I know this question , or variations of it , has been asked many times. I will try to ask a different way. I understand this medication works for some and not others.
my question is for anyone that it worked for. Did it work right away or did it take a period of time to be effective. I have been struggling and lately run for couple weeks where the angina just won’t completely let up. Nitro helps but only dulls down and not completely gone. I am on the other standard meds for this condition. (Ccbs, imdur, and bp medicine)
I am trying to understand how long I should try this medicine before knowing if it’s effective or not. If it takes a bit or not? My cardiologist is not super helpful with all of this and tends to just right a script and say “here try this”. I am guessing I’m not unique in that I am constantly paranoid that I now have some progression of worse issues and I need to have another heart cath. (Since it’s been about 18 months since last clear one) I had clear echo and ct scan of aortic artery from chest to pelvis which all was clear in September. Only reason I was able to get those tests was a trip to the hospital as my cardiologist just refuses to do any other tests.
thanks for any replies.
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Andy5S
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Is it possible to have a second opinion from a Cardiologist who is more knowledgeable about vasospastic and microvascular angina?
The research shows that having an accurate diagnosis helps to target the treatment options.
Rather than a trial an error approach to treatment.
A functional angiogram using adenosine and guidewires along with acetylcholine is now recommended for patients with persistent chestpain and clear coronary arteries.
Ranolazine is an interesting medication. You're right, it either works or it doesn't.
I found within about a week that I started experiencing palpitations.
It didn't help reduce my coronary vasospasms. I stopped taking Ranolazine as a result.
The research suggests that Ranolazine is better suited to treat microvascular dysfunction rather than vasospastic angina.
Vasospastic angina symptoms can wax and wane.
I am more symptomatic in the colder months and during storms when the air pressure drops.
I have had perfusion MRIs and stress echoes, so I am not unduly worried that I am developing obstructive coronary disease.
I am on statins, follow a heart healthy diet, exercise and manage my stress.
One of the most important things for me is knowing I have a confirmed diagnosis following a Functional angiogram and having a supportive Interventional Cardiologist who listens!
Did you see my post about a patient survey being carried out?
I wish I could get a cardiac MRI but they refuse to give me one. Very frustrating! What they are doing is throwing medicine at me to see what sticks. They are not knowledgeable here about this condition and see it as something to just give pills over. If you complain about weeks of daily angina pain, they say go to ER.
This is what they told me today and I’m here yet again. Man this thing is just a nightmare!
Are you taking calcium channel blockers aswell? Because I think if I remember correctly it was that combination that sent my heart into first degree heart block. Check to see , I think they are not supposed to be taken together.
I take it in combination with ccb and nicorandil . Not a very high dose , that really suits me . If I stop one then I realise how much good they are doing . I have prodominantly CAS , I think many of us have a mixed picture
When I first started having vasospasms, after a night in A&E I was admitted to the cardiac ward and stayed there over the weekend. The cardiologist I saw described my condition as ‘Unstable Angina’. He prescribed Ranexa and Amlodipine. It did not touch my vasospasms. After about a month I went back to my GP who said ‘I think you have coronary artery spasm’ and changed the prescription to isorbide mononitrate (30mg at first) which improved things but did not eliminate the attacks. Over time this was increased to 120 mg and my bisoprolol switched to Ivabradine. Two more angiograms followed that said my main arteries were clear. Cardiologist now changed the diagnosis to ‘Refractory Angina’ and added Nicorandil to the medication which gave some improvement. On the advice of Milkfairy I sought a second opinion from a cardiologist with INOCA expertise. He gave me another angio including the acetylcholine provocation test and detected vasospasm and microvascular angina. He added Ranexa to my medication. 12 months on I am much better, the vasospasms are rare (about every 6 weeks) and I am less breathless than before. For me, it’s the combination of medicines that have made the difference not one alone. Cardiologist told me it’s not unusual to have MVA with vasospasm so it makes sense. I have found that my body takes a month or so to settle down after each adjustment to medication. With the Ranexa I have improved slowly over the past year.
thanks for replies and sorry for delay. I spent night in hospital and today did another stress test with echo. I complained about 2 + weeks of intense angina where nitro would dull down but not completely be gone. So stress test I got MEPS 11 and went to 100% of my max heart rate. I am waiting for it all to be read but I assume they will say, no issues here try another medication. This condition clearly can go on a rampage for days, weeks, or even months.
Can I ask your current medication and dosages? I understand we are all different but helpful to see others regimen. Also I have learned some medication you may take in UK is NOT available in US because our FDA is so stellar!
Ironically after today’s stress test and chat with cardiology. They recommended going to 120mg Imdur for a week and then add Ranexa 750mg and see how it goes.
I seem to be hypersensitive to meds beyond current dosages so my guess is the additional Imdur will give me headaches for a bit and not sure with Ranexa. I would be thrilled to reduce both frequency and intensity of attacks. So guess we will see how it goes.
Hi Andy sorry you are having a difficult time . I tried Ranolazine and it did not help me with my chest pain . It actually made it worse . I struggle with angina probably vasospastic and I am just given meds to try . I am very sensitive and so far I have not tolerated calcium channel blockers or Nitro patches . Yesterday I was prescribed Ivabradine to try . I am very discouraged and my symptoms are getting worse . I am weak and have presyncope almost daily. I ended up in ER several times . I did not have a functional angio as I don't tolerate the treatment . Sorry about my rant and good luck with meds .
Hi, Andy, Been diagnosed with MVA and coronary heart spasms for some 3 years now following a long period of being told there was nothing wrong with me, once diagnosed my turning point was when a young consultant advised my cardiologist to prescribe Ranolazine and later my cardiologist prescribed Isobidemononitrate.
My medication for the past twelve months:
15mg once per day
My medication for the past twelve months:
Lansaprazole 15mg once per day
Amlodipine 10mg once per day
Isorbide Mononitrate 40mg twice per day
Ranolazine 750 mg twice per day
All of this took some time to balance out, but most days are good with episodes appearing every couple of weeks when I have to take my GTN spray andrest for a day or two to get back to ‘normal’.
Stick with it and be positive: life can still be good once the balance is achieved. And I agree this forum is fantastic in keeping one’s mood up there.
Yes this is another factor that I see many say around “time”. There seems to be no universal “if a medication works it will be within x amount of time”. I have experienced when there is adverse effects which seems to be quickly.
How long would you estimate for things start to stabilize once on the regimen you have now?
Hi, Andy, I was fine for a couple of months on the initial diagnosis and medication of Ranolazine 250mg twice a day, Amlodopine 10mg and Lansaprazole 15mg once per day, but then started getting the same symptoms of seriously bad chest pain and incredible breathlessness. Cardiologist increased Ranolazine to 500mg and, again fine for a couple of months, but then I was really poorly again on several occasions being taken into A&E so Ranolazine increased to 750mg twice a day.
Several weeks , later same story re trips to A&E with excruciating chest pain so Cardiologist completely reviewed medication and advised I added Isobide Mononitrate although I was anxious about taking this having read of the challenging side effects. However, eventually decided to take it and after two weeks of really bad headaches I have stuck with it. The last year had been really good despite occasional episodes which, having retired, I have now learnt to manage with one or two days of rest.
All of this rambling (sorry) is about the importance and patience in trial and error and trust in my cardiologist mixing and matching until I have, thankfully, reached a point where I am now able to live a pretty normal life with just the occasional ‘thump’ and pained episodes.
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