Efficacy and safety of ranolazine in patients with chronic stable angina

Chronic stable angina (CSA) impairs patient quality of life, is associated with increased patient mortality, and is a prominent symptom of coronary artery disease (CAD), the latter being prevalent worldwide in patients. Currently, therapeutic options for patients with CSA include β-blockers, calcium channel blockers, nitrates, and ranolazine. Ranolazine is a first-in-class piperazine derivative that inhibits the late inward sodium current in cardiac cells and is considered an effective and safe option for treating patients with CSA. As with any first-in-class agent, it is important for the practitioner to be familiar with the safety profile of the drug. Therefore, the objective of our article is to review safety data on the use of ranolazine in patients with CSA. Clinical data show that ranolazine is well tolerated: major treatment-associated adverse events include dizziness, nausea, headache, and constipation. Ranolazine treatment is also associated with QTc-interval prolongation; however, QTc-interval prolongation with ranolazine does not appear to have clinical consequences-in fact, several studies suggest that ranolazine therapy may have an antiarrhythmic effect in patients. Notably, ranolazine is hemodynamically neutral in that it exerts its antianginal effect without significantly impacting patient heart rate or blood pressure. In addition, small decreases in glycosylated hemoglobin levels have been seen in patients with type 2 diabetes mellitus. Overall, ranolazine (in doses of 500 mg and 1000 mg, twice daily) is a safe and effective option for monotherapy or add-on therapy to reduce anginal symptoms in patients with CSA.