Ranolazine and Hallucinations

Abstract

Ranolazine is a piperazine derivative which produces its anti-ischemic effect by decreasing myocardial oxygen demand and enhancing myocardial perfusion without having any effect on heart rate or blood pressure. Many trials have proved its benefits in the management of chronic stable angina; however, some rare neurological side effects have been seen in elderly population. In this case report, we describe a case of a 75-year-old female with underlying coronary artery disease, chronic kidney disease and mild cognitive impairment who was admitted for a new onset auditory and visual hallucinations along with new onset tremors in both upper and lower extremity after she was started on ranolazine for management of her chronic stable angina. Her workup was negative for any source of infection and no metabolic derangements, drugs or stroke were found. Her symptoms resolved after the ranolazine was discontinued. We recommend starting ranolazine in elderly population only when other anti-ischemic therapies have been exhausted and starting with the lowest therapeutic dose possible. Ranolazine should be discontinued immediately if any signs of neurological adverse effect appear. We also recommend monitoring renal functions in these patients and withholding ranolazine if any signs of worsening renal functions appear. J Med Cases. 2017;8(3):90-92 doi: https://doi.org/10.14740/jmc2774w