty sleeping (insomnia).
- Feeling sleepy, tired or lethargic.
- Loss of sensation.
- Reduced appetite.
- Weight loss.
- Painful hands and feet.
- Pain or difficulty urinating (dysuria).
- Blood in the urine (haematuria).
- Change in the colour of urine.
Rare (affect between 1 in 1000 and 1 in 10,000 people)
- Cold sweats.
- Coldness in hands and feet.
- Changes in sense of smell.
- Hearing problems.
- Numbness of mouth and lips.
- Allergic skin reaction.
- Loss of memory.
- Feeling disorientated.
- Inflammation of the pancreas (pancreatitis).
- Tightness of throat.
- A drop in blood pressure that occurs when moving from a lying down or sitting position to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
- Loss of consciousness.
- Acute kidney failure.
- Erectile dysfunction.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
The following medicines should not be taken in combination with ranolazine as they may increase the blood level of ranolazine and thus increase the chance of serious side effects :
- protease inhibitors for HIV infection, eg ritonavir, saquinavir, tipranavir, nelfinavir, lopinavir, fosamprenavir,atazanavirindinavir
The following medicines may also increase the level of ranolazine in the blood, so could increase the risk its of side effects:
Ranolazine may increase the level of the following medicines in the blood. Your doctor may need to perform extra monitoring or reduce your doses of these medicine if you are taking them in combination with Ranexa tablets:
- digoxin (if you are taking this medicine in combination with digoxin you should let your doctor know if you experience any side effects that could suggest your digoxin level has risen too high, for example feeling sick or vomiting, diarrhoea, dizziness, blurred vision or a yellow tinge to your vision. Your doctor may want to check your digoxin level)
There may be an increased chance of an abnormal heart rhythm, seen as a 'prolonged QT interval' on an ECG, if this medicine is taken in combination with other medicines that can have this side effect, such as those listed below. The manufacturer states that this medicine should be used with caution in people taking any of these:
- medicines to treat abnormal heart rhythms (anti-arrhythmics), eg amiodarone, (procainamide, quinidine, disopyramide and sotalol should not be used in combination with this medicine)
- certain antidepressants, eg maprotiline, amitriptyline, clomipramine, imipramine
- the antihistamines terfenadine or mizolastine
- certain antimalarials, eg chloroquine, quinine, Riamet, mefloquine
- certain antimicrobials, eg erythromycin given by injection, levofloxacin, moxifloxacin, voriconazole or pentamidine
- certain antipsychotics, eg amisulpride, thioridazine, chlorpromazine, sertindole, haloperidol, zuclopenthixol, sulpiride
- arsenic trioxide
The following medicines may increase the breakdown of ranolazine in the body and could therefore make it less effective. Ranolazine should not be taken in combination with these medicines:
- the herbal remedy St John’s wort (Hypericum perforatum).
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain ranolazine as the active ingredient.