Ranolazibe

[Sweetie68]

After an angiogram for suspected angina which showed no narrowing of arteries and much less hardrning than would be expected fir my age ( almost) 80. The cardiologist doing the angiogram suspected vasospasm/ and the paroxysmal arrhythmia. my cardiologist suspects microvascular angina. Original symptoms tightening in front on neck BUT no pain. I have been prescribed 375mg of Ranolazibe twice a day. I think this causing a worsening of Original symptoms and more palpations. Has anyone had experience of this? Thankyou

[Tos92]

Hi Sweetie68,

I have something called Vasospastic angina where my coronary arteries go into spasm. My arteries are clear from obstructions.

Ranalozine is usually the drug of choice to treat microvascular angina, however, not everyone with microvascular angina gets on well with it. I have previously tried Ranalozine and found that it would make my heart feel like it was thumping hard.

It is thought that microvascular angina occurs as a result of the smaller blood vessels not being able to dilate properly upon exercising or movement, causing angina like symptoms and shortness of breath. It can also occur at rest.

You are on a higher dosage of Ranalozine. You might benefit from discussing a reduction in your dosage, or rather, decreasing how often you take it with your GP or cardiologist to see if that helps with your side effects to the medication. There are other medication options available to treat microvascular angina.

Alternatively, you might want to ask your cardiologist for further testing to confirm your diagnosis of microvascular angina if you feel the medications are not helping. A stress MRI can help with a diagnosis.

There are some useful links below which discuss microvascular angina, treatment options, and its pathologies.

bhf.org.uk/informationsuppo...

inocainternational.com/what...

Good luck and I hope your cardiologist is able to help.

All the best.

Tos

[Sweetie68 in reply to Tos92]

Thank you for your response and advice.

[Sljp0000 in reply to Tos92]

Interesting you say 375mg is a higher dose of Ranolozine. I started on that dose as prescribed by my Cardiologist. My GP said the normal, most effective dose is 500mg twice a day. I couldn't tolerate that as I kept feeling incredibly faint as my BP dropped. Back down to the 'starting' dose of 375mg twice a day.Hope you're well

Susie x

[Tos92 in reply to Sljp0000]

I was started on 375mg once a day. I couldn’t tolerate it, so I was then instructed to half the tablet. I still had side effects to the lowered dose, so I was advised to stop it completely in the end. It’s a hit and miss medication. Some people find that it really helps, and others can’t seem to tolerate it or find that it doesn’t make a difference to their symptoms.

I hope you are feeling better on 375mg twice a day and it is helping with your symptoms.

Tos x

[Milkfairy Heart Star]

Hello,

I was presumed to have microvascular angina originally over 10 years ago and prescribed Ranolazine.

I found it didn't help me, I experienced more palpitations and chest pain.

Ranolazine is usually started on 375mgs twice a day then increased to 500mgs twice day after a few weeks. The maximum dose is 750mgs twice a day.

cks.nice.org.uk/topics/angi...

I had a functional angiogram in 2014 which confirmed the cause of my symptoms, coronary vasospasms.

You can have coronary vasospasms in your small or large blood vessels. I do, I don't have microvascular dysfunction.

We are all individuals and respond differently to medications in our own way. What works for one person may not help another person.

I have over the years been prescribed many different medications to try and treat my vasospastic angina, which in my case has remained stubbornly resistant to treatment.

Calcium channel blockers can be helpful to help treat microvascular and vasospastic angina as well helping with heart rhythm problems too.

I suggest you keep a log of your symptoms see if you can spot any triggers of your symptoms.

Then perhaps discuss this with your Cardiologist and ask if an alternative medication could be tried.

A good starting point is having a correct, confirmed, diagnosis which can help your Cardiologist to target your treatment. It might be worth asking for further testing to determine the cause of your symptoms.

This website has some stratergies about how to live with microvascular and vasospastic angina.

internationalheartspasmsall...

I have included an illustration from recent paper about the various suggested treatment options of microvascular and vasospastic angina. The umbrella term for these types of angina are angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA.

Here's the reference for the article. My Cardiologist and I often send each other papers about vasospastic angina as we work together on my treatment.

sciencedirect.com/science/a...

There are quite a few of us on the forum who live with microvascular or vasospastic angina. Hopefully they will be along to share their experiences with you too.

Ranolazine is a bit of a marmite medication, it seems either to work really well for some people or cause more problems for others.

Treatment options for microvascular and vasospastic angina

[Sharpglo]

interesting about your upper chest/neck tightness, I get that every day from 5pm onwards. As I had my thyroid out many years ago it was much like I had when in need of thyroxine I thought, so I’ve started taking an extra .5 of thyroxine which seems to help it. Of course when I had the bad heart failure last November this was present until I received medication. Have you ever had thyroid prob? Did dr say what is causing the neck ache?

[Sweetie68 in reply to Sharpglo]

Yes came off carbimazole fir overactive thyroid 2 months ago !

[Frogman53]

I've been on 500mg morning and 750mg night time of Ranaolozine for years and I can't say I've noticed too many negative side affects.

[Crystal614]

Hi Sweetie68,

I was prescribed Ranolazine for MVA. I stopped it after 5 days as it was making problems worse not better. I am now under the care of another hospital as I have ongoing "electrical" problems affecting the heart rhythm which it seems to have been brought about by previous ablation and an attempt at ablation for SVT. I think adding Ranolazine, whilst taking Flecainide and I also have a pacemaker made me feel as though my heart was slowing right down and was going to stop. Cardiology have asked me to give it another go. No chance! I'm happy with my current medication I am taking.

[sandandkev]

I have mild coronary heart disease and my angina is rather just an ache over chest but was started on Diltiazem twice a day and no side effects(dizzy to begin with) and feel great as no anxiety regarding heart