Ranolazine, a new treatment for chronic, stable angina, is discussed as
a safe and effective option for patients in a New Drug Class paper
released on October 10, 2008 in The Lancet.
Chronic stable angina is a prolonged chest pain which is often linked
to heart disease. It is often present when the patient is exercising.
This kind of angina is highly prevalent in developed nations, and in
the United States, 9.1 million have the condition. There are 30 times
as many angina patients admitted to hospitals as heart attack victims.
Current treatments for angina include β blockers, statins,
aspirin, and diet and exercise. In 1986, ranolozine was patented, then
further approved for use in the USA in 2006. It is indicated for angina
patients whose symptoms continue even after trying one or more of the
standard treatments.
According to the article, Dr Stephen Nash and Dr David Nash
of Syracuse Preventive Medicine, NY, USA, ranzoline has been assessed
in several randomized, controlled trials, including MARISA, CARISA, and
ERICA. In these, it was shown to extend the amount of time that
patients could continue to exercise before experiencing an attack of
angina. Additionally, patients suffered an average of one attack less
per week. The drug was more effective for exercise in men than in
women, despite angina's higher prevalence in women.
The drug's side effects include nausea, constipation, and dizziness.
While questions still remain over the drug's cost-effectiveness, as it
can cost between $207 and $413 USD for just 30 days of medication, the
authors say: "Expense must be balanced against the cost of an
alternative therapy. In
chronic stable angina, the alternative is often an invasive
revascularisation."
The authors conclude that ranolazine should be used in addition to the
traditional treatment regimen for chronic stable angina:
“Ranolazine seems to be a safe addition to current
traditional drugs for chronic stable angina, especially in aggressive
multidrug regimens...physicians in practice understand that lifestyle
changes, including a low-fat diet with low cholesterol, a
near-vegetarian diet, a regular exercise programme with excellent
compliance, and a programme of stress-reduction measures are important
in the treatment and prevention of angina. Studies of combinations of
these lifestyle changes have shown efficacy in reducing the symptoms of
chronic stable angina. Combination of such interventions with the use
of ranolazine should be studied in carefully designed controlled
trials, and almost certainly will be. The future outlook for patients
with chronic stable angina should then be brighter.”
Ranolazine for chronic stable angina
David T Nash, Stephen D Nash
Lancet 2008; 372: 1335-41
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Anna Sophia McKenney