Aspruzyo Sprinkle, Ranexa

Introduction

Written by Helen Marshall BPharm MRPharmS
Medically reviewed by Melissa Badowski, PharmD, MPH, FCCP
Updated on August 4, 2023

Ranolazine (ra NOE la zeen) is a generic medication prescribed for angina (chest pain that happens when your heart doesn’t get enough oxygen). Ranolazine belongs to a group of drugs called antianginals.

Side effects of ranolazine

Ranolazine may cause mild or serious side effects. More common mild side effects of ranolazine and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about ranolazine’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for ranolazine listed in the “Resources” section.

Mild side effects

More common mild side effects reported with ranolazine are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about ranolazine’s side effects, refer to the prescribing information for ranolazine listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Ranolazine extended-release* oral tablet’s mild side effects include:

• dizziness
• headache
• constipation
• nausea
• mild allergic reaction†

* Extended release means the drug is slowly released into your body over a long period of time.
† For details about this side effect, see the “Interactions and warnings for ranolazine” section.

Serious side effects

Serious side effects of ranolazine are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about ranolazine’s side effects, refer to the prescribing information for ranolazine listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, ranolazine’s serious side effects include:

• long QT syndrome (a condition that affects heart rhythm)
• acute (sudden) kidney failure
• orthostatic hypotension (drop in blood pressure when getting up that could cause dizziness or fainting)
• severe allergic reaction*

* For details about this side effect, see the “Interactions and warnings for ranolazine” section.

Common questions about ranolazine

Below you’ll find answers to a few commonly asked questions about ranolazine.

What is ranolazine’s mechanism of action? How does the drug work?

Ranolazine treats angina, a type of chest pain that happens when your heart doesn’t get enough oxygen.

Ranolazine works by helping your heart to relax. Once relaxed, it doesn’t need to use as much oxygen. It does this by reducing the flow of calcium into your heart muscle cells. Calcium usually makes muscle cells contract.

By reducing calcium in your heart muscle cells, ranolazine reduces heart contractions. This helps prevent episodes of chest pain.

Ranolazine usually starts working in about 2–5 hours. But it may take about 3 days to have its full effect.

If you’d like to know more about this, talk with your doctor or pharmacist.

Is ranolazine a beta-blocker?

No, ranolazine is not a beta-blocker. It’s a different type of medication called an antianginal.

Doctors usually prescribe beta-blockers as one of the first treatments for angina. Beta-blockers are taken every day to help prevent episodes of chest pain. Examples include atenolol (Tenormin) and bisoprolol.

If a beta-blocker doesn’t work well enough to prevent chest pain, your doctor may also prescribe ranolazine. Ranolazine works differently than beta-blockers to help prevent episodes of chest pain.

If you have questions about beta-blockers and antianginal medications, talk with your doctor or pharmacist.

How does ranolazine compare with isosorbide?

Like ranolazine, isosorbide mononitrate (Isordil, Monoket, and others) is a medication doctors may prescribe to help prevent episodes of angina. It’s a nitrate medication that works in a different way than ranolazine.

Isosorbide may be taken once or twice daily, depending on the form prescribed. However, ranolazine is usually taken twice a day. These medications can cause some similar and some different side effects. Isosorbide is more likely to cause dizziness and headache than ranolazine.

To learn more about how these medications compare, talk with your doctor. They can help determine whether one of these medications is a good choice for you.

Interactions and warnings for ranolazine

Below, you’ll find information about ranolazine’s possible interactions and warnings.

Interactions of ranolazine

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods*, or taking the drug with other medications. This effect is called a drug interaction.

Before you take ranolazine, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for ranolazine” section below.

* It’s recommended that you avoid drinking grapefruit juice and eating grapefruit while taking ranolazine. Talk with your doctor if you have concerns about avoiding grapefruit during treatment.

Warnings for ranolazine

Some people should not take ranolazine, and others should take it cautiously.

Ranolazine could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether ranolazine is a safe option for you.

Ask your doctor about specific warnings for ranolazine, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Ranolazine can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to ranolazine or any of its ingredients, your doctor will likely not prescribe ranolazine. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to ranolazine, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of ranolazine

You should not take more ranolazine than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much ranolazine, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and ranolazine

Information about ranolazine and pregnancy and breastfeeding is described below.

Ranolazine and pregnancy

It’s not known whether ranolazine should be taken during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication.

Ranolazine and breastfeeding

It’s not known whether ranolazine should be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication.

Uses of ranolazine

The Food and Drug Administration (FDA) approves prescription drugs such as ranolazine for certain conditions. An approved use for ranolazine is described below.

Use for angina

Doctors may prescribe ranolazine extended-release* tablet for treating angina. It’s prescribed for this purpose in adults. It’s usually prescribed as a long-term treatment.

Angina is a type of chest pain that happens when your heart doesn’t get enough oxygen. It’s caused by reduced blood flow to your heart muscle. This can occur if you have narrowing or hardening of the arteries that supply blood to your heart. Angina is a symptom of coronary artery disease.

With angina, you have episodes of chest pain that are usually triggered by physical activity or emotional stress. Along with chest pain, you may also have a feeling of pressure or squeezing in your chest, neck, shoulders, or arms. You may also have shortness of breath, nausea, sweating, dizziness, and anxiety.

Ranolazine is a treatment that you take every day to help prevent episodes of angina. Note that ranolazine won’t work to stop an episode of angina.

Ranolazine is usually prescribed together with other medications for angina. Examples of these include beta-blockers such as atenolol (Tenormin) and nitrates such as nitroglycerin (Nitromist, Nitro-dur, and others).

* Extended-release tablets release the medication slowly over time rather than all at once.

What to ask your doctor

Let your doctor know if you have questions about ranolazine or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Will ranolazine slow down my heart rate?
• Will ranolazine lower my risk of having a heart attack?
• Are there any alternative medications I can take for my condition?
• Am I at higher risk of side effects than others?
• What dose of ranolazine will I need?

Resources

• Ranolazine extended-release tablets, for oral use. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/e2a8c9f9-5f6a-4496-8fd6-2439e564db4f/spl-doc
• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.