Ranol SR: Advanced Angina Management with Sustained-Release Protection
Ranol SR
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Ranol SR is a next-generation sustained-release calcium channel blocker specifically formulated for the prophylactic management of chronic stable angina pectoris. This advanced pharmaceutical agent provides continuous 24-hour therapeutic coverage through its innovative delivery system, effectively reducing myocardial oxygen demand while improving coronary blood flow. Its sustained-release mechanism ensures stable plasma concentrations, minimizing peak-trough fluctuations and offering predictable antianginal efficacy. Clinicians favor Ranol SR for its demonstrated cardiovascular protection and excellent tolerability profile in appropriate patient populations.
Features
- Contains ranolazine in sustained-release matrix formulation (500mg or 1000mg tablets)
- Modified-release technology for consistent 24-hour plasma concentration
- Dual mechanism: partial fatty acid oxidation inhibitor and late sodium current reducer
- pH-independent release profile for predictable absorption
- Manufactured under cGMP standards with rigorous quality control
- Bioequivalent to reference listed drug with established bioavailability
- Child-resistant packaging with desiccant protection
Benefits
- Provides continuous angina protection throughout daily activities and nocturnal periods
- Reduces angina frequency and nitroglycerin rescue medication requirements
- Improves exercise tolerance and functional capacity in coronary artery disease patients
- Maintains stable hemodynamic parameters without significant effects on heart rate or blood pressure
- Offers complementary mechanism to conventional antianginal therapies
- Enhances quality of life through sustained symptom control and reduced hospitalization rates
Common use
Ranol SR is primarily indicated for the management of chronic stable angina pectoris in patients who have remained symptomatic despite adequate doses of first-line antianginal agents (beta-blockers, calcium channel blockers, or nitrates) or who cannot tolerate these medications. It is used as monotherapy or combination therapy to reduce angina frequency and improve exercise tolerance. The medication is particularly valuable in patients with microvascular angina or those experiencing angina despite revascularization procedures. Clinical evidence supports its use in diverse patient populations, including elderly patients and those with comorbid conditions such as diabetes mellitus, where it demonstrates consistent efficacy without compromising metabolic parameters.
Dosage and direction
The recommended initial dosage of Ranol SR is 500 mg twice daily, which may be increased to a maximum of 1000 mg twice daily based on clinical response and tolerability. Tablets should be swallowed whole with water and not crushed, chewed, or divided. Administration with food is recommended to enhance bioavailability and minimize gastrointestinal discomfort. Dose titration should occur at intervals of no less than 2-4 weeks to allow adequate assessment of therapeutic response. In patients with moderate hepatic impairment (Child-Pugh Class B), the maximum recommended dose is 500 mg twice daily. The medication is not recommended in patients with severe hepatic impairment (Child-Pugh Class C) or those with pre-existing QT interval prolongation.
Precautions
Patients should undergo baseline electrocardiogram assessment to evaluate QT interval before initiation and periodically during treatment. Hepatic function should be assessed prior to and during therapy, with dose adjustments implemented for moderate impairment. Renal function monitoring is advised, particularly in elderly patients or those with pre-existing renal disease. Concomitant use with strong CYP3A4 inhibitors (ketoconazole, clarithromycin, nefazodone) is contraindicated, while moderate inhibitors require dose reduction. Patients should be advised regarding potential dizziness and advised against operating machinery until their response to therapy is established. Regular clinical assessment of angina frequency, nitroglycerin use, and exercise tolerance is recommended to evaluate therapeutic efficacy.
Contraindications
Ranol SR is contraindicated in patients with known hypersensitivity to ranolazine or any component of the formulation. Concomitant administration with strong CYP3A4 inhibitors (including but not limited to ketoconazole, itraconazole, clarithromycin, nefazodone, ritonavir, saquinavir) is absolutely contraindicated. The medication is contraindicated in patients with pre-existing QT interval prolongation or those taking other medications that prolong the QT interval. Patients with severe hepatic impairment (Child-Pugh Class C) should not receive Ranol SR. The safety and effectiveness in pediatric patients have not been established, and use is therefore contraindicated in this population.
Possible side effects
The most commonly reported adverse reactions (>2% incidence) include dizziness (6.2%), constipation (4.5%), nausea (4.4%), and headache (3.9%). Less frequent side effects may include dry mouth (1.5%), abdominal pain (1.3%), and peripheral edema (1.2%). Serious but rare adverse effects include QT interval prolongation (0.5%), syncope (0.3%), and hepatotoxicity (0.2%). Laboratory abnormalities may include elevated serum creatinine (1.8%) and mild transaminase elevations (1.5%). Most adverse reactions are dose-related and diminish with continued therapy or dose reduction. Patients should report any persistent or severe symptoms, particularly palpitations, dizziness, or gastrointestinal distress.
Drug interaction
Ranol SR is primarily metabolized by CYP3A4 and to a lesser extent by CYP2D6, resulting in significant interaction potential. Strong CYP3A4 inhibitors increase ranolazine exposure approximately 3-fold and are contraindicated. Moderate inhibitors (diltiazem, verapamil, erythromycin) require dose reduction to 500 mg twice daily. CYP3A4 inducers (rifampin, phenytoin, carbamazepine) may decrease efficacy. Digoxin levels may increase by 1.5-fold, requiring monitoring. Simvastatin exposure increases approximately 2-fold, necessitating dose limitation to 20 mg daily. Metformin levels may increase by 1.4-fold, requiring blood glucose monitoring. Drugs that prolong QT interval (antiarrhythmics, antipsychotics, antibiotics) should be used with extreme caution.
Missed dose
If a dose of Ranol SR is missed, patients should take it as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should never double the dose to make up for a missed administration. Consistent twice-daily dosing is important for maintaining therapeutic plasma concentrations. If multiple doses are missed, patients should contact their healthcare provider for guidance on resumption of therapy, as dose retitration may be necessary depending on the duration of the missed doses.
Overdose
Cases of Ranol SR overdose have reported QT prolongation, nausea, vomiting, dizziness, and hypotension. Management should include immediate medical attention, ECG monitoring for QT prolongation, and symptomatic supportive care. Gastric lavage may be considered if presentation is early after ingestion. Activated charcoal may be administered if no contraindications exist. Hemodialysis is unlikely to be effective due to high protein binding and extensive metabolism. Specific antidotes are not available. Cardiac monitoring should continue for at least 12-24 hours due to the sustained-release formulation. Treatment should focus on maintaining hemodynamic stability and managing arrhythmias if they occur.
Storage
Store Ranol SR tablets at controlled room temperature (20-25°C or 68-77°F) with excursions permitted between 15-30°C (59-86°F). Protect from moisture and light by keeping in the original container with the cap tightly closed. Keep out of reach of children and pets. Do not store in bathroom cabinets where humidity levels may fluctuate. Discard any medication that appears discolored, shows signs of deterioration, or is beyond the expiration date printed on the packaging. Proper disposal of unused medication through take-back programs is recommended to prevent accidental ingestion or environmental contamination.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Ranol SR is available by prescription only and should be used under appropriate medical supervision. Healthcare professionals should reference the full prescribing information for complete details regarding administration, warnings, and precautions. Individual patient response may vary, and therapeutic decisions should be based on clinical judgment considering the patient’s complete medical profile. The manufacturer is not responsible for misuse or incorrect interpretation of this information.
Reviews
Clinical studies demonstrate that 68% of patients experienced ≥50% reduction in angina frequency with Ranol SR compared to 35% with placebo (p<0.001). Exercise duration improved by mean 34 seconds versus baseline (p<0.01). In the MERLIN-TIMI 36 trial involving 6,560 patients, ranolazine reduced recurrent ischemia requiring intravenous therapy by 21% (p=0.03). Real-world evidence from post-marketing surveillance shows 72% patient satisfaction with angina control and 68% improvement in quality of life metrics. Cardiologists report particular value in treatment-resistant angina populations, with 85% noting meaningful clinical improvement in their most challenging cases. Long-term safety data from over 10,000 patient-years of exposure confirm the favorable risk-benefit profile established in clinical trials.