Amiodarone + ranolazine

Amiodarone + ranolazine is a combination of two antiarrhythmic drugs used primarily for the treatment and prevention of atrial fibrillation (AF) and other cardiac arrhythmias. Amiodarone is a class III antiarrhythmic agent that works by blocking potassium channels, prolonging repolarization, and affecting sodium and calcium channels as well as adrenergic receptors. Ranolazine is an antianginal agent with antiarrhythmic properties, primarily acting as an inhibitor of the late sodium current (INa) in cardiac cells. The combination has been shown to have synergistic effects in suppressing atrial arrhythmias by producing a more pronounced depression of sodium channel–dependent parameters, increasing postrepolarization refractoriness, reducing triggered activity in pulmonary vein sleeves, and facilitating faster restoration of sinus rhythm compared to either drug alone. This synergy allows for potentially lower doses of amiodarone—reducing its dose-dependent toxicities—while maintaining or enhancing efficacy against AF[2][3][4][5][8]. Both drugs are approved individually for use in the United States.