Ranolazine for PVCs?

Ranolazine

by Gemita - 2023-11-16 14:11:26

Thank you for this interesting post.  Oh to be rid of ectopics!

My husband was given Ranolazine for angina a few years ago.  (He was having episodes of PVCs, ventricular tachycardia (non sustained) and Atrial Fibrillation at the time too.  It was quite powerful I recall and caused some difficult symptoms during the first few weeks of treatment (worsening rhythm disturbances, unsteadiness).  I remember he had to have frequent blood tests to check his kidney function.  He was started on 500 mg, twice a day which proved too high a dose, so he was switched back to Isosorbide mononitrate after only a few months.

There are a number of med/food interactions so care has to be taken with Ranolazine but it was very helpful for his angina, not so sure about a good treatment for his heart rhythm disturbances since it caused high potassium levels (hyperkalemia) and worsening arrhythmias.  He also developed acute kidney injury due poor kidney function I suspect, since I see Ranolazine is metabilised in the liver.

I have read the link. It does sound extremely promising as an antiarrhythmic. What can I say, maybe ask to try it if you are really symptomatic, starting off on a low dose.  Personally, I feel that a beta blocker or a calcium channel blocker at a low dose might be safer options until further trials on Ranolazine have been carried out?  Ranolazine is an expensive med, so that is another consideration if you have to pay for the prescription (although I see there is a generic version available)? 

Premature Ventricular Contractions (PVCs)

by Gemita - 2023-11-17 03:25:43

DoingMyBest, I hope I haven't dampened enthusiasm for a new, potentially effective medication such as Ranolazine for the treatment of PVCs.   There would seem to be so many “unknowns” in the treatment of ectopics and so many potential causes.   Like all other rhythm disturbances, PVCs if frequent/prolonged and not controlled can cause difficult symptoms and lead to other arrhythmias in both the upper and lower chambers.

I was told (and this seems to be especially true for me) that for exercise induced ectopics, a beta blocker is a good choice, whereas for vagally induced ectopics (occurring at rest) a calcium channel blocker like Diltiazem or Verapamil might work better.

Perhaps others will chime in and tell us what 'worked' for them?  

New Treatments for Ectopics?

by DoingMyBest - 2023-11-17 14:36:00

No worries Gemita. I'm happy that someone (you) could provide some meaningful comment on Ranolazine. My purpose is only to shed some light (and hope) on something promising I ran across that others might have missed.

I've located the cited article on Ranolazine at
  Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy
  https://pubmed.ncbi.nlm.nih.gov/27867290/ (abstract only).

For those unfamiliar with Dr Sanjay Gupta, he has an active YouTube channel
  https://www.youtube.com/@YorkCardiology
  
He's got numerous videos addressing ectopics and PVCs. One that caught my eye regarded the psychosomatic aspect whereby we make things worse by our anxiety. He's sensible and easy to listen to.

Effective treatment for PVCs?

by Gemita - 2023-11-17 19:44:22

DoingMyBest, Yes the results are indeed extremely impressive for the effectiveness of Ranolazine in treating ventricular ectopy.  That was a very useful find of yours and I am going to ask my EP whether he has had success with it.   I certainly would be prepared to try it because it seems to have a fairly good safety profile, certainly better than some anti arrhythmic meds like Amiodarone.

As to Sanjay Gupta, I was quite enthusiastic about him and listened to a lot of his You Tube recordings about 5 years ago when I was looking for a cure for my AF.  He seems to be popping up everywhere now and has got quite a following.  I even thought about getting a private consultation with him in York at one time, but my arrhythmias have calmed quite a bit and I am happy with the care provided by my hospital and my new EP.  

Yes the natural fear that comes with an irregular heart beat, be it from PVCs, or from any other rhythm disturbance, can certainly cause anxiety.  I will never forget how poorly I was one night with my arrhythmias.  They were constant, in and out of sinus rhythm, fast, slow, pausing.  I thought I was on my way out.  My blood flow was chaotic I recall, and I thought I was going to have a stroke.  My heart today seems at peace.  Unbelievable what pacing has done for me.

Thank you again for your helpful research