Ranitidine

What is Ranitidine?

Ranitidine (or Zantac) is an anti-acid medication used to treat gastroesophageal reflux disease (GERD) or heartburn. It is available over the counter or with a prescription. Ranitidine is one of the first-line medications used to treat GERD, esophagitis, heartburn and is generally well tolerated. Historically, it was one of the most popular medications in the US.

What is acid reflux?

Acid reflux is a very common condition. Classic symptoms include burning pain in the stomach and mid-chest area, often after eating or worse when lying down, as food and stomach acid travels up into the esophagus.

What is Ranitidine used to treat?

Ranitidine is used to treat acid reflux (gastroesophageal reflux disease, or GERD), esophagitis, and stomach ulcers.

How does Ranitidine work?

Ranitidine belongs to a class of medications called “H2 blockers”, which decreases gastric acid secretion in the stomach cells. Over time, acid can erode the esophagus and cause inflammation and ulcers. By decreasing the amount of stomach acid, the stomach and the esophagus are allowed to heal, and symptoms are relieved.

How effective is Ranitidine?

Ranitidine is effective at reducing symptoms of moderate or severe GERD. However, it is generally less effective than its competitor PPI (proton pump inhibitor) medications such as Omeprazole or Lansoprazole. In one study, a greater proportion of Omeprazole-treated patients (70%) experienced no more than mild heartburn compared with Ranitidine-treated patients (49%) after 8 weeks. Also, more patients in the Omeprazole group experienced complete resolution of heart-burn (46%) than in the Ranitidine group (16%). 

When does Ranitidine start to work?

Approximately 2-3 hours after it is taken, Ranitidine achieves high enough levels in the blood to start working. If you continue taking it regularly, you should start to feel the results sooner after taking your dose (usually 1-2 hours after, and lasting up to 12 hours).

Active ingredients

Ranitidine contains the active ingredient ranitidine hydrochloride at a concentration of 150mg, or 300mg, depending upon the strength of the tablet.

Inactive ingredients

Ranitidine also contains the following inactive ingredients: Yellow No. 6 Aluminum Lake, hypromellose, magnesium stearate, microcrystalline cellulose, titanium dioxide, triacetin, and yellow iron oxide

How to take Ranitidine

Always take Ranitidine exactly as prescribed by your doctor.

For mild and intermittent symptoms (<2 episodes per week) Ranitidine can be taken at a dose of 75mg or 150mg twice daily as needed. If symptoms are not relieved by 75mg twice daily, the dose can be increased to 150mg twice daily for a maximum dose of 300mg per day.

For people with kidney disease, the dose is reduced to a maximum of 150mg per day.

If a dose is missed and it is almost time for your next dose, skip the one you forgot and take the one that is due. Do not double the doses.

The treatment for acid reflux usually lasts between 4 and 8 weeks, but may vary depending on your doctor’s recommendation. Also, lifestyle changes such as weight loss and diet changes may help with symptoms.

Ranitidine dosage

For mild and intermittent symptoms (<2 episodes per week):

• 75mg or 150mg twice daily as needed. 
• If symptoms are not relieved by 75mg twice daily, the dose can be increased to 150mg twice daily for a maximum dose of 300mg per day.

For people with kidney disease, the dose is reduced to a maximum of 150mg per day.  

What should I do if I take too much Ranitidine?

Ranitidine even in larger quantities than prescribed generally does not have severe dangerous side effects, however, it is safest to always call the Poison Control Center at 1-800-222-1222 or seek immediate medical attention to ensure that this is the case.

What should I do if I miss a dose of Ranitidine?

Skip the missed dose, and resume the next dose at the next planned time. Do not double up to make up for the missed dose. 

Precautions

Improvement in symptoms with Ranitidine does not exclude the possibility of having stomach cancer, and you should see a doctor periodically to monitor symptoms. Since Ranitidine is removed by the kidney, the dose needs to be reduced in patients with kidney disease. Avoid Ranitidine if you have a history of acute porphyria. Rare cases of reversible confusion have been reported in elderly patients. Vitamin B12 deficiency has been reported in prolonged treatment (>2 years).

Side Effects

Stop taking these tablets and tell your doctor immediately if you experience an allergic reaction such as swelling of the tongue/throat/face, difficulty breathing, rash, difficulty swallowing.

Notify your doctor if you have frequent chest pain; frequent wheezing particularly with heartburn; nausea/vomiting; unexplained weight loss; stomach pain; heartburn longer than 3 months; heartburn with light-headedness, sweating, or dizziness; chest pain or shoulder pain with shortness of breath; sweating or pain that spreads to arms, neck, or shoulders; light-headedness. Stop use and notify your health care provider if heartburn continues, worsens, or lasts longer than 14 days.

Some possible common side effects include:

• Malaise
• Insomnia
• Dizziness
• Depression
• Confusion
• Abnormal heart rhythms
• Diarrhea
• Constipation

• Nausea/Vomiting
• Abdominal pain or discomfort
• Elevated liver enzymes
• Blood count changes
• Feeling tired, or weak
• Joint pain
• Rash

Drug Interactions

The co-administration of Ranitidine with other medicines may interact with the effects of Ranitidine, or these other medicines. This is the list of medications that are known to interact with Ranitidine. Always inform your doctor of all the drugs and supplements you take.

• Procainamide
• Warfarin
• Atazanavir
• Delavirdine
• Gefitinb
• Glipizide
• Ketoconazole
• Midazolam
• Traizolam
• Chemotherapy and immunologic therapy

Contraindications

It is contraindicated to take Ranitidine in the following cases:

If you are allergic to ranitidine hydrochloride or any other ingredients in Ranitidine (see ingredients)

If you have trouble or pain when swallowing food, vomiting with blood, or bloody or black stools, allergic reaction to ranitidine or other acid reducers.

Do not use with other acid reducers. Do not use 150 mg tablet with kidney disease without medical advice.

Is Ranitidine safe in pregnancy?

Ranitidine does cross the placenta. However, if needed, Ranitidine is the agent of choice for GERD during pregnancy. Ask your doctor before use if pregnant or planning to become pregnant.

Is Ranitidine safe during breastfeeding?

Ranitidine is excreted into breast milk. The manufacturer recommends caution be used if taking Ranitidine while breastfeeding. It is best to ask your doctor if this medication is safe and necessary during breastfeeding.