[Ranolazine: established indications and emerging therapeutic potential]

Ranolazine, approved for the symptomatic treatment of chronic stable angina, is currently indicated as an additional treatment when angina symptoms are not controlled with traditional drugs such as beta-blockers and calcium channel blockers. This review summarizes clinical studies that support current established recommendations for its use and discusses emerging evidence in clinical settings other than ischemic heart disease. A growing number of studies have shown a significant antiarrhythmic effect of this molecule, at both atrial and ventricular levels. Treatment with ranolazine has been associated with a reduced risk of atrial fibrillation and a greater likelihood of restoring sinus rhythm. Additionally, ranolazine is associated with a reduced risk of ventricular arrhythmias in various clinical settings. Ranolazine also plays a modest but clinically significant role in controlling glucose metabolism and is mentioned in the 2023 European Society of Cardiology guidelines on diabetes as a treatment capable of reducing glycated hemoglobin, especially in diabetic patients with poor metabolic control. In cardio-oncology, preclinical and clinical studies have shown a potential cardioprotective effect of ranolazine during certain chemotherapy treatments. In vitro and in vivo studies also suggest a favorable impact of ranolazine on the nervous system, with potential therapeutic effects, for example, in the treatment of neuropathic pain. Although the aforementioned contexts require further evaluation in targeted clinical trials, in all these areas ranolazine's pharmacodynamic profile suggests clinical benefits. Overall, a review that integrates current recommendations with a critical analysis of emerging therapeutic frontiers lays the foundation for an increasingly personalized therapeutic approach.