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Ranolazine Side Effects

More frequently reported side effects include dizziness, constipation, and nausea. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to ranolazine: oral tablet extended release

As well as its needed effects, ranolazine may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking ranolazine, check with your doctor immediately:

More common
  • Dizziness
Less common
  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • continuous ringing or buzzing or other unexplained noise in the ears
  • difficult or labored breathing
  • fast, irregular, pounding, or racing heartbeat or pulse
  • feeling of constant movement of self or surroundings
  • hearing loss
  • lightheadedness
  • rapid weight gain
  • sensation of spinning
  • tightness in the chest
  • tingling of the hands or feet
  • unusual weight gain or loss
  • Abnormal or decreased touch sensation
  • agitation
  • blood in the urine
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain or discomfort
  • chills
  • cold sweats
  • coma
  • confusion
  • decreased urine output
  • depression
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fainting
  • headache
  • hostility
  • irritability
  • lethargy
  • muscle twitching
  • nausea
  • seizures
  • shakiness in the legs, arms, hands, or feet
  • slow or irregular heartbeat
  • stupor
  • sweating
  • trembling or shaking of the hands or feet
  • unusual tiredness or weakness

Some ranolazine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Difficulty having a bowel movement (stool)
Less common
  • Dry mouth
  • stomach pain
  • Lack or loss of strength

For Healthcare Professionals

Applies to ranolazine: oral tablet extended release


Other side effects have included peripheral edema (8.3%), fatigue (7%), asthenia (4.4%), vertigo (4.3%), and influenza (4.2%). Other side effects occurring in less than 2% of patients have included tinnitus.[Ref]

Nervous system

Nervous system side effects have included dizziness (6.2% to 11.8%) and headache (5.5%). Nervous system reactions that were rare (0.5% or less), but potentially medically important, included hypoesthesia, paraesthesia, and tremor. Additional side effects have included confusional state.[Ref]


Gastrointestinal side effects have included constipation (4.5% to 10.9%), nausea (4.4% to 5.6%), and diarrhea (3.8%). Other, less common reactions (less than 2%) included abdominal pain, dry mouth, and vomiting.[Ref]


The variable blood levels attained after a given dose of ranolazine result in a wide range of effects on QTc. At Tmax following repeat dosing at 1000 mg twice a day, the mean change in QTc is about 6 msec. However, in 5% of the population with the highest plasma concentrations, the prolongation of QTc is at least 15 msec. The relationship between ranolazine plasma level and QTc is linear over a concentration range up to 4 fold greater than the concentrations produced by a dosage of 1000 mg twice a day, and this relationship is not significantly affected by age, weight, gender, race, heart rate, congestive heart failure NYHA class, or diabetes. In subjects with hepatic impairment, the relationship between plasma level of ranolazine and QTc is much steeper.

During a long-term safety study (ROLE program) involving patients with chronic angina (n=746), there were no treatment discontinuations due to QTc prolongation and no episodes of Torsades de Pointes were reported.[Ref]

Cardiovascular side effects occurring in less than 2% of patients have included palpitations, bradycardia, hypotension, orthostatic hypotension, and syncope. ECG abnormalities have included dose- and plasma concentration related increases in the QTc interval, reductions in T wave amplitude, and notched T waves.[Ref]


In general, a higher incidence of adverse events has been reported in elderly patients 75 years or older than in younger patients.

In general, long-term therapy with ranolazine is well tolerated in high-risk patients. During a long-term safety study (ROLE program) involving patients with chronic angina (n=746), more than two years after initial dosing, 76.7% of patients remained on therapy and 9.7% discontinued ranolazine due to adverse effects. In this study, age (greater than or equal to 64 years) was associated with increased adverse effects related withdrawals.[Ref]


Renal side effects have included small, reversible elevations in serum creatinine and BUN levels. These elevations were observed without evidence of renal toxicity. Renal failure has been rarely (less than 0.5%) reported.[Ref]


Metabolic side effects have been minimal. Ranolazine does not appear to significantly affect triglyceride or blood glucose levels; however, diabetes has been reported as an adverse effect. In contrast, in patients with diabetes, ranolazine has produced a dose-related reduction in glycosylated hemoglobin (HbA1c).[Ref]


Respiratory side effects have included cough (6%) and dyspnea (4.3%). Pulmonary fibrosis has been rarely (less than 0.5%) reported.[Ref]


Musculoskeletal side effects have included back pain (4.8%) and arthralgia (4.4%).[Ref]


Hematologic side effects have included anemia (4.6%). Additional side effects have included thrombocytopenia, leukopenia, and pancytopenia (less than 0.5%).[Ref]


Hypersensitivity side effects have included angioedema and eosinophilia (less than 0.5%).


Psychiatric side effects have included post marketing reports of hallucinations.


Dermatologic side effects have included angioedema, pruritus and rash.


1. Siddiqui MA, Keam SJ "Ranolazine: a review of its use in chronic stable angina pectoris." Drugs 66 (2006): 693-710

2. Koren MJ, Crager MR, Sweeney M "Long-term safety of a novel antianginal agent in patients with severe chronic stable angina: the Ranolazine Open Label Experience (ROLE)." J Am Coll Cardiol 49 (2007): 1027-34

3. Pham DQ, Mehta M "Ranolazine: a novel agent that improves dysfunctional sodium channels." Int J Clin Pract 61 (2007): 864-72

4. "Product Information. Ranexa (ranolazine)." Calmoseptine Inc, Huntington Beach, CA.

It is possible that some side effects of ranolazine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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