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More Detail on Drug Interactions With Ranolazine

The following sections explain in detail the potentially negative reactions that can occur when ranolazine is combined with any of the drugs listed above.
 
Antipsychotics
Ranolazine can increase the level of some antipsychotics in the blood, perhaps increasing the risk of side effects. Check with your doctor before combining these medications, as you may need a lower dosage of the antipsychotic. 
 
CYP 3A4 Inducers
The liver breaks down (metabolizes) ranolazine using enzymes known as CYP 3A4 enzymes. Some medications known as CYP 3A4 inducers speed up the activity of these enzymes, increasing the rate at which ranolazine is broken down and making it less effective. Check with your healthcare provider before using these drugs together. In general, ranolazine should not be taken with CYP 3A4 inducers.
 
Moderate CYP 3A4 Inhibitors
The liver breaks down (metabolizes) ranolazine using enzymes known as CYP 3A4 enzymes. Some medications known as CYP 3A4 inhibitors slow down the activity of these enzymes, decreasing the rate at which ranolazine is broken down. Ranolazine may be combined with moderate CYP 3A4 inhibitors, although a lower-than-normal maximum ranolazine dosage (no more than 500 mg twice daily) is recommended.
 
There may be occasions where a CYP 3A4 inhibitor needs to be taken only temporarily, such as with an antibiotic. This presents a difficult dosing challenge. If possible, a different medication that does not affect ranolazine should be chosen instead.
 
Strong CYP 3A4 Inhibitors
The liver breaks down (metabolizes) ranolazine using enzymes known as CYP 3A4 enzymes. Some medications known as CYP 3A4 inhibitors slow down the activity of these enzymes, decreasing the rate at which ranolazine is broken down. Ranolazine should not be combined with strong CYP 3A4 inhibitors.
 
There may be occasions where a CYP 3A4 inhibitor needs to be taken only temporarily, such as with an antibiotic. This presents a difficult dosing challenge. If possible, a different medication that does not affect ranolazine should be chosen instead.
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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