Ranolazine: Drug overview and possible role in primary microvascular angina management

•Ranolazine is a novel safe, well-tolerated anti-anginal drug.•Ranolazine has been approved as a second-line treatment for stable angina.•Primary MVA is characterized by high variability and low response to treatment.•Clinical and preclinical evidence suggests ranolazine usefulness in primary MVA.•Further trials are needed to investigate the efficacy of ranolazine in primary MVA.

Ranolazine is a novel well-tolerated anti-ischemic drug, which selectively inhibits late sodium current and exerts metabolic properties without any hemodynamic effect. Ranolazine has been approved as a second-line medical treatment for symptomatic stable coronary artery disease. Primary microvascular angina (MVA) is suspected when angina symptoms occur in patients with demonstrated myocardial ischemia, absence of myocardial disease and normal coronary artery angiography. Recent clinical data suggest that MVA represents a complex entity, which has been increasingly recognized as a significant cause of morbidity. High variability and low response to traditional anti-anginal treatment characterize primary MVA. Despite the fact that clinical and preclinical evidence provides information regarding ranolazine usefulness in primary MVA management, only three recent small randomized trials have investigated this issue. By selecting peer-reviewed literature in Pubmed and Cochrane Library, this review provides an overview on ranolazine pharmacology and efficacy, focusing on recent evidence suggesting its usefulness in management of primary MVA.