tag:blogger.com,1999:blog-18943510.post7324961293873700720..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: Is Ranolazine Safe?DrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-18943510.post-87078858398537642532007-09-16T15:56:00.000-05:002007-09-16T15:56:00.000-05:00Wondering what your thoughts are on this now?"http...Wondering what your thoughts are on this now?<BR/><BR/>"http://biz.yahoo.com/bw/070904/20070904006410.html?.v=1&printer=1"<BR/><BR/>Is it your opinion that this drug is still not safe and doesnt work? I would love to hear any stories of your patients that have tried it. Not for arrhythmias, but for ischemia.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-16905380679637734712007-03-07T15:21:00.000-06:002007-03-07T15:21:00.000-06:00Looks like the top line Merlin results are out. D...Looks like the top line Merlin results are out. Didn't show any benefit for ACS, but no trend towards increased mortality or arrythmias. <BR/>I guess you can use the drug now.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-50569510110685560162007-02-19T12:06:00.000-06:002007-02-19T12:06:00.000-06:00Anony 10:35 - Thanks for pointing this out. But "...Anony 10:35 - <BR/><BR/>Thanks for pointing this out. But "pharmacokinetic trials" are not mortality trials, are they? You are correct when the package labeling suggests no dose adjustment is required (based on dosing studies) for patients with NYHA Class I-IV heart failure. <BR/><BR/>But there are other (counter-intuitive) CONTRAINDICATIONS to dosing Ranexa ALSO on its label: <I>"Ranexa is DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-22103576624080292532007-02-19T10:35:00.000-06:002007-02-19T10:35:00.000-06:00Actually, it seems that the drug has been studied ...Actually, it seems that the drug has been studied in NYHA class 1-4 CHF- per the label- and that there was no effect on pharmacokinetics.<BR/>Seems like you might want to check your facts a little better. Reading the FDA approved label would be a good place to start or you could try googling ranolazine and CHF as I just did.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-5501760648312013702007-02-18T06:05:00.000-06:002007-02-18T06:05:00.000-06:00Sam-Thank you. Your point is well-taken. A correct...Sam-<BR/><BR/>Thank you. Your point is well-taken. A correction has been posted. <BR/><BR/>Although I am unaware if you were Anony 5:57, I would like to respond to one other issue made by that commentor:<BR/><BR/><I>"There has never been a case of torsades."</I><BR/><BR/>How, really, can one differentiate ventricular fibrillation from "sustained" torsades? It is a minor point, but an important DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-83833325589237875152007-02-15T07:15:00.000-06:002007-02-15T07:15:00.000-06:00I just wanted to make a few points regarding your ...I just wanted to make a few points regarding your analysis. <BR/> 1- The mortality rate was higher as you point out, but not 10 fold. The RR was about 1.5. Look at the much larger follow up in the ranolazine group.<BR/>2- This data included older trials on older formulations and from dose finding studies. The data from CARISA and MARISA- although they represent an even smaller data set- are Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-19574514433300822032007-02-15T01:08:00.000-06:002007-02-15T01:08:00.000-06:00I won't be an early adopter of this medication eit...I won't be an early adopter of this medication either. <BR/><BR/>I'm not that impressed with the clinical improvement for one and agree that there are still QT concerns. <BR/><BR/>I also don't think the patient population represented in the last study represented those who are being put on the drug in clinical practice. <BR/><BR/>Just to really stir the pot: low-dose long acting MS contin is a View from the Trekanthttps://www.blogger.com/profile/08811435898947430343noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-58585765542750680852007-02-14T22:09:00.000-06:002007-02-14T22:09:00.000-06:00I agree that as a treatment for chronic angina, Ra...I agree that as a treatment for chronic angina, Ranexa is used in a very sick - and very torsades-prone - patient group. <BR/><BR/>Ranexa was approved on risk-benefit grounds and I believe the decision was reasonable. Chronic exertional angina is a debilitating disease, available therapeutic options were not always effective, and there was a substantial safety database that did not suggest Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-6980498563440090562007-02-14T18:30:00.000-06:002007-02-14T18:30:00.000-06:00Anony-Thanks for your clarification. I genuinely ...Anony-<BR/>Thanks for your clarification. I genuinely hope that we find that the low incidence rates are confirmed in the MERLIN trial. However, we must realize that this drug is used on our sickest of coronary patients (those with active angina refractory to medical therapy) with a high baseline mortality rate. While Torsades may not have been identified in the database to date, I would argueDrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-40052678759015649202007-02-14T17:57:00.000-06:002007-02-14T17:57:00.000-06:00Dr. Fisher, thanks for your thoughtful post. With...Dr. Fisher, thanks for your thoughtful post. With respect, I believe you have misunderstood the data.<BR/><BR/>For placebo patients, there were 2 deaths from VF in 169 patient-years of follow-up. This is 0.012 VF events per patient-year.<BR/><BR/>For Ranexa, there were 21 deaths from VF in 1848 patient years. This is a rate of 0.011 VF events per patient year.<BR/><BR/>There is no Anonymousnoreply@blogger.com