Ranolazine: a new approach to management of patients with angina.

OBJECTIVE

To review the pharmacology, pharmacokinetics, and clinical efficacy of ranolazine for the treatment of chronic stable angina.

DATA SOURCES

MEDLINE was searched (1966-February 2006) using the English-language key terms ranolazine and chronic stable angina. Additional studies were identified from the bibliographies of the reviewed literature.

STUDY SELECTION AND DATA EXTRACTION

Studies evaluating ranolazine, alone or in combination with other agents, were incorporated in this review.

DATA SYNTHESIS

Ranolazine is a metabolic modulator designed to improve cardiac energy availability and cardiac metabolism. It is believed to be a partial fatty acid oxidation inhibitor. Ranolazine has been shown to improve exercise duration and time to anginal attacks without significantly affecting heart rate or blood pressure. Adverse effects of ranolazine are reported to be dose related. The elimination half-life of ranolazine is estimated to be between 1.4 and 1.9 hours for the immediate-release and 7 hours for sustained-release preparations.

CONCLUSIONS

Ranolazine has a unique mechanism of action that is different from that of conventional agents. It has been studied as monotherapy or in combination with other commonly prescribed agents. It appears that ranolazine has a promising safety data profile and does not affect hemodynamic parameters. At this point, although ranolazine should not be used in place of conventional therapy, it appears that ranolazine may be considered in the management of symptomatic patients when standard antianginal medications are not tolerated or are ineffective.