II. Indications
- Peptic Ulcer Disease
- Esophageal Reflux disease
- Gastritis
- Allergic Reaction (adjunct)
III. Mechanism
- See H2 Blocker
IV. Dosing
- Adult
- Removed from U.S. market in 2020 due to NDMA contaminant (see adverse effects below)
- Bolus IV Dosing: 50 mg IV every 6 to 8 hours
- Continuous IV Dosing: 6.25 mg/hour IV
- Oral Dosing: 150 mg orally twice daily
- Child (15 mg/ml oral syrup)
- Removed from U.S. market in 2020 due to NDMA contaminant (see adverse effects below)
- Age <16 years old
- Dose: 5-10 mg/kg/day (max 300 mg) divided every 12 hours
- Adult dosing for over age 16 years old
- Dose: 150 mg twice daily
-
Creatinine Clearance <50 ml/min
- Give at half dose
V. Efficacy
- See H2 Blocker
VI. Adverse Effects
- See H2 Blocker
- Ranitidine (Zantac) was removed from U.S. market in 2020 due to NDMA contaminant
- NDMA has been associated with several cancers
- NDMA was found both as a manufacturing contaminant
- NDMA also appears to form in vivo with Ranitidine use
- Resulted in the complete withdrawal of Ranitidine from U.S. market
- In-vivo NDMA formation does not appear to occur with other H2 Blockers
- FDA Recall Information
- IV Ranitidine associated adverse effects
- Alanine Aminotransferase (ALT) increase
- Associated with prolonged (>5 days), high dose IV use
- Bradycardia
- Associated with rapid IV administration
- Alanine Aminotransferase (ALT) increase
VII. Drug Interactions
-
Antacids
- Take Cimetidine at least 1-2 hours before or after Antacid medications
- Decreases absorption of other medications
-
Warfarin
- May affect drug levels
VIII. Safety
- Pregnancy Category B
- Unknown safety in Lactation
IX. Resources
X. References
- (2012) Presc Lett, 19(7): 38
- Baird (2015) Am Fam Physician 92(8): 705-14 [PubMed]