Pharmacotherapy for the management of chronic
stable angina has not changed much in the past 10-20 years. Although the use of revascularization has increased, beta-
blockers, calcium channel blockers, and long-acting
nitrates are still widely used in the management of patients with
chronic stable angina. Despite the demonstrated effectiveness of these agents, a number of patients do not achieve the American College of Cardiology-American Heart Association goal of freedom from exertional angina attacks. For the first time in more than a decade, a new agent,
ranolazine, is available to assist in controlling exertional angina.
Ranolazine has a novel mechanism of action of inhibiting the late
sodium current during ventricular depolarization. This mechanism contributes to a reduction in intracellular
sodium and, therefore, a reduction in intracellular
calcium, reducing ischemic injury. Unlike currently available
pharmacotherapy for
chronic stable angina,
ranolazine does not produce clinically meaningful changes in heart rate or blood pressure. A number of clinical trials have demonstrated the ability of
ranolazine to increase exercise tolerance, decrease weekly anginal episodes, and decrease sublingual
nitroglycerin consumption for breakthrough angina. Based on the results of these trials,
ranolazine recently was approved by the United States Food and Drug Administration for treatment of patients with
chronic stable angina. Because of
ranolazine's pharmacokinetic and pharmacodynamic profile, pharmacists will have to play a significant role in patient selection and monitoring.