Mitapivat and Ranolazine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ranolazine
Mitapivat
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
Reduced ranolazine exposure and increased mitapivat exposure
Interaction Deep Dive
Coadministration of ranolazine with mitapivat (a CYP3A4 inducer and a sensitive CYP3A4 substrate) is contraindicated as it may reduce ranolazine exposure and increase the exposure of mitapivat. If coadministered, dose adjustment of mitapivat may be required as ranolazine may increase plasma concentrations of mitapivat1.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of ranolazine; inhibition of CYP3A4-mediated metabolism of mitapivat
Literature reports
1 report — tap to read
a) In a drug interaction study, coadministration of rifAMPin (CYP3A4 inducer) 600 mg once daily and ranolazine (1000 mg twice daily) resulted in reduced ranolazine exposure by approximately 95% 1.
Common questions
Can I take Mitapivat and Ranolazine together?
Reduced ranolazine exposure and increased mitapivat exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Mitapivat and Ranolazine interaction?
It is rated contraindicated. These should generally not be used together.
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 Mitapivat 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 Mitapivat
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