Ranolazine

  Issues for Surgery

For treatment of angina – exacerbation of symptoms if omitted.

Risk of QT-interval prolongation if continued (see Interaction(s) with Common Anaesthetic Agents and Interaction(s) with other Common Medicines used in the Perioperative Period).

  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

QT-Interval prolongation (see also Interaction(s) with other Common Medicines used in the Perioperative Period)
Ranolazine prolongs the QT-interval.  Co-administration with other medicines known to prolong the QT-interval must be based on careful assessment of the potential risks and benefits for each patient².

Anaesthetic agents that may be used in the perioperative period that are known to, or predicted to, prolong the QT-interval include^{1, 2}: -

• desflurane, isoflurane, sevoflurane - avoid
• thiopental (theoretical)*

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

  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]