Ranolazine

INTRODUCTION

Indications

Chronic angina pectoris not adequately controlled by conventional antianginals (amlodipine, beta blockers, nitrates).

Action

Does not decrease blood pressure or heart rate; remainder of mechanism is not known. Therapeutic Effects: Decreased frequency of angina.

Adverse Reactions/Side Effects

CNS: dizziness, headache. EENT: tinnitus. CV: palpitations, QTc prolongation. GI: abdominal pain, constipation, dry mouth, nausea, vomiting.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Design and implement aerobic exercise and endurance training programs to increase coronary perfusion and reduce angina.

• Because of an increased risk of cardiac arrhythmias, use caution during aerobic exercise and endurance conditioning. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, unusual fatigue), or displays other criteria for exercise termination (See Appendix L).

Patient/Client-Related Instruction

• Remind patients to take medication as directed to control angina even if they are asymptomatic.

• Counsel patients about additional interventions to help control angina and cardiac dysfunction such as regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.

• Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged headache, ringing/buzzing in the ears (tinnitus), or GI problems (nausea, vomiting, constipation, dry mouth, abdominal pain).

Pharmacokinetics

Absorption: Highly variable.

Distribution: Unknown.

Metabolism and Excretion: Metabolized in the gut (P-glycoprotein) and by the liver (primarily CYP3A and less by CYP2D6); <5% excreted unchanged in urine and feces.

Half-life: 7 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Preexisting QTc prolongation or concurrent use of other medications causing QTc prolongation; Potent inhibitors of CYP3A (ketoconazole, verapamil, diltiazem); Hepatic impairment; Lactation.

Use Cautiously in: Geri: Patients >75 yr (↑ risk of adverse reactions; Severe renal impairment [may ↑ blood pressure]); OB: Pregnancy (use only when use outweighs risk to fetus); Pedi: Children (safety not established).

Interactions