Ranolazine (Ranexa ®) is a novel agent licensed as add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled on, or intolerant to, first-line antianginal therapies. Unlike other antianginal drugs it does not significantly alter heart rate or blood pressure. 

In clinical trials patients treated with ranolazine showed a statistically significant improvement in exercise duration and angina frequency compared with placebo. However, these effects were modest and there are limited data on concurrent use with maximal doses of first-line antianginal agents. Doses used in clinical trials were higher than the licensed dose. 

The most frequent adverse effects in clinical trials were dizziness, nausea and vomiting. There is a sharp increase in adverse effects at higher doses and some patients are at increased risk: the elderly, those with body weight ≤60kg, mild renal or hepatic impairment, or congestive heart failure. 

Ranolazine interacts with a wide variety of medicines. It is contraindicated with potent CYP3A4 inhibitors e.g. clarithromycin and class Ia or class III antiarrythmics (except amiodarone). 

Ranolazine will only be suitable for a select group of patients who do not have significant co-morbidities or concomitant medications that would preclude its use, and who can tolerate it.