Ranolazine

I recall that a few years ago Ranolazine (an angina drug) showed a lot of promise for off-label use to treat PAF. If I recall correctly it has atria-selective Na-blocking properties and it reduces Ca overload. Has anyone here tried it? Failing that, do any of you guys here know where things stand with it at present? My EP is willing to let me experiment with it if I decide to. On the face of it it seems to share a lot of properties with Flecainide but without the proarrhythmia risk in addition to which it is as per above atria selective. I'm half wondering about cutting the daily Flec dose in half and adding a low dose of Ranolazine as a start.... Any views guys?? I appreciate that both drugs can prolong the QT interval but what I don't know is each would exacerbate the effect of the other - a Q for the EP I think. Just thinking about options....

I just looked a list of Flecainide interactions here:

<[bnf.nice.org.uk];

and if that's to be believed one pretty much can't take ANYTHING (including Ranolazine) along with Flecainide - including any BB to take with a PiP Flecainide dose as many here have done/do (including me).

Best to all as always,

Mike



Edited 1 time(s). Last edit at 11/10/2017 04:15AM by mwcf.

Your link appears to be down for the moment. Looked at <[online.epocrates.com] and for mag carbonate, hydroxide & trisilicate it gives the same message for each: "flecainide + magnesium carbonate caution advised w/ frequent or high dose antacid use: combo may incr. flecainide levels, risk of adverse effects (renal excretion decreased in alkaline urine)"

I commonly take mag citrate when I take flec. Likely doesn't make a difference for on-demand use except may keep serum concentrations higher for a little longer but won't increase max concentration. For chronic/daily use, can see how this applies.

Quote
mwcf
I just looked a list of Flecainide interactions here:



and if that's to be believed one pretty much can't take ANYTHING (including Ranolazine) along with Flecainide - including any BB to take with a PiP Flecainide dose as many here have done/do (including me).

That link is inaccessible, but if it says you can't take beta blockers with flecainide it's dead wrong. Perhaps it just gives a list of drugs that have interactions with flecainide, like this one. You'll notice that the list of drugs with major interactions includes all the beta blockers, but just because a drug appears in that list doesn't mean it's contraindicated; it just means it has some sort of interaction. In the case of BBs, that interaction is the two drugs enhance each other's effects, which is often a desirable effect. So don't go by a drug simply having an interaction. You have to read what that interaction is.

Thanks George and Carey.

That link still works from my end - weird!

I take your point guys as in yes there is an interaction but not by virtue thereof a contraindication.

Cheers,

Mike