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

None^{1, 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 include^{1, 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 13^th May 2019]
2. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 13^th 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 13^th 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]