ranolazine (Ranexa)

SMC did not accept ranolazine as an add-on therapy for the symptomatic treatment of
patients with stable angina pectoris who are inadequately controlled or do not tolerate first-line
antianginal therapy such as beta-blockers and or calcium antagonists.

• Stable angina pectoris is chest pain that is caused by insufficient blood reaching the heart muscle. This is the result of a build up of fatty deposits lining the arteries (blood vessel) and making them narrower, reducing the flow of blood to the heart. Symptoms may only appear at times when the heart needs more blood supply and has to work harder, such as during exercise or periods of stress.
   
• A number of medicines can be taken to treat the symptoms of stable angina and slow down progression of the condition. Ranolazine acts to improve blood flow by altering the sodium currents across cells, to avoid build up of the salts sodium and calcium inside cells and the damaging effects of intracellular calcium. Unlike other medicines used to treat stable angina, it does not alter heart rate or blood pressure. Ranolazine is a tablet taken twice daily.
   
• A study showed that after 12 weeks of treatment patients treated with ranolazine in addition to standard doses of antianginal medicines increased their exercise duration by at least 23 seconds and had fewer angina attacks per week compared with those treated with placebo (a dummy medicine containing no active treatment).
   
• The most common side effects of ranolazine were constipation, dizziness, nausea, headache and asthenia (physical weakness). Ranolazine can also cause abnormal electrical activity of the heart and can interact with other medicines.
   
• SMC did not accept ranolazine for use in NHSScotland because a number of key weaknesses in the clinical and economic case presented by the manufacturer meant the medicine was not value for money.