Clinical Experience with Ranolazine in a Veteran Population with Chronic Stable Angina

• Published in: The Annals of pharmacotherapy 2012-01, Vol.46 (1), p.42-50
• Main Authors: Reeder, Don N, Gillette, Michael A, Franck, Andrew J, Frohnapple, David J
• Format: Article
• Language: English
• Subjects: Acetanilides - administration & dosage; Acetanilides - adverse effects; Acetanilides - therapeutic use; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Aged; Aged, 80 and over; Angina, Stable - drug therapy; Biological and medical sciences; Calcium Channel Blockers - administration & dosage; Calcium Channel Blockers - adverse effects; Calcium Channel Blockers - therapeutic use; Cardiology. Vascular system; Chronic Disease; Coronary heart disease; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Drug Therapy, Combination; Electrocardiography; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Nitroglycerin - administration & dosage; Nitroglycerin - adverse effects; Nitroglycerin - therapeutic use; Pharmacology. Drug treatments; Piperazines - administration & dosage; Piperazines - adverse effects; Piperazines - therapeutic use; Ranolazine; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Vasodilator Agents - administration & dosage; Vasodilator Agents - adverse effects; Vasodilator Agents - therapeutic use; Veterans
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1Q487

BACKGROUND: Efficacy of ranolazine in the treatment of chronic stable angina (CSA) has been established; however, pivotal trials did not require the optimization of conventional antianginal drug therapy (CADT) prior to use in a veteran population. OBJECTIVE: To determine whether ranolazine, when added to optimized doses of CADT, improves angina in a veteran population with CSA and refractory symptoms. METHODS: In an observational retrospective study, 35 patients prescribed ranolazine and having a baseline Seattle Angina Questionnaire (SAQ) administered at a Veterans Affairs medical center in Gainesville, FL, were evaluated. Patients who were prescribed ranolazine by a provider from outside the institution and did not obtain a baseline SAQ were excluded. The primary outcome measure was the change in SAQ scores from baseline to 1 and 3 months after initiation of ranolazine treatment. Secondary measures included clinically significant QTc interval prolongation (>500 msec or an increase of at least 60 msec from baseline), adverse drug reactions, discontinuation rates, and drug-drug interactions. RESULTS: The addition of ranolazine to optimized CADT was associated with improvement in all dimensions of the SAQ scores at 1 and 3 months compared to baseline scores (p < 0.001 for all dimensions). Mean changes in SAQ dimension scores at 1 and 3 months, respectively, were as follows: physical limitation, +9.86 and +11.94; angina stability, +39.29 and +32.69; angina frequency, +26.79 and +25.38; treatment satisfaction, +11.38 and +10.66; and disease perception, +16.85 and +18.59. Improvments in all dimensions, except treatment satisfaction, were clinically significant as defined by set criteria. Of the 7 patients whose ranolazine dosages were increased to 1000 mg twice daily, only 2 patients were able to maintain treatment at that dosage. CONCLUSIONS: Ranolazine added to optimized doses of CADT demonstrated an improvement in angina symptoms when given to a veteran population with persistent CSA.