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Drug Interactions between Chantix and ranolazine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

ranolazine varenicline

Applies to: ranolazine and Chantix (varenicline)

MONITOR: Coadministration with ranolazine may increase the plasma concentrations of drugs that are substrates of the organic cation transporter 2 (OCT2). The proposed mechanism is inhibition of OCT2-mediated renal tubular secretion by ranolazine, resulting in decreased clearance of drugs that are eliminated by this pathway such as metformin. When metformin 1000 mg twice daily was administered concomitantly with ranolazine 500 mg and 1000 mg twice daily in subjects with type 2 diabetes mellitus, metformin systemic exposure (AUC) increased by 40% and 80%, respectively, compared to administration of metformin alone.

MANAGEMENT: It may be advisable to monitor for altered efficacy and safety when an OCT2 substrate is coadministered with ranolazine, particularly in the elderly and patients with renal impairment. A dosage adjustment of the OCT2 substrate may be required.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. EMEA. European Medicines Agency (2007) EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid
  3. (2023) "Product Information. Ranexa (ranolazine)." Gilead Sciences
  4. (2020) "Product Information. Corzyna (ranolazine)." Kye Pharmaceuticals Inc
View all 4 references

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Drug and food interactions

Major

ranolazine food

Applies to: ranolazine

GENERALLY AVOID: Grapefruit and grapefruit juice may significantly increase the plasma concentrations of orally administered ranolazine. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because ranolazine prolongs QT interval in a dose-dependent manner, high plasma levels of ranolazine may increase the risk of ventricular arrhythmias such as ventricular tachycardia, ventricular fibrillation, and torsade de pointes.

MANAGEMENT: Patients treated with ranolazine should avoid consumption of grapefruit juice and other grapefruit products if possible. Otherwise, the dosage of ranolazine should be limited to 500 mg twice a day.

References

  1. (2006) "Product Information. Ranexa (ranolazine)." Calmoseptine Inc

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Moderate

varenicline food

Applies to: Chantix (varenicline)

GENERALLY AVOID: Varenicline may enhance the effects of alcohol as well as alter the way an individual reacts to alcohol. During postmarketing use, some patients have reported experiencing increased intoxicating effects of alcohol while taking varenicline. In addition, some reported cases of neuropsychiatric events, including unusual and sometimes aggressive behavior directed toward oneself or others, may have been worsened by concomitant use of alcohol. These events were often accompanied by amnesia.

MANAGEMENT: Patients should be advised to limit their consumption of alcohol until they know whether varenicline affects their tolerance for alcohol, and to exercise caution driving or operating machinery until they know how quitting smoking and/or varenicline may affect them. Patients should immediately stop taking varenicline and contact their physician if they develop agitation, hostility, aggressive behavior, depressed mood, or changes in behavior or thinking that are not typical for them, or if they develop suicidal ideation or behavior.

References

  1. (2006) "Product Information. Chantix (varenicline)." Pfizer U.S. Pharmaceuticals Group
  2. FDA. U.S. Food and Drug Administration (2015) Drug Safety Communications: FDA updates label for stop smoking drug Chantix (varenicline) to include potential alcohol interaction, rare risk of seizures, and studies of side effects on mood, behavior, and thinking. Safety announcement. http://www.fda.go

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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