Usage of Ranomax 500
Ranomax 500 is indicated for:
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Chronic stable angina pectoris
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Add-on therapy in patients not adequately controlled with amlodipine, beta-blockers, or nitrates
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Alternative to beta-blockers in bradycardia or hypotension
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Microvascular angina (Cardiac Syndrome X)
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Diastolic dysfunction-related ischemia (off-label)
Mechanism of Action
Ranolazine inhibits the late phase of the inward sodium current (INa) in cardiac myocytes. This action:
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Reduces intracellular sodium and calcium overload
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Enhances myocardial relaxation and perfusion
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Improves myocardial oxygen efficiency without affecting systemic hemodynamics
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Offers anti-ischemic effects without lowering BP or HR
Key Benefits
✅ Effective antianginal relief without bradycardia or hypotension
✅ Safe in patients with low heart rate or borderline BP
✅ Improves exercise tolerance and reduces angina frequency
✅ Beneficial in diabetic patients with angina
✅ Minimal effect on conduction system and QTc prolongation when used appropriately
Common Side Effects
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Dizziness
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Constipation
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Nausea
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Headache
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Rare: QT interval prolongation (dose-dependent)
Most side effects are mild and transient.
Precautions
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Use cautiously in patients with:
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Severe hepatic impairment (contraindicated)
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Prolonged QT interval or electrolyte imbalance
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Kidney dysfunction — monitor closely
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Avoid in combination with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin)
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Regular ECG monitoring advised in high-risk patients
Drug Interactions
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CYP3A4 and CYP2D6 substrate – avoid with strong inhibitors or inducers
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Increases levels of digoxin, simvastatin, metformin — dose adjustments may be needed
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Avoid grapefruit juice
Dosage and Administration
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Initial dose: 500 mg twice daily
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May be increased to 1000 mg twice daily based on response and tolerability
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Tablets should be swallowed whole — do not crush or chew
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Can be taken with or without food
Storage
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Store below 25°C in a dry place
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Protect from moisture and direct sunlight
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Keep out of reach of children
Patient Counseling Points
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Take at the same times each day for best results
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Do not stop the medication abruptly
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Report symptoms like palpitations, light-headedness, or muscle cramps
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Avoid grapefruit juice and inform your doctor about all ongoing medications
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Continue lifestyle modifications and cardiac monitoring
