Ranolazine
- (RS)- N-(2,6 -dimethylphenyl ) - 2 - [4 - [2 -hydroxy-3 -(2- methoxyphenoxy) - propyl]- piperazin-1 -yl] acetamide
- (±)- N-(2,6 -dimethylphenyl ) - 2 - [4 - [2 -hydroxy-3 -(2- methoxyphenoxy) - propyl]- piperazin-1 -yl] acetamide
- DL- N-(2,6 -dimethylphenyl ) - 2 - [4 - [2 -hydroxy-3 -(2- methoxyphenoxy) - propyl]- piperazin-1 -yl] acetamide
C01EB18
Coronary
Sodium calcium channel inhibitors
Template: Infobox chemical / molecular formula search available
Ranolazine ( Ranexa ® trade name, . Manufacturer Berlin-Chemie Menarini, respectively ) is an antianginal drug from the group of piperazine derivatives, which is used for the adjunctive treatment of stable angina pectoris. Ranolazine acts through a reduction of sodium and calcium overload against the reduced perfusion of the heart muscle.
- 2.1 Mechanism of Action
Clinical information
Approved Areas of application
Ranolazine is approved for the relief of chest pain due to insufficient blood supply to the heart (stable angina). It may only be used in addition to an existing treatment of those patients whose disease is not adequately controlled by other medicines such as beta blockers or calcium antagonists, or in patients who can not tolerate these drugs.
Adverse effects
The following adverse drug reactions were frequently observed during treatment with ranolazine: headache, fatigue, dizziness, constipation, and weakness.
Interactions with other substances
Ranolazine is metabolized mainly via the cytochrome P450 3A4. About this pathway numerous interactions are known. The pharmacist must therefore deliver with risk warnings at each delivery of ranolazine, a patient information card ( PIK).
Pharmacological properties
Mechanism of Action
It is believed that ranolazine reduced the influx of sodium ions into cardiac muscle cells. This in turn should reduce on the surface of heart muscle cells, the activity of sodium-dependent calcium channels. Thus the number of the incoming calcium ion decreases. Calcium ions are required for the contraction of the heart muscle. Ranolazine carries by a reduction in calcium influx contributes to relaxation of the cardiac muscle in diastole, thereby improving the blood supply to the heart muscle, and thus relieved the angina symptoms.
Chemical information
Ranolazine contains a chiral center and is therefore a chiral substance. There are two enantiomers of Ranolazins, the ( R) form and the ( S) form. The drug is a 1:1 mixture of the enantiomers (racemate ). Both enantiomers are pharmacologically active.
Criticism
The European Medicines Agency notes that the effectiveness of Ranexa in improving the symptoms of patients with stable angina pectoris is excessive that it may be in patients who have not fully responded to other drugs, but useful. The prognosis of coronary heart disease is 36 with 6500 patients not improved significantly after the MERLIN -TIMI randomized study with acute coronary syndrome. The drug telegram considered the benefit-risk balance of ranolazine on current knowledge, as negative.
History
Ranolazine was first described in 1987 in the open literature. It ( now part of Roche ) was first developed at Syntex and 1996 licensed to the company CV Therapeutics.
2006 took place in the U.S., the first registration as a medicinal product. There ranolazine was brought by the company CV Therapeutics under the trade name Ranexa in the trade. The EU approval was granted in mid-2008 under the trade name Latixa. A few weeks later, the trading name was changed to the EU on Ranexa. In Switzerland, ranolazine was approved in April 2010.
Ranolazine is distributed in the EU by the Italian company Menarini, in Germany through its subsidiary Berlin-Chemie.