Although ranolazine has been well studied in SIHD, the agent was not administered in the COURAGE (Clinical Outcomes Utilizing Revasculariza- tion and Aggressive Drug Evaluation) study,366 and further clinical evaluation is needed, especially of ranolazine as an element of intensive interventions for multiple risk factors. The ranolazine extended-release preparation reduces the frequency of angina, improves exercise performance, and delays the development of exercise-induced angina and ST- segment depression.847,884 In one study, ranolazine reduced weekly anginal frequency by 36% and nitroglycerin use by 43% in comparison with placebo.848 Other studies indicated that among patients with ACS, ranolazine did not reduce the incidence of MI or death885 but did reduce recurrent ischemia in the postinfarction period.886 In patients with preexisting angina, it was superior to placebo in improving patients angina and quality of life.887 Ranolazine could exert a beneficial effect on glycemic control and has demonstrated consistent reductions in HbA1c in patients with diabetes Ranolazine blocks the delayed rectifier potassium current and prolongs the QTc interval in a dose-related manner, resulting in a mean increase in QTc of approximately 6 msec at maximal recommended dosing. Currently, there is limited experience with concomitant administration of ranolazine and other drugs that prolong the QT interval, including Class IA and III antiarrhythmics and certain antipsychotics (thiorida- zine and ziprasidone). In 3162 patients with ACS, there was no increased risk of proarrhythmia or sudden death. In this study, there was a significantly lower incidence of arrhyth- mias, including ventricular tachycardia, bradycardia, su- praventricular tachycardia, and new atrial fibrillation, in patients treated with ranolazine (80%) versus placebo Ranolazine does not require dose adjustment for age, sex, New York Heart Association class I IV heart failure, or diabetes mellitus. 