Author Topic: Ranolazine  (Read 4756 times)

anita

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Ranolazine
« on: January 24, 2012, 12:50:38 PM »
Hi All,

Does anyone take Ranolazine for chronic cardiac angina? 

I saw a new cardiologist at Hopkins yesterday and he suggested it for my chest pain associated with coronary artery vasospasms...which is both an autonomic dysfunction and from the CAD.  He said most don't have any side-effects and it may even help with my cardiac extertional tachy rates and SOB.

I'm curious if anyone has used it and whether they had good results.

Thanks,
Anita
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

Linda196

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Re: Ranolazine
« Reply #1 on: January 24, 2012, 01:06:00 PM »
I don't take the drug myself, but I do know it's contraindicated with many other drugs, two of which are hydroxychloroquin (Plaquenil) and diltiazeim(Cardizem) Please have your cardiologist and/or pharmacist thouroughly research this before considering taking it.
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anita

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Re: Ranolazine
« Reply #2 on: January 24, 2012, 01:57:13 PM »
He knows I take both and we specifically talked about the Cardizem.    This is very odd; most RX sites list it as a contraindication in one part, but then say it works well with Cardizem.  Here's one of the quotes, "In addition, it has been shown to both decrease angina episodes and increase exercise tolerance in individuals taking concomitant atenolol, amlodipine, or diltiazem."  Then in the next paragraph is list it under drug interactions.   Go figure.

The Plaquenil we didn't discuss...but I will certainly ask him.  Do you know what the interaction consists of with Plaquenil?  Is there a site that someone can put two medicines into and get possible interactions?  That would be a nice tool to have on hand.

Thanks Linda
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

anita

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Re: Ranolazine
« Reply #3 on: January 25, 2012, 03:48:22 AM »
Bump...in hopes that someone has taking this and can share their experience.  I think it is rather new (approved in US in 2006).

52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

Linda196

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Re: Ranolazine
« Reply #4 on: January 25, 2012, 04:01:14 AM »
This is a pretty good site for checking drug interactions:
http://www.drugs.com/drug_interactions.html

It lists Plaquenil as a mild interaction, and doesn't list Cardiazem at all, so my original information may have been incorrect, although it was from the monologue for Ranolazine from the manufacturer.

Just another example of check, doublecheck and triplecheck...answers may vary!
Please check out our home page at http://www.sjogrensworld.org/index.html {{INCLUDES A LINK TO AMAZON SHOPPING!!}}
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anita

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Re: Ranolazine
« Reply #5 on: February 18, 2012, 04:22:29 AM »
Linda,

We both should have stuck with your original thoughts...that it does NOT go together well with Cardizem!!!  After about 10 days of taking it with no problem, suddenly I had a huge reaction.  Both meds are, in fact, inhibitors of the same excretion pathway.  Their fight for excretion caused both drugs to compound their potency...like a huge overdose of each.  It was horrific!!!  I had to have my hubby keep constant interaction (getting me to talk, etc) just to stay conscious.  Truly a struggle all the way around!!  Thank God I have a pacemaker...I really believe it saved my life.

Lesson learned??  Go to drug.com/interaction (which is now on my desktop) for EVERY new med.  Do NOT count on the pharmacy to watch for interactions.  She told me there were only yellow flag warnings, so probably not a problem!!

So much for warnings on one sight and 'works well together' or omission on other sites.  Contradicting info has its consequences.

Apparently, Cardizem is notorious for interactions in this pathway.
« Last Edit: February 18, 2012, 04:25:51 AM by anita »
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

anita

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Re: Ranolazine
« Reply #6 on: February 20, 2012, 03:15:50 PM »
Bump so Linda can see it.
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

ohiolady

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Re: Ranolazine
« Reply #7 on: February 20, 2012, 06:37:09 PM »
I'll bump this up so Linda can see she was right in her initial caution to you.

Anna
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anita

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Re: Ranolazine
« Reply #8 on: February 20, 2012, 07:19:09 PM »
Thanks Anna.  Yes, I wanted her to see this.  It was odd that her initial check showed it contraindicated, then it didn't show it on the next check.  I found a place that had both a contraindication AND a statement that they worked well together in the SAME place.  This is scary.  Information can be misleading and confusing.

My doctor said it generally works okay together for most people (why he tried it) BUT it does have the potential for this type of reaction.   
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

soycoffee

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Re: Ranolazine
« Reply #9 on: February 21, 2012, 07:05:19 AM »
Drugs.com is difficult to use. Interactions are listed under generic names, so none for Cardizem but YES Major interaction for diltiazem, the generic (that I take).
Quote
diltiazem ? ranolazine
Applies to:diltiazem and ranolazine
ADJUST DOSE: Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of ranolazine, which is primarily metabolized by the isoenzyme. Because ranolazine prolongs QT interval in a dose-dependent manner, high plasma levels of ranolazine may increase the risk of ventricular arrhythmias such as ventricular tachycardia, ventricular fibrillation, and torsade de pointes. In pharmacokinetic studies, plasma levels of ranolazine (1000 mg twice a day) were increased 3.2-fold by the potent CYP450 3A4 inhibitor, ketoconazole (200 mg twice a day), and 1.8- to 2.3-fold by the moderately potent inhibitor diltiazem (180 to 360 mg/day). Plasma levels of ranolazine (750 mg twice a day) were increased about 2-fold by the CYP450 3A4 and P-glycoprotein inhibitor, verapamil (120 mg three times a day).

MANAGEMENT: The dosage of ranolazine should not exceed 500 mg twice a day when coadministered with moderate inhibitors of CYP450 3A4, including but not limited to diltiazem, verapamil, aprepitant, erythromycin, fluconazole, and grapefruit juice. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, or syncope.

Sorry I didn't see your query earlier. I'm glad you got through it.
Soycoffee, who has been checking her own interactions with Cardizem/diltiazem -- which has many other names, such as Matzim.


soycoffee

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Re: Ranolazine
« Reply #10 on: February 21, 2012, 07:23:56 AM »
To check drug /herb interactions for Cardizem/diltiazem at the easy to use (if you know the class of drug) site

http://www.compassionateacupuncture.com/herb%20drug_interactions.htm

use the class of drug term "calcium channel blocker." The major common interaction of Cardizem/diltiazem is with high dose Vitamin D and calcium supplements, as in "might interfere with." Some herbs such as burdock root, and a food, grapefruit juice, also come into play.

Soycoffee




anita

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Re: Ranolazine
« Reply #11 on: February 21, 2012, 07:45:59 AM »
Actually Drugs.com is pretty straight forward (at least the drug interaction tool).  And it picks up either name...brand or generic.  I will run EVERY drug I take through this from now on.

It's the basic info... it is just hit or miss from one site to the next.  One site actually listed the contraindication, but then followed in the same paragraph that the two drugs work well together to increase cardiac endurance during exertion (one of the things the doctor mentioned and we were hoping it would help).  And Linda saw a contraindication on her first check, but then it didn't appear on the next. 

Yes, now I know that Cardizem/diltiazem is notorious for inhibiting excretion and compounding potency.  This makes two reactions from this medicine (first one was with Biaxin)...the ER NEVER should have prescribed that this past summer.   

The ranolazine/diltiazem combo could have been lethal. 
« Last Edit: February 21, 2012, 07:49:29 AM by anita »
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

soycoffee

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Re: Ranolazine
« Reply #12 on: February 21, 2012, 08:10:29 AM »
Still a third way to check for interactions is to consult wikipedia via Google. If Google is your chosen search engine, and you are using the Chrome browser, you can just enter on the line where the URL usually appears, the following query

"what class of drugs is ranolazine" gets you to the wikipedia entry for the drug and its interactions.

Also,
I just found the quick way to check on Drugs.com (as long as you know the generic name for the drug -- which needs to be used even when its for sale only as the trade name)/

Use the url http://www.drugs.com/cdi/diltiazem.html

then modify it by
http://www.drugs.com/cdi/ranolazine.html

then use the same stub, including /cdi/ and follow it with the generic drug name PLUS the ending  ".html"

It has taken me a month of checking my own interactions to find this OBSCURE trick to using the Drugs.com database to check my interactions, as my doctor requested. Hope you can use it, too.

In closing, here is the Drugs.com classification table for drug interactions:

Quote
Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.

Major   Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate   Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor   Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

NOW a caution. None of these strategies picked up the actual problem between Diltiazem and Ranolazine, shown in the first of my three posts today, as far as I could see.

We try, Linda tried. Best, I think, to post a query on every potential interaction, as Linda did. Still not a sure thing. Best to check the exact combination; the combinations in this post above provide general information about interactions.

Soycoffee




anita

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Re: Ranolazine
« Reply #13 on: February 21, 2012, 08:26:17 AM »
Soycoffee,

The quote I listed early in this thread came from Wikipedia about the medicine ranolazine.  It was the one with both the contraindication and 'working well together' in the same paragraph.

The link Linda provided from drugs.com (specifically to search interactions) is the best tool.  It does list it as a "major" interaction, and it automatically gives generic when brand name is used or vise verse.

Oddly, I contacted the pharmacy after this reaction.  She told me (and double checked right then) the pharmacy tool only lists this combo as a moderate interaction (yellow flag), so the doctor is not contacted and patient is not necessary told anything.  She did however, call the manufacturer and report the reaction.

Linda helped point me in the right direction from the start.  Sadly, when I went to look myself (or when she looked again), the information was inconsistent.  I know now to use the tool Linda gave me and double check with the doctor whenever a new medicine is added.  I also have a pharmacy tool that shows other meds (by drug class) using the CYP450 3A4 pathway. 

This was a learning experience...tough way to learn but trust me I will be over cautious from now on.
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

anita

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Re: Ranolazine
« Reply #14 on: February 21, 2012, 10:47:51 AM »

NOW a caution. None of these strategies picked up the actual problem between Diltiazem and Ranolazine, shown in the first of my three posts today, as far as I could see.

We try, Linda tried. Best, I think, to post a query on every potential interaction, as Linda did. Still not a sure thing. Best to check the exact combination; the combinations in this post above provide general information about interactions.

Soycoffee


Thanks Soycoffee for all your input!!!  Don't you find this scary that one place shows a MAJOR interaction, yet other places show nothing?  I guess it's best to check multiple sources.
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran