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. Theoretically, such drugs could increase the risk of ranolazine-induced QTc prolongation and ventricular arrhythmias. The product information states that ranolazine is contraindicated with potent CYP3A4 inhibitors.

Class 2: Use Only if Benefit Felt to Outweigh Risk

• Use 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.