Ranolazine, ACE Inhibitors, and Angiotensin Receptor Blockers.
Am J Med. 2019 Mar 11;:
Authors: Marciniak TA, Serebruany V
BACKGROUND: Ranolazine is an anti-angina agent with many metabolites creating the potential for off-target effects. FDA reviews sometimes contain clinically relevant data not found in other sources.
METHODS: We reanalyzed data in an FDA review of the placebo-controlled MERLIN trial of ranolazine to display differences in adverse event rates graphically.
RESULTS: Rates of ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB)-related adverse events (angioedema, dry cough, renal impairment, hypotension, anemia, and serum potassium >5.5mmol/L) were higher in patients receiving ranolazine and an ACEI or ARB. Rates of adverse events that should be decreased by ACEI/ARBs (hypokalemia, hypertension, and serum potassium <3.5mmol/L) were lower in patients receiving ranolazine and an ACEI or ARB compared to rates in patients receiving placebo and an ACEI or ARB.
CONCLUSIONS: Ranolazine potentiates the effects of ACEIs and ARBs. Clinicians should monitor for this potentiation when initiating treatment with ranolazine and an ACEI or ARB.
PMID: 30871921 [PubMed - as supplied by publisher]