Ranolazine


  Issues for Surgery


For treatment of angina – exacerbation of symptoms if omitted.


  Advice in the Perioperative period

 

Elective and Emergency Surgery

Continue.

Post-operative Advice

Restart post-operatively as soon as next dose is due.


  Interaction(s) with Common Anaesthetic Agents


None1, 2, 3, 4.


  Interaction(s) with other Common Medicines used in the Perioperative Period


QT-Interval Prolongation

Ranolazine prolongs the QT-interval in a dose-dependent manner3. Concurrent use with other drugs that can prolong the QT-interval might increase the risk. These include1, 2, 3, 4: -

  • ciprofloxacin*
  • clarithromycin – avoid 
  • domperidone – avoid 
  • droperidol – avoid 
  • erythromycin (particularly intravenous)*
  • granisetron – ideally avoid
  • haloperidol – avoid 
  • loperamide – increased risk with high doses
  • ondansetron – avoid
  • prochlorperazine*

*monitor ECG with concurrent use if risk factors for QT-interval prolongation also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia)

Hypokalaemia

Corticosteroids may cause hypokalaemia, potentially increasing the risk of torsades de pointes – monitor serum potassium concentrations1.


  Further Information

 

 None relevant.

 

  References


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 13th May 2019]
  2. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 13th May 2019]
  3. Ranolazine. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 13th May 2019]
  4. Summary of Product Characteristics – Ranexa® (ranolazine) prolonged-release Tablets A. Menarini Farmacaeutica Internazionale SRL. Accessed via www.medicines.org.uk 13/05/2019 [date of revision of the text April 2019]