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Ranolazine: a potential new treatment for chronic stable angina.

Ranolazine is a novel antianginal agent currently under investigation as monotherapy and adjunct therapy for the treatment of chronic stable angina. Although the mechanism of action of ranolazine is not completely understood, it is believed to involve a reduction in fatty acid oxidation, ultimately leading to a shift in myocardial energy production from fatty acid oxidation to glucose oxidation. Because the oxidation of glucose requires less oxygen than the oxidation of fatty acids, ranolazine can help maintain myocardial function in times of ischemia. In addition, ranolazine does not significantly affect blood pressure, heart rate, or cardiac conduction. The clinical data with ranolazine focuses on its use in chronic stable angina, where it has been shown to increase exercise tolerance and decrease angina compared with placebo and in combination with beta-blockers and calcium-channel blockers. The use of ranolazine for other cardiac conditions and the effect of ranolazine on morbidity and mortality remain to be determined.