Ranexa^® (ranolazine) overview

What is Ranexa^® (ranolazine) and what is it used for?

Ranexa^® is the prolonged-release tablet form of ranolazine. It is an add-on antianginal therapy indicated for the treatment of adults with stable angina who are inadequately controlled or intolerant to first-line antianginal therapies.¹ Recommended by NICE² and ESC³ as an add-on therapy for patients who remain symptomatic after their first line therapy, Ranexa^® offers the potential for a tailored approach towards angina treatment management.

Management of Chronic Angina Video

How does Ranexa^® (ranolazine) provide symptom relief for stable angina patients?

The primary aim of antianginal therapies is to prevent episodes of angina.² Through inhibition of the late sodium current in cardiomyocytes, Ranexa^® reduces intracellular sodium and calcium overload,^4,5 resulting in improved diastolic relaxation and myocardial blood flow.⁶ This allows the heart to relax during diastole, improving coronary blood flow and reducing chest pain.^1,5,6

This symptom relief is achieved without causing changes to the heart rate, blood pressure or vasodilation.^1,5,6 Thanks to its different mode of action, Ranexa^® can provide patients with additional symptom relief whilst remaining haemodynamically neutral, when compared to other antianginal drugs.^1,7

Why choose Ranexa^® (ranolazine)?

Unlike other add in therapies, Ranexa^® is able to deliver additional antianginal effect without changing heart rate, blood pressure or vasodilation.^1,5,6 With a different mode of action and neutral haemodynamic effects,^1,7 Ranexa^® improves diastolic relaxation and myocardial blood flow without compromising the level of symptom control achieved by first-line therapy.^1,8

Ranexa^® provides additional symptom relief, reducing angina frequency and improving exercise duration.⁸ Data from the Phase 3 CARISA trial showed that after 3 months of treatment with Ranexa^® patients experienced a 42% additional reduction in weekly angina attacks vs baseline.⁸

Ranexa^® also provides a similar efficacy in older and younger patients and is generally well-tolerated with an established safety profile, being associated with fewer adverse effects than some of the other antianginals such as nicorandil and isosorbide mononitrate.⁹ Undesirable effects in patients receiving Ranexa^® are generally mild to moderate in severity and often develop within the first 2 weeks of treatment.¹

How can you optimise medical management in stable angina?

NICE guidelines recommend that before considering revascularisation, medical treatment should be optimised.² For patients whose symptoms are not effectively managed using beta-blockers or calcium channel blockers and where other monotherapy options are contraindicated or not well tolerated, there are four potential add on therapies which could be considered; Ranexa^®, ivabradine, nicorandil or a long-acting nitrate.²

ESC guidelines outline a suggested stepwise strategy for the long-term anti-ischaemic optimisation of drug therapy in patients with chronic coronary syndromes and specific baseline characteristics.³ Over time the need to adapt to each patient’s individual characteristics and preferences has become stronger as we drive towards a more patient-tailored approach based on patient’s cardiovascular profile, haemodynamic status, risk factors and co-morbidities.^1,10 A review by Manolis et al. (2016) highlighted that objectives of individualised treatment could also be extended to include; achieving heart rate control, avoiding high or low blood pressure or improving glucose profile.¹⁰

A large number of patients who are treated for stable angina have low blood pressure and heart rates.¹¹ ESC guidelines³ recommend that these patients are started on antianginal drugs that have no or limited effect on blood pressure or do not lower heart rate, further highlighting the importance of having haemodynamically neutral treatment options.

Ranexa^® (ranolazine) has demonstrated efficacy in special populations¹²

ESC guidelines also recognise that when treating stable angina patients, diabetes and increasing age are among important factors to consider when making decisions around stable angina treatment.³ Ranexa^® has demonstrated additional symptomatic relief to first-line therapy in patients with microvascular angina, patients aged ≥70 years, and patients with diabetes and angina pectoris.^3,6,12

Diastolic relaxation can help improve the quality of life of women with stable angina and coronary microvascular dysfunction (CMD)¹³

The pathophysiology of angina often differs in men and women, with angina cases in women less likely to be associated with angiographically significant coronary obstruction.¹⁴ Studies suggest that in the absence of significant coronary obstruction, CMD may be the cause of angina¹⁵ and in this instance it is important for treatment to increase blood flow to prevent ischaemia. Ranexa^® has been shown to significantly improve Seattle Assessment Questionnaire (SAQ) and Euro Quality of Life (EuroQoL) scores, compared to the placebo and use of Ranexa^® has resulted in significant improvement in all but one score, when compared to ivabradine.¹³

Haemodynamic independence can help lower the risk of falls

We know that within our elderly population falls can have a huge impact, often resulting in a loss of independence.¹⁶ However, many cardiovascular drugs are associated with an increased risk of falls, as any drug that lowers blood pressure or heart rate can cause falls.¹⁷ Ranexa^® provides effective symptom relief without the haemodynamic impacts that may be associated with increasing a patient’s risk of falls. Suitable for use in the elderly¹, Ranexa^® has a similar efficacy in both older and younger patients¹² and can reduce angina frequency and improve exercise duration.¹²

Ranexa^® (ranolazine) may provide an added benefit for those angina patients with diabetes^10,19

Ranexa^® is as effective in reducing angina frequency in diabetic and non-diabetic patients, without the need for dose adjustments¹⁰ and can also provide the added benefit of improving glycaemic control by significantly decreasing HbA1c levels.¹⁹ A post-hoc analysis by Timmis et al (2006) also showed that HbA1c concentrations remain consistent over time during long-term treatment.¹⁹

Provide symptom relief by adding in Ranexa^® (ranolazine)

In adults, the recommended initial dose of Ranexa^® is 375mg twice daily. 2-4 weeks later the dose should be titrated to 500mg twice daily and depending on the patient’s response this could be titrated further to a maximum dose of 750mg twice daily after an additional 2-4 weeks. This maximum dose should be decided by the patient’s doctor in line with the SmPC. The patient’s GP can initiate both an increase and decrease in dose titration as required.¹

For more information about the potential side effects, down titration and contraindications please consult the SmPC.¹