Ranitidine

Aka: Ranitidine, Zantac

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II. Indications

  1. Peptic Ulcer Disease
  2. Esophageal Reflux disease
  3. Gastritis
  4. Allergic Reaction (adjunct)

III. Mechanism

  1. See H2 Blocker

IV. Dosing

  1. Adult
    1. Removed from U.S. market in 2020 due to NDMA contaminant (see adverse effects below)
    2. Bolus IV Dosing: 50 mg IV every 6 to 8 hours
    3. Continuous IV Dosing: 6.25 mg/hour IV
    4. Oral Dosing: 150 mg orally twice daily
  2. Child (15 mg/ml oral syrup)
    1. Removed from U.S. market in 2020 due to NDMA contaminant (see adverse effects below)
    2. Age <16 years old
      1. Dose: 5-10 mg/kg/day (max 300 mg) divided every 12 hours
    3. Adult dosing for over age 16 years old
      1. Dose: 150 mg twice daily
  3. Creatinine Clearance <50 ml/min
    1. Give at half dose

V. Efficacy

  1. See H2 Blocker

VI. Adverse Effects

  1. See H2 Blocker
  2. Ranitidine (Zantac) was removed from U.S. market in 2020 due to NDMA contaminant
    1. NDMA has been associated with several cancers
    2. NDMA was found both as a manufacturing contaminant
    3. NDMA also appears to form in vivo with Ranitidine use
      1. Resulted in the complete withdrawal of Ranitidine from U.S. market
      2. In-vivo NDMA formation does not appear to occur with other H2 Blockers
    4. FDA Recall Information
      1. https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-zantac-ranitidine
  3. IV Ranitidine associated adverse effects
    1. Alanine Aminotransferase (ALT) increase
      1. Associated with prolonged (>5 days), high dose IV use
    2. Bradycardia
      1. Associated with rapid IV administration

VII. Drug Interactions

  1. Antacids
    1. Take Cimetidine at least 1-2 hours before or after Antacid medications
  2. Decreases absorption of other medications
    1. Ketoconazole
    2. Itraconazole
  3. Warfarin
    1. May affect drug levels

VIII. Safety

  1. Pregnancy Category B
  2. Unknown safety in Lactation

IX. Resources

  1. Ranitidine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b0af5ca1-9189-4c62-bdf1-f1124ec337e7

X. References

  1. (2012) Presc Lett, 19(7): 38
  2. Baird (2015) Am Fam Physician 92(8): 705-14 [PubMed]

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