title: Should  ranolazine  be used for all patients with ischemic heart disease or only for symptomatic patients with stable angina or for those with refractory angina pectoris? A critical appraisal.
abstract: BACKGROUND
  Ranolazine is a novel antianginal and anti-ischemic agent, that, unlike other available antianginal drugs in the United States (beta-blockers, organic nitrates, and calcium channel blockers), has no significant effect on either heart rate or blood pressure. Its exact mechanism of action is unknown. Ranolazine does increase electrocardiographic QTc interval in a dose-related manner, but at therapeutic doses it has no proarrhythmic effects. Ranolazine (ER) at doses of 500 and 1,000 mg twice daily is currently approved for the treatment of angina pectoris either as monotherapy or added to beta-blockers, nitrates, and calcium channel blockers. Ranolazine (ER) is currently not approved for the treatment of unstable angina, silent ischemia, or cardiac arrhythmias. The most common adverse effects reported in clinical trials during ranolazine (ER) treatment are dizziness, headaches, constipation, and nausea.
  
  
  METHODS
  Recent changes in ranolazine (ER) labeling have led to its increased use for treating patients with ischemic heart disease. This review addresses its appropriate use. All publications were reviewed and those relevant were included.
  
  
  CONCLUSIONS
  Ranolazine (ER) is an effective antianginal and anti-ischemic agent, but I restrict its use to treat patients with stable angina pectoris.
authors.affiliation: University of Oklahoma Health Sciences Center, OU Medical Center, Oklahoma City, OK 73104, USA. Udho-Thadani@ouhsc.edu
authors.forename: Udho
authors.initials: U
authors.lastname: Thadani
mesh_terms: D000083:Acetanilides / Q000494:pharmacology / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy*; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use*; D011358:Product Surveillance, Postmarketing; D000069458:Ranolazine; D026941:Sodium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000083:Acetanilides; D002316:Cardiotonic Agents; D010879:Piperazines; D026941:Sodium Channel Blockers; D000069458:Ranolazine