Ranolazine in the management of chronic stable angina

Abstract

Ranolazine is a novel antianginal drug that does not have a clinically significant effect on haemodynamic parameters such as heart rate and blood pressure. It has been available as Ranexa® (ranolazine prolonged-release tablets) in the US since 2006 and it received approval from the European Medicines Agency (EMA) for use in the EU in 2008. The approved indication is as add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled or intolerant to first-line antianginal therapies (such as beta blockers and/or calcium antagonists). Ranolazine has been evaluated in three trials in patients with stable angina (MARISA, CARISA and ERICA) and one large trial of patients with non-ST elevation acute coronary syndromes (MERLIN-TIMI 36). It has shown an improvement in exercise performance and a decrease in angina attacks. Ranolazine has similar efficacy in younger and elderly patients. Observational experience with ranolazine from a large UK centre is described.