Ranolazine in combination improves angina
Ranolazine can increase exercise capacity and provide additional anti-anginal relief to patients with severe chronic angina taking standard anti-anginal therapy, according to new research.
The CARISA (combination assessment of ranolazine in stable angina) trial
involved 823 adults with symptomatic chronic angina taking standard doses
of atenolol, amlodipine or diltiazem. The patients were randomly
assigned to receive twice-daily doses of
ranolazine (750mg or 1,000mg) or placebo for 12 weeks. Those taking ranolazine
could exercise for longer than those given placebo (P=0.01). The times
to angina and electrocardiographic ischaemia also increased in the
ranolazine groups. Ranolazine reduced angina attacks and nitroglycerin
use by about one per week compared with placebo (P<0.02).
The authors suggest that the anti-anginal action of ranolazine may be
related to partial inhibition of fatty acid oxidation, increasing glucose
oxidation and generating more adenosine triphosphate per molecule of
oxygen consumed. The drug “may be particularly useful in patients
who cannot tolerate the initiation or upward titration of currently available
anti-anginal drugs because of their depressive effects on blood pressure
and heart rate”, they conclude (JAMA 2004;291:309). |
The
Pharmaceutical Journal