Ranoquid 500 Tablet

Ranoquid 500 Tablet is an medication containing Ranolazine, an anti-anginal agent used exclusively in adults for the long-term management of chronic stable angina pectoris (persistent chest pain caused by heart disease). It is most commonly prescribed as an add-on therapy for individuals whose angina symptoms are not adequately controlled by other first-line medications (such as beta-blockers or calcium channel blockers), or who cannot tolerate those treatments. Ranolazine improves the efficiency of the heart muscle's oxygen use, thereby reducing the frequency of angina attacks and enhancing exercise tolerance. Importantly, it achieves this effect without significantly altering the patient's blood pressure or heart rate. It is not indicated for the acute relief of sudden chest pain. The extended-release tablets are taken twice daily and must be swallowed whole.

Ranoquid 500 Tablet (Ranolazine) is a distinct pharmacological agent in cardiovascular medicine, serving as a continuous maintenance therapy to stabilise chronic stable angina and reduce the burden of ischemic symptoms. Its primary role is to manage persistent, recurring chest discomfort caused by insufficient coronary blood supply during physical exertion or stress.

Clinical evidence shows that when added to conventional therapy, Ranolazine can significantly reduce the average weekly frequency of angina episodes and decrease the need for rescue medications like sublingual nitroglycerin. Patients need to understand that Ranoquid 500 Tablet is a prophylactic (preventative) medication. It works over time to prevent the underlying cellular events that lead to angina, but does not act quickly enough to terminate an acute angina attack. Patients must rely on their rapid-acting nitrate medication for sudden chest pain as directed by their physician.

Ranoquid 500 Tablet is indicated for the following chronic cardiovascular condition:

• Chronic Stable Angina Pectoris: Used for the symptomatic treatment of adults with stable angina who are inadequately controlled or intolerant to first-line anti-anginal therapies.

• Effective Symptom Control: Significantly reduces the frequency of angina attacks.

• Reduced Need for Rescue Medication: Decreases the patient's reliance on sublingual nitroglycerin for breakthrough pain.

• Improved Exercise Tolerance: Increases the duration of exercise a patient can perform before experiencing angina (as measured during exercise testing).

• Hemodynamic Neutrality: Provides anti-anginal relief without significantly lowering resting heart rate or blood pressure, a key advantage for patients already on maximal doses of other drugs or those with low baseline heart rate or blood pressure.

• Suitable Add-on Therapy: Provides a unique mechanism of action that complements the effects of other anti-anginal drug classes (e.g., beta-blockers).

Side effects are usually mild to moderate. Inform your doctor if any side effect persists or worsen.

Common Side Effects (Usually Mild and may lessen with continued use):

• Dizziness (feeling lightheaded or unsteady)

• Constipation

• Nausea

• Headache

Serious Side Effects (Stop taking the medicine and seek urgent medical attention if you experience):

• Severe Dizziness or Fainting (Syncope): May be a sign of a dangerously slow or irregular heart rhythm.

• Signs of Allergic Reaction: Rash, hives, swelling of the face, lips, tongue, or throat, or trouble breathing.

• Severe Arrhythmias (Heart Rhythm Problems): Although rare, Ranolazine can prolong the QT interval on an ECG, increasing the risk of serious ventricular arrhythmias, such as Torsade de Pointes. Symptoms include severe, sudden lightheadedness or a racing heart.

• Signs of Kidney Issues: Swelling of the hands, ankles, or feet, or a decrease in the amount of urine produced.

• Follow your doctor's instructions: Always take Ranoquid 500 Tablet exactly as prescribed. Do not stop or change your dose without consulting them.

• Dosing: The usual starting dose is twice daily (BID) depending on the strength of the drug form. Your doctor may increase the dose if your symptoms are not controlled.

• Timing: Take the tablet approximately every 12 hours (e.g., morning and evening) to maintain a steady level of the medicine in your body.

• How to take it: You must swallow the tablet whole with water. Do not crush, chew, or break the tablet, as this will destroy the extended-release mechanism and could lead to an unsafe, rapid release of the drug (dose dumping).

• With or without food: Ranoquid 500 Tablet can be taken with or without food.

• Prophylactic Use Only: Remember Ranoquid 500 Tablet is a preventative medicine for chronic angina. If you experience sudden chest pain, use your prescribed rapid-acting nitroglycerin.

• Swallow Whole: Never crush, chew, or break the Extended-Release tablet. It must be swallowed whole to work correctly and safely.

• Consistent Timing: Take the medicine every 12 hours, at the same time each day, to maintain steady drug levels.

• Watch for Interactions: Inform your doctor and pharmacist about all other medicines, herbal products, and grapefruit consumption, as Ranolazine interacts with many common medications.

• Avoid Abrupt Stop: Do not suddenly stop taking Ranoquid 500 Tablet, as this could lead to a sudden worsening of your angina symptoms.

• Monitor for Dizziness: Dizziness and constipation are common. If dizziness is severe or causes fainting, seek medical attention.

• Store Ranoquid 500 Tablet at room temperature, ideally between 20°C and 25°C

• Keep the medication in its original container, protected from excessive moisture, heat, and direct light.

• Keep the tablets strictly out of the reach and sight of children and pets.

• Food: Ranoquid 500 Tablet can be taken with or without food, as food does not significantly affect its absorption.

• Grapefruit Juice: Avoid consumption of grapefruit and grapefruit juice while on Ranoquid 500 Tablet. Grapefruit juice inhibits the metabolism of Ranolazine, leading to significantly higher blood levels and increased risk of side effects, including QTc prolongation.

The CYP3A4 enzyme extensively metabolises Ranolazine and is also a P-glycoprotein (P-gp) substrate, making it highly susceptible to significant drug interactions.

• Strong CYP3A4 Inhibitors (e.g., Ketoconazole, Clarithromycin, HIV Protease Inhibitors): CONTRAINDICATED. These drugs dramatically increase Ranolazine levels, significantly raising the risk of toxicity and QTc prolongation.

• Strong CYP3A4 Inducers (e.g., Rifampin, Phenytoin, St. John’s Wort): CONTRAINDICATED. These drugs drastically decrease Ranolazine levels, leading to therapeutic failure and a return of angina symptoms.

• Moderate CYP3A4 Inhibitors (e.g., Diltiazem, Verapamil, Erythromycin): Use with caution. The Ranolazine dose must be limited to 500 mg BID when used concurrently with these medications.

• Other QTc-Prolonging Drugs (e.g., Amiodarone, Sotalol, certain antipsychotics): Use with extreme caution. The combination increases the risk of serious ventricular arrhythmias.

• Digoxin or Cyclosporine (P-gp Substrates): Ranolazine can increase the plasma concentration of these drugs, requiring a dose reduction and close monitoring of the co-administered drugs.

This medicine is contraindicated or requires careful use if you have specific health problems:

• Hepatic Impairment (Liver Disease): Ranolazine is contraindicated in patients with severe hepatic impairment (liver cirrhosis). It should be used with caution and careful monitoring in patients with moderate liver impairment.

• Renal Impairment (Kidney Disease): Use is not recommended in patients with severe renal impairment (Creatinine Clearance <30 mL/min) due to reduced clearance and potential drug accumulation.

• Congenital Long QT Syndrome or Family History: Caution is required due to Ranolazine's potential to prolong the QTc interval. It should be avoided in patients with known congenital long QT syndrome.

• Pre-existing Arrhythmias: Use with caution in patients with known ventricular arrhythmias or uncorrected hypokalemia (low potassium).

The specific daily dose is determined by the treating physician based on the patient's response and tolerance. The recommended dosing is:

• Starting Dose: 500mg twice daily (BID).

• Maximum Recommended Dose: 1000mg twice daily (BID).

An overdose of Ranoquid 500 Tablet is a medical emergency. Symptoms may include severe dizziness, nausea and vomiting, confusion, increased QTc prolongation, and, in severe cases, the risk of developing life-threatening heart rhythms like Torsade de Pointes. If an overdose is suspected, seek emergency medical care immediately. Treatment is generally supportive, focusing on cardiovascular monitoring and symptom management.

If you miss a dose of Ranoquid 500 Tablet, simply skip the missed dose and take your next dose at the regular scheduled time. Do not take two doses at the same time or a double dose to make up for the missed one. Maintaining the regular twice-daily schedule is essential for effective symptom prevention.