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Ranexa (ranolazine) is a medication used, on its own or with other medications, to treat chronic angina. It is suitable for use in patients age 18 and up, though most of its users are much older.

Angina is chest pain, and chronic angina is chest pain which keeps coming back. Ranexa can help reduce the frequency and severity of angina attacks. Note that it is not a "rescue" treatment---it will not stop an angina attack in progress; other medications---like nitroglycerin---should still be used if needed.

The exact mechanism by which Ranexa works is unclear, but it does work---patients taking it experience fewer angina attacks and reduced rescue medication use. Benefits are generally more pronounced in men than in women.

Angina Basics

Angina is usually caused by coronary artery disease, but does have some other causes. Pain is experienced when the heart fails to get enough oxygen-rich blood. In addition to chest pain, angina can cause:

• Indigestion feeling
• Pressure in chest
• Pain in arms, shoulders, neck, jaw, or back
• Shortness of breath

As symptoms can largely mimic symptoms of a heart attack, angina can be a very distressing condition. Symptoms typically occur when a patient is:

• Exercising
• Under mental or emotional stress
• Exposed to extreme temperatures
• Shortly after eating

Other medications may be given along with Ranexa to address the underlying issue. In addition to medications, lifestyle changes are also encouraged; quitting smoking, losing weight, exercise, and so forth. These may be enough to improve the condition to such an extent that medications are no longer needed. Unfortunately, lifestyle changes don't always address the issue---or may be insufficient---in which case medications will likely be needed for the remainder of life.

Taking Ranexa

Ranexa comes in tablets which are taken twice per day, with or without food. They must be swallowed whole, not split or crushed.

Treatment can be somewhat varied, depending on patient health and response:

• Patients are typically started on 500 mg twice per day (1000 mg per day total).
• After a few weeks, dosage may be increased up to 1000 mg twice per day (2000 mg per day total).
• Some patients---particularly those with liver damage---may be given lower doses of 375 mg twice per day (750 mg per day total).
• Others may be given 750 mg twice per day (1500 mg per day total).

It takes a few weeks of treatment to really evaluate results, giving the medication time to work and then seeing if angina still occurs. Patients should continue to take Ranexa for at least a month, assuming no serious side effects develop, even if not feeling particularly better during the first few weeks.

Precautions before Use

Ranexa has two drawbacks that can influence dosage and perhaps make the medication completely unsuitable; those are prolonged QT intervals and kidney damage.

Patients with a history---including family history---of prolonged QT intervals (sometimes called QT prolongation or long QT syndrome) should be sure to notify the prescribing physician before taking Ranexa. Liver damage increases the risk that prolonged QT intervals will be experienced. Tests may be performed on the heart. Ranexa may not be suitable; if it is given, be alert for symptoms of the heart beating rapidly or irregularly.

Individuals who have preexisting kidney damage may experience kidney failure while taking Ranexa; those with severe kidney damage should probably avoid this product.

Ranexa can also interact with a range of other medications. Of most concern are those designed to treat:

• Fungal infections
• Bacterial infections
• Mental/mood disorders
• HIV infections
• Tuberculosis
• Seizures
• St. John's wort

If taking the above Ranexa treatment may not be suitable. Double-check with a doctor or pharmacist before taking other medications with Ranexa.

There is no evidence that Ranexa is harmful to unborn or nursing babies. However, it has not been thoroughly studied and pregnant or breastfeeding mothers should discuss risks versus benefits with a doctor.