OBJECT DRUGS

• Ranolazine (Ranexa)

PRECIPITANT DRUGS

Antidepressants:

• Fluvoxamine (Luvox, etc.)
• Nefazodone

Comment:

Ranolazine is metabolized primarily by CYP3A4, and inhibitors of this isozyme increase the serum concentrations of ranolazine. The product information states that ranolazine is contraindicated with potent (nefazodone) or moderately potent (fluvoxamine) CYP3A4 inhibitors. Theoretically, such drugs could increase the risk of ranolazine-induced QTc prolongation and ventricular arrhythmias.

Class 2: Use Only if Benefit Felt to Outweigh Risk

• Consider Alternative:Sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and venlafaxine (Effexor), have little effect on CYP3A4.
• Circumvent/Minimize: Consider reducing the dose of ranolazine if enzyme inhibitors are coadministered.
• Monitor: If the combination is used, the primary concern is QTc prolongation. Monitor the ECG and advise the patient to report any episodes of dizziness or syncope.