Ranexa

Legal status and availability in the UK

In our online pharmacy, Ranexa is available without a prescription, with discreet delivery to the United Kingdom in 9–21 days.

Basic Ranexa information

• INN (international nonproprietary name): Ranolazine
• Brand names available in the United Kingdom: Ranexa; generic ranolazine (e.g. Accord)
• ATC code: C01EB18 (other antianginal agents)
• Forms and dosages: Prolonged-release tablets 375 mg, 500 mg, 750 mg
• Manufacturers in the United Kingdom: Menarini (Ranexa); Accord (generic)
• Registration status in the United Kingdom: Licensed by the MHRA
• OTC / Rx classification: Prescription-only medicine (POM)

What Ranexa (ranolazine) is — INN, class and ATC

Key identifiers

Ranolazine is the International Nonproprietary Name for the active ingredient in Ranexa.

The drug is classified under ATC code C01EB18 as an “other antianginal” agent used in cardiac therapy.

Ranexa is formulated as extended‑release oral tablets intended for twice‑daily dosing to provide steady plasma levels.

Available strengths in the UK are 375 mg, 500 mg and 750 mg.

Ranexa is a prescription-only medicine (POM) in the UK, and MHRA oversight applies to its supply and labelling.

Key specifications:

Indications, approvals and UK regulatory status

Where it fits in practice

Ranexa is licensed for chronic stable angina in adults who remain symptomatic on, or are intolerant of, other antianginal therapies.

Use is specialist‑guided and long‑term therapy is common, rather than treatment for acute attacks.

Ranolazine is not indicated for acute angina relief and has not been approved for paediatric use.

Off‑label uses such as atrial fibrillation prevention remain investigational and are not routine practice.

High‑level contraindications include severe hepatic impairment, concomitant strong CYP3A inhibitors and existing QT prolongation syndromes.

Ranexa is prescribed by a GP or cardiologist on an NHS or private prescription.

Ranexa is a prescription-only medicine (POM) and is subject to MHRA oversight in the UK.

Available formulations and brands in the UK

Strengths and packaging

Ranolazine is distributed almost exclusively as extended‑release oral tablets with common strengths of 375 mg, 500 mg and 750 mg.

Packaging varies by manufacturer and is most often blister packs.

In the UK, Ranexa is supplied by Menarini and generic ranolazine by Accord in blister packs labelled as prolonged‑release tablets.

Dosing and titration

Starting doses, increases and maximums

Standard adult initiation is a 375 mg prolonged‑release tablet taken twice daily.

After 2–4 weeks the dose may be increased to 500 mg twice daily and, depending on response and tolerability, to a maximum of 750 mg twice daily.

Ranexa is intended for chronic management and should not be taken as a PRN spray or rescue medication for acute angina.

Adjustments are required in special situations: severe hepatic impairment is a contraindication, moderate hepatic impairment may require dose reduction and severe renal impairment is not recommended.

Administration advice: take doses at consistent times each day to preserve even plasma levels, and follow cardiology guidance for titration.

Missed dose instructions: take the next scheduled dose at the usual time and do not double up.

Overdose action: seek urgent medical attention for symptoms such as severe dizziness, fainting or abnormal heart rhythms.

Mechanism of action and practical clinical effects

Why patients may feel different compared with other antianginals

Ranolazine works by inhibiting the late inward sodium current in cardiomyocytes, which reduces diastolic wall tension and improves myocardial oxygen efficiency.

The drug typically does this without causing significant reductions in heart rate or blood pressure, differentiating it from beta‑blockers and nitrates.

For patients, that can mean fewer angina episodes and improved exercise tolerance without the symptomatic bradycardia or hypotension experienced with some alternatives.

Compared with amlodipine or isosorbide mononitrate, ranolazine may be preferred when heart‑rate lowering is undesirable or when other agents cause intolerable side effects.

Clinical response varies and combination therapy with beta‑blockers, calcium channel blockers or nitrates is common under specialist supervision.

Comparison with other antianginal medicines:

Safety profile, common adverse effects and monitoring

What to watch for and when to seek help

Common side effects reported include constipation, nausea, headache and dizziness.

Less commonly patients may experience palpitations or syncope, and ranolazine carries a dose‑dependent risk of QT interval prolongation.

ECG monitoring is indicated when combined with other QT‑prolonging drugs or in patients with existing cardiac conduction concerns.

Elderly patients and those with hepatic or severe renal impairment require closer monitoring due to increased susceptibility to adverse effects and QT changes.

Immediate‑action advice: stop medication and seek urgent care for fainting, severe dizziness or marked palpitations.

Storage guidance: keep tablets at 20–25°C in a dry place, protect from moisture and light, and keep out of reach of children.

Adverse reactions:

• Common ADRs: constipation, nausea, headache, dizziness.
• Serious ADRs: syncope, palpitations, QT prolongation — report via Yellow Card if suspected.

Drug interactions, contraindications and cautions

Key interactions

The most critical interactions are with strong CYP3A inhibitors such as ketoconazole and clarithromycin, which contra‑indicate ranolazine use.

Moderate CYP3A inhibitors or inducers require caution or dose adjustment, and concurrent QT‑prolonging drugs increase the risk of dangerous arrhythmias.

Other interaction domains include CYP2D6 substrates where ranolazine may alter concentrations of co‑prescribed medicines.

Absolute contraindications include known hypersensitivity to ranolazine, severe hepatic impairment and pre‑existing QT prolongation syndromes.

Interaction summary:

• Strong CYP3A inhibitors: contraindicated (avoid).
• Moderate inhibitors/inducers: consider dose change or alternative drug.
• QT‑prolonging agents: avoid combination where possible and monitor ECG.

Check interactions with a pharmacist or prescriber, and do not change essential cardiac therapy without medical advice.

Counselling points

Key messages for patients

Advise patients to take ranolazine as an extended‑release tablet twice daily at the same times each day for consistent effect.

Instruct patients not to crush or chew the tablet and to follow the missed‑dose guidance of taking the next dose at the scheduled time without doubling up.

Explain common side effects such as constipation, dizziness and headache, and advise stopping the drug and seeking urgent care for fainting or severe palpitations.

Warn about driving or operating machinery if dizziness occurs, and suggest a medication list card showing ranolazine and other prescriptions to aid interaction checks.

Provide written patient information or a pharmacy‑printed leaflet summarising dosing, storage at 20–25°C and contact details for urgent queries.

Special populations: elderly, hepatic/renal impairment, pregnancy and children

Key points

Ranexa is not approved for children; safety and efficacy in paediatric populations have not been established.

Severe hepatic impairment is an absolute contraindication; moderate hepatic impairment requires caution and potential dose reduction.

Severe renal impairment is not recommended due to higher plasma levels and QT‑prolongation risk; mild to moderate renal disease warrants clinical judgment and monitoring.

Elderly patients, especially those over 75, may have increased sensitivity and merit closer ECG and adverse‑event surveillance.

Pregnancy and breastfeeding data are limited; avoid ranolazine during pregnancy unless a specialist determines the benefits outweigh the risks.

Switching between brand and generic ranolazine

When switching from brand to generic, advise patients to expect different pill markings or leaflets while assuring them that generics meet bioequivalence standards.

If symptom control changes after a switch, clinicians may reassess therapy and consider monitoring or returning to a branded product if clinically justified.

Legal status, off‑label use and reporting side effects

Reporting side effects

Ranexa is prescription‑only under MHRA rules and must be supplied to a valid prescription with appropriate record‑keeping in the pharmacy PMR.

Off‑label prescribing, for example in atrial fibrillation prevention, should be clinician‑led with documented rationale in the patient record.

Pharmacovigilance is essential: report suspected adverse reactions via the Yellow Card Scheme and record batch numbers for quality or safety investigations.

Imported unlicensed versions carry regulatory risk; only licensed products should be used.

Quick specifications and FAQ

At a glance

Frequently asked questions:

• Is Ranexa available on the NHS?: It can be prescribed on the NHS when clinically indicated, subject to local formulary and specialist input.
• Can I take Ranexa with my statin?: Many statins are compatible, but interaction checks are required for specific agents and doses.
• How soon will I notice benefits?: Review after 4–12 weeks to assess symptom reduction and tolerability.

Delivery across the United Kingdom