Antianginal – late sodium current inhibitor
ATC code: C01EB18 (Ranolazine)
Brand names
Ranolazina Cinfa
A selective inhibitor of the late sodium current (late INa) in cardiomyocytes. Reduces intracellular sodium and calcium overload in ischemic myocardial cells, improving relaxation and reducing cardiac workload without effects on HR or BP. Principally different from β-blockers, calcium antagonists, and nitrates. CYP3A4-metabolized – significant interactions with CYP3A4 inhibitors and inducers.
Second line
Second-line for stable angina per 2024 in patients with inadequate symptom control on β-blockers and/or calcium antagonists, or with intolerance. Dose 375–750 mg twice daily. Particularly useful in patients with bradycardia, hypotension, or heart failure where β-blockers and nitrates are limited. ERICA showed 30% reduction in angina episodes and improved exercise tolerance.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ranolazine is an antianginal drug with a metabolic mechanism of action (a late sodium current inhibitor). It is prescribed for stable angina as add-on therapy to β-blockers or CCBs when symptom control is inadequate ( 2024, AEMPS Ficha Técnica). In anti-aging regimens, ranolazine is positioned as a metabolic modulator for anti-aging of the myocardium in healthy adults. In people without angina, no clinical studies of prophylactic use exist. The drug causes constipation, nausea, dizziness, QT-interval prolongation, and CYP3A4-mediated drug interactions. If ranolazine was prescribed to a person without angina, consider seeking a second opinion.
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Limited data. In pregnant angina patients, decisions are made with the cardiologist.
Not used during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Ranolazine is evaluated for the following indications with varying evidence strength: Stable angina (evidence tier B), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ranolazine (≥ 1 in 100): Dizziness, Constipation, Nausea, Fatigue, Headache. See the Safety section for uncommon and serious reactions.
FDA category C. Limited data. In pregnant angina patients, decisions are made with the cardiologist.
Not used during lactation.
Ranolazine is contraindicated in: Ranolazine hypersensitivity; Severe hepatic impairment; Severe renal impairment (eGFR under 30); Concomitant strong CYP3A4 inhibitors; Concomitant class Ia and III antiarrhythmics. Full list in the Safety section.