Midostaurin and Ranolazine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ranolazine
Midostaurin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased ranolazine exposure and an increased CYP3A4 substrate exposure
Interaction Deep Dive
Concomitant use of ranolazine and P-gp inhibitors and sensitive CYP3A4 substrates or with NTI may increase ranolazine and these substrates exposure. If coadministered, titrate ranolazine based on clinical response and dose adjustment of other sensitive CYP3A4 substrates and CYP3A4 substrates with a narrow therapeutic range may be required1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of ranolazine; inhibition of CYP3A4-substrate metabolism by ranolazine
Literature reports
1 report — tap to read
a) In a drug interaction study, in healthy volunteers coadministration of ranolazine 1000 mg twice daily and simvastatin 80 mg once daily, a CYP3A4 substrate resulted in increased simvastatin and its active metabolite exposure by 100%. Similarly, mean exposure to atorvastatin (80 mg daily) is increased by 40% following coadministration with ranolazine (1000 mg twice daily) in healthy volunteers. However, in one subject the exposure to atorvastatin and metabolites was increased by approximately 400% in the presence of ranolazine 1.
Common questions
Can I take Midostaurin and Ranolazine together?
Increased ranolazine exposure and an increased CYP3A4 substrate exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Midostaurin and Ranolazine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Midostaurin or Ranolazine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: RANOLAZINE oral extended-release tablets, ranolazine oral extended-release tablets. Viona Pharmaceuticals Inc. (per Dailymed), Cranford, NJ, 2023. DailyMed
Keep reading about Ranolazine
Keep reading about Midostaurin
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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