Intervention: Ranolazine
Trial phase: Phase 4
ATC code: C01EB18
SMILES: COc1ccccc1OCC(O)CN1CCN(CC(=O)Nc2c(C)cccc2C)CC1
Sex: Female
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 16
Group description: Ranolazine would start with 500 mg BID and be force titrated to 1 gram po BID after 3 weeks. Down titration would only be allowed for side effects. This would be on top of all standard medical therapy
Eligibility criteria:
Inclusion Criteria:

Patients with chronic stable angina (> 3 months) on evidence based adequate therapy
Evidence of stable coronary artery disease by any of these:
MI, PCI or CABG > 30 days prior to enrollment or
Angiography showing > 50% stenosis in major vessel, branch or bypass graft > 30 days of enrollment or
Abnormal stress MPI nuclear study, or DBA stress echo where the decision has been to treat medically and where angina has remained stable for >= 3 months
Evidence of the Metabolic Syndrome: As defined by ATP III criteria i.e 3/5 of following Abdominal circumference F > 88 cm (35 in), M > 102 cm (40 in) Hypertriglyceridemia ≥ 150 mg/dl HDL F < 50 mg/dl M < 40 mg/dl Blood Pressure ≥130/85 Fasting Glucose ≥100 mg/dl For reproductive age women, a negative urine pregnancy test is required if all other inclusion criteria are met.

Exclusion Criteria:

Exclusion of patients with contraindications to use of RANEXA, including patients on CYP3A4 inducers/potent inhibitors, and patients with liver cirrhosis.
Exclusion of Patients with CrCl < 30 mL/min
Limit dose of RANEXA to 500mg BID in patients on concurrent diltiazem/ verapamil
Limit concurrent simvastatin to 20 mg/day
Limit concurrent metformin to 1700 mg/day Additional Exclusion
Patients with variable -inconsistent symptoms
Patients with unstable coronary artery disease or revascularization within 30 days of enrollment.
Patients who have known severe liver disease.
Patients already receiving maximal ranolazine therapy for more than 4 weeks
Presence of diabetes (AIC≥ 6.5 and /or on insulin therapy or anti-diabetic medication other than metformin) unstable hypothyroidism, active infection, active cancer (or ongoing chemotherapy and/or radiation within a year who are not on remission) and/or recent major surgery or illness.
Patients with any contraindication to ranolazine see above
Women of reproductive age are excluded if they are planning to become pregnant in the next 6 -12 months after randomization.
Patients who are pregnant or lactating
Documented allergic reaction to ranolazine in the past.
Unexplained prolongation of the QTc > 500 milliseconds.
Current or planned co-administration of moderate CYP3A inhibitors (eg, diltiazem, verapamil, aprepitant, erythromycin, fluconazole, and grapefruit juice or grapefruit-containing products) is not a full contraindication, if meet inclusion criteria otherwise, these patients could be accepted in trial but dose will be limited to 500 mg BID as stated previously.
Current or planned co-administration of strong CYP3A inhibitors (eg, ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir, and saquinavir) OR strong CYP3A inducers (eg, rifampin, rifabutin, rifapentine, phenobarbital, phenytoin,carbamazepine, and St. John's Wort) is a contraindication.