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Medication Safety Issues

Sound-alike/look-alike issues:

Ranitidine may be confused with amantadine, rimantadine

Zantac® may be confused with Xanax®, Zarontin®, Zofran®, Zyrtec®

International issues:

Antagon®: Brand name for astemizole in Mexico; brand name for ganirelix in the U.S.

Pronunciation

(ra NI ti deen)

U.S. Brand Names

• Zantac 150® [OTC]
• Zantac 75® [OTC]
• Zantac®
• Zantac® EFFERdose®

Index Terms

• Ranitidine Hydrochloride

Generic Available

Yes: Excludes effervescent tablet

Canadian Brand Names

• Acid Reducer
• Acid Reducer Maximum Strength Non Prescription
• Apo-Ranitidine®
• CO Ranitidine
• Dom-Ranitidine
• Gen-Ranidine
• Mylan-Ranitidine
• Novo-Ranidine
• Nu-Ranit
• PMS-Ranitidine
• Ranitidine Injection, USP
• ratio-Ranitidine
• Riva-Ranitidine
• Sandoz-Ranitidine
• ScheinPharm Ranitidine
• Zantac 75®
• Zantac Maximum Strength Non-Prescription
• Zantac®

Pharmacologic Category

• Histamine H2 Antagonist

Pharmacologic Category Synonyms

• Anthistamine
• Antihistamine, H₂ Selective
• H₂ Antagonist
• H₂ Blocker

Use: Labeled Indications

Zantac®: Short-term and maintenance therapy of duodenal ulcer, gastric ulcer, gastroesophageal reflux disease (GERD), active benign ulcer, erosive esophagitis, and pathological hypersecretory conditions; as part of a multidrug regimen for H. pylori eradication to reduce the risk of duodenal ulcer recurrence

Zantac 75® [OTC]: Relief of heartburn, acid indigestion, and sour stomach

Use: Unlabeled/Investigational

Recurrent postoperative ulcer, upper GI bleeding, prevention of acid-aspiration pneumonitis during surgery, and prevention of stress-induced ulcers

Pregnancy Risk Factor

B

Pregnancy Considerations

Adverse events were not observed in animal reproduction studies, therefore ranitidine is classified as pregnancy category B. Ranitidine crosses the placenta; available information suggests that it is not teratogenic in humans.

Lactation

Enters breast milk/use caution

Contraindications

Hypersensitivity to ranitidine or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• B₁₂ deficiency: Long-term therapy may be associated with vitamin B₁₂ deficiency.

• Confusion: Reversible confusional states (rare), usually clearing within 3-4 days after discontinuation, have been linked to use. Increased age (>50 years) and renal or hepatic impairment are thought to be associated.

Disease-related concerns:

• Gastric malignancy: Relief of symptoms does not preclude the presence of a gastric malignancy.

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Porphyria: Avoid use in patients with a history of acute porphyria; may precipitate attacks.

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.

Special populations:

• Pediatrics: Safety and efficacy have not been established in infants <1 month of age.

Dosage form specific issues:

• Phenylalanine: EFFERdose® formulation contains phenylalanine.

Adverse Reactions

Frequency not defined.

Cardiovascular: Asystole, atrioventricular block, bradycardia (with rapid I.V. administration), premature ventricular beats, tachycardia, vasculitis

Central nervous system: Agitation, dizziness, depression, hallucinations, headache, insomnia, malaise, mental confusion, somnolence, vertigo

Dermatologic: Alopecia, erythema multiforme, rash

Endocrine & metabolic: Prolactin levels increased

Gastrointestinal: Abdominal discomfort/pain, constipation, diarrhea, nausea, pancreatitis, vomiting

Hematologic: Acquired immune hemolytic anemia, acute porphyritic attack, agranulocytosis, aplastic anemia, granulocytopenia, leukopenia, pancytopenia, thrombocytopenia

Hepatic: Cholestatic hepatitis, hepatic failure, hepatitis, jaundice

Local: Transient pain, burning or itching at the injection site

Neuromuscular & skeletal: Arthralgia, involuntary motor disturbance, myalgia

Ocular: Blurred vision

Renal: Acute interstitial nephritis, serum creatinine increased

Respiratory: Pneumonia (causal relationship not established)

Miscellaneous: Anaphylaxis, angioneurotic edema, hypersensitivity reactions (eg, bronchospasm, fever, eosinophilia)

Metabolism/Transport Effects

Substrate (minor) of CYP1A2, 2C19, 2D6; Inhibits CYP1A2 (weak), 2D6 (weak)

Drug Interactions

Antifungal Agents (Azole Derivatives, Systemic): H2-Antagonists may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification

Atazanavir: H2-Antagonists may decrease the absorption of Atazanavir. Risk D: Consider therapy modification

Cefpodoxime: H2-Antagonists may decrease the absorption of Cefpodoxime. Separate oral doses by at least 2 hours. Risk C: Monitor therapy

Cefuroxime: H2-Antagonists may decrease the absorption of Cefuroxime. Separate oral doses by at least 2 hours. Risk C: Monitor therapy

Dasatinib: H2-Antagonists may decrease the absorption of Dasatinib. Risk D: Consider therapy modification

Delavirdine: H2-Antagonists may decrease the serum concentration of Delavirdine. Management: Chronic therapy with H2-antagonists should be avoided in patients who are being treated with delavirdine. The clinical significance of short-term H2-antagonist therapy with delavirdine is uncertain, but such therapy should be undertaken with caution. Risk X: Avoid combination

Erlotinib: H2-Antagonists may decrease the serum concentration of Erlotinib. Risk X: Avoid combination

Fosamprenavir: H2-Antagonists may decrease the serum concentration of Fosamprenavir. Cimetidine may also inhibit the metabolism of the active metabolite amprenavir, making its effects on fosamprenavir/amprenavir concentrations difficult to predict. Risk C: Monitor therapy

Gefitinib: Ranitidine may decrease the serum concentration of Gefitinib. Risk C: Monitor therapy

Indinavir: H2-Antagonists may decrease the serum concentration of Indinavir. Risk C: Monitor therapy

Iron Salts: H2-Antagonists may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk C: Monitor therapy

Mesalamine: H2-Antagonists may diminish the therapeutic effect of Mesalamine. Histamine H2-Antagonist-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Consider avoiding concurrent administration of high-dose histamine H2-receptor antagnists with sustained-release mesalamine products. Risk D: Consider therapy modification

Nelfinavir: H2-Antagonists may decrease the serum concentration of Nelfinavir. Concentrations of the active M8 metabolite may also be reduced. Risk C: Monitor therapy

Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy

P-Glycoprotein Inducers: May decrease the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy

P-Glycoprotein Inhibitors: May increase the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy

Prasugrel: Ranitidine may decrease serum concentrations of the active metabolite(s) of Prasugrel. Risk C: Monitor therapy

Procainamide: Ranitidine may increase the serum concentration of Procainamide. Ranitidine may also increase the concentration of the active N-acetyl-procainamide (NAPA) metabolite. Risk C: Monitor therapy

Saquinavir: H2-Antagonists may increase the serum concentration of Saquinavir. Risk C: Monitor therapy

Sulfonylureas: Ranitidine may increase the serum concentration of Sulfonylureas. Risk C: Monitor therapy

Warfarin: Ranitidine may increase the serum concentration of Warfarin. Risk C: Monitor therapy

Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid ethanol (may cause gastric mucosal irritation).

Food: Does not interfere with absorption of ranitidine.

Storage

Injection: Vials: Store between 4°C to 25°C (39°F to 77°F); excursion permitted to 30°C (86°F). Protect from light. Solution is a clear, colorless to yellow solution; slight darkening does not affect potency. Vials mixed with NS or D₅W are stable for 48 hours at room temperature.

Premixed bag: Store between 2°C to 25°C (36°F to 77°F). Protect from light.

EFFERdose® formulations: Store between 2°C to 30°C (36°F to 86°F).

Syrup: Store between 4°C to 25°C (39°F to 77°F). Protect from light.

Tablets: Store in dry place, between 15°C to 30°C (59°F to 86°F). Protect from light.

Reconstitution

Vials can be mixed with NS or D₅W.

Intermittent bolus injection, continuous infusion: Dilute to maximum of 2.5 mg/mL.

Intermittent infusion: Dilute to maximum of 0.5 mg/mL.

Compatibility

Stable in D₅1/2NS, D₅W, D₁₀W, fat emulsion 10%, LR, NS, sodium bicarbonate 5%; for injection, do not add other medications to premixed bag; variable compatibility (consult detailed reference) in D₅LR, TPN.

Y-site administration: Compatible: Acyclovir, alcohol (ethyl), aldesleukin, allopurinol, amifostine, aminophylline, amsacrine, anidulafungin, atracurium, aztreonam, bivalirudin, cefazolin, cefepime, cefoxitin, ceftazidime, ceftizoxime, ciprofloxacin, cisatracurium, cisplatin, cladribine, clarithromycin, cyclophosphamide, cytarabine, dexmedetomidine, diltiazem, dobutamine, docetaxel, dopamine, doripenem, doxapram, doxorubicin, doxorubicin liposome, enalaprilat, epinephrine, esmolol, etoposide, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, foscarnet, furosemide, gatifloxacin, gemcitabine, granisetron, heparin, hetastarch in lactated electrolyte injection (Hextend®), hydromorphone, idarubicin, labetalol, linezolid, lorazepam, melphalan, meperidine, methotrexate, midazolam, milrinone, morphine, nicardipine, nitroglycerin, norepinephrine, ondansetron, ondansetron with paclitaxel, oxaliplatin, paclitaxel, pancuronium, pemetrexed, piperacillin, piperacillin/tazobactam, procainamide, propofol, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, tigecycline, vecuronium, vinorelbine, warfarin, zidovudine. Incompatible: Amphotericin B cholesteryl sulfate complex, drotrecogin alfa, hetastarch in sodium chloride 0.9%, insulin (regular), lansoprazole, pantoprazole. Variable (consult detailed reference): TPN.

Compatibility in syringe: Compatible: Atropine, cyclizine, dexamethasone sodium phosphate, dimenhydrinate, diphenhydramine, dobutamine, dopamine, fentanyl, glycopyrrolate, heparin, hydromorphone, isoproterenol, meperidine, metoclopramide, morphine, nalbuphine, oxymorphone, pentazocine, perphenazine, prochlorperazine edisylate, promethazine, scopolamine. Incompatible: Hydroxyzine, methotrimeprazine, midazolam, pantoprazole, pentobarbital, phenobarbital. Variable (consult detailed reference): Chlorpromazine, diazepam, lorazepam.

Compatibility when admixed: Compatible: Acetazolamide, amikacin, aminophylline, ampicillin, chloramphenicol, chlorothiazide, ciprofloxacin, colistimethate, dexamethasone sodium phosphate, digoxin, dobutamine, dopamine, doxycycline, epinephrine, erythromycin lactobionate, fluconazole with ondansetron, flumazenil, furosemide, gentamicin, heparin, isoproterenol, lidocaine, lincomycin, meperidine, meropenem, methylprednisolone sodium succinate, metoclopramide, midazolam, morphine, nitroprusside, ondansetron, penicillin G potassium, penicillin G sodium, polymyxin B sulfate, potassium chloride, protamine, quinidine gluconate, tobramycin, vancomycin, vinorelbine, vitamin B complex, zidovudine. Incompatible: Amphotericin B, atracurium, ceftazidime, cefuroxime, ethacrynate, phytonadione. Variable (consult detailed reference): Cefazolin, cefoxitin, clindamycin, insulin (regular), norepinephrine.

Mechanism of Action

Competitive inhibition of histamine at H₂-receptors of the gastric parietal cells, which inhibits gastric acid secretion, gastric volume, and hydrogen ion concentration are reduced. Does not affect pepsin secretion, pentagastrin-stimulated intrinsic factor secretion, or serum gastrin.

Pharmacodynamics/Kinetics

Absorption: Oral: 50%

Distribution: Normal renal function: V_d: ~1.4 L/kg; Cl_cr 25-35 mL/minute: 1.76 L/kg minimally penetrates the blood-brain barrier; enters breast milk

Protein binding: 15%

Metabolism: Hepatic to N-oxide, S-oxide, and N-desmethyl metabolites

Bioavailability: Oral: 48% to 50%; I.M.: 90% to 100%

Half-life elimination:

Oral: Normal renal function: 2.5-3 hours; Cl_cr 25-35 mL/minute: 4.8 hours

I.V.: Normal renal function: 2-2.5 hours

Time to peak, serum: Oral: 2-3 hours; I.M.: ?15 minutes

Excretion: Urine: Oral: 30%, I.V.: 70% (as unchanged drug); feces (as metabolites)

Dosage

Children 1 month to 16 years:

Duodenal and gastric ulcer:

Oral:

Treatment: 4-8 mg/kg/day divided twice daily; maximum: 300 mg/day

Maintenance: 2-4 mg/kg/day once daily; maximum: 150 mg/day

I.V.: 2-4 mg/kg/day divided every 6-8 hours; maximum: 200 mg/day

GERD and erosive esophagitis:

Oral: 5-10 mg/kg/day divided twice daily; maximum: GERD: 300 mg/day, erosive esophagitis: 600 mg/day

I.V. (unlabeled): 2-4 mg/kg/day divided every 6-8 hours; maximum: 200 mg/day or as an alternative

Continuous infusion: Initial: 1 mg/kg/dose for one dose followed by infusion of 0.08-0.17 mg/kg/hour or 2-4 mg/kg/day

Children ?12 years: Prevention of heartburn: Oral: Zantac 75® [OTC]: 75 mg 30-60 minutes before eating food or drinking beverages which cause heartburn; maximum: 150 mg/24 hours; do not use for more than 14 days

Adults:

Duodenal ulcer: Oral: Treatment: 150 mg twice daily, or 300 mg once daily after the evening meal or at bedtime; maintenance: 150 mg once daily at bedtime

Helicobacter pylori eradication: 150 mg twice daily; requires combination therapy

Pathological hypersecretory conditions:

Oral: 150 mg twice daily; adjust dose or frequency as clinically indicated; doses of up to 6 g/day have been used

I.V.: Continuous infusion for Zollinger-Ellison: Initial: 1 mg/kg/hour; measure gastric acid output at 4 hours, if >10 mEq or if patient is symptomatic, increase dose in increments of 0.5 mg/kg/hour; doses of up to 2.5 mg/kg/hour (or 220 mg/hour) have been used

Gastric ulcer, benign: Oral: 150 mg twice daily; maintenance: 150 mg once daily at bedtime

GERD: Oral: 150 mg twice daily

Erosive esophagitis: Oral: Treatment: 150 mg 4 times/day; maintenance: 150 mg twice daily

Prevention of heartburn: Oral: Zantac 75® [OTC]: 75 mg 30-60 minutes before eating food or drinking beverages which cause heartburn; maximum: 150 mg in 24 hours; do not use for more than 14 days

Patients not able to take oral medication:

I.M.: 50 mg every 6-8 hours

I.V.: Intermittent bolus or infusion: 50 mg every 6-8 hours

Continuous I.V. infusion: 6.25 mg/hour

Elderly: Ulcer healing rates and incidence of adverse effects are similar in the elderly, when compared to younger patients; dosing adjustments not necessary based on age alone

Dosing adjustment in renal impairment: Adults: Cl_cr <50 mL/minute:

Oral: 150 mg every 24 hours; adjust dose cautiously if needed

I.V.: 50 mg every 18-24 hours; adjust dose cautiously if needed

Hemodialysis: Adjust dosing schedule so that dose coincides with the end of hemodialysis

Dosing adjustment/comments in hepatic disease: Patients with hepatic impairment may have minor changes in ranitidine half-life, distribution, clearance, and bioavailability; dosing adjustments not necessary, monitor

Administration: Oral

EFFERdose®: Should not be chewed, swallowed whole, or dissolved on tongue: 25 mg tablet: Dissolve in at least 5 mL (1 teaspoonful) of water; wait until completely dissolved before administering

Administration: I.M.

No dilution is needed

Administration: I.V.

I.V. push: Ranitidine (usually 50 mg) should be diluted to a total of 20 mL (or a concentration not exceeding 2.5 mg/mL) with NS or D₅W and administered over at least 5 minutes or a maximum rate of 10 mg/minute.

Intermittent I.V. infusion: Dilute to a maximum concentration of 0.5 mg/mL; administer over 15-20 minutes

Continuous I.V. infusion: Dilute to a maximum concentration of 2.5 mg/mL. Titrate dosage based on gastric pH.

Administration: I.V. Detail

I.V. must be diluted; may be administered I.V. push, intermittent I.V. infusion, or continuous I.V. infusion

pH: 6.7-7.3

Monitoring Parameters

AST, ALT, serum creatinine; when used to prevent stress-related GI bleeding, measure the intragastric pH and try to maintain pH >4; signs and symptoms of peptic ulcer disease, occult blood with GI bleeding, monitor renal function to correct dose

Test Interactions

False-positive urine protein using Multistix®; gastric acid secretion test; skin test allergen extracts

Dietary Considerations

Some products may contain sodium. Oral dosage forms may be taken with or without food.

Patient Education

Do not take any new prescription or OTC medications or herbal products during therapy without consulting healthcare provider. Read Instructions carefully and take exactly as directed; do not exceed recommended dose. May take several days before you notice relief. Allow 1 hour between taking any other antacids (if approved by prescriber) and ranitidine. Avoid excessive alcohol. Follow diet as prescriber recommends. May cause drowsiness, dizziness, or fatigue (use caution when driving or engaging in tasks requiring alertness until response to drug is known). Report immediately chest pain or irregular heartbeat; skin rash; CNS changes (mental confusion, hallucinations, somnolence); unusual persistent weakness or lethargy; yellowing of skin or eyes; or change in color of urine or stool. Breast-feeding precaution: Consult prescriber if breast-feeding.

Geriatric Considerations

Ulcer healing rates and incidence of adverse effects are similar in the elderly, when compared to younger patients; dosing adjustments not necessary based on age alone. Always adjust dose based upon creatinine clearance. Serum half-life is increased to 3-4 hours in elderly patients. H₂ blockers are the preferred drugs for treating PUD in the elderly due to cost and ease of administration. These agents are no less or more effective than any other therapy. The preferred agents, due to side effects and drug interaction profile and pharmacokinetics are ranitidine, famotidine, and nizatidine. Treatment for PUD in the elderly is recommended for 12 weeks since their lesions are larger; therefore, take longer to heal. This drug is substantially cleared renally, and elderly, having decreased renal function in general, should be monitored closely for adverse effects, especially CNS.

Anesthesia and Critical Care Concerns/Other Considerations

Clinical Pearls/Comments: Ranitidine causes fewer CNS adverse reactions and drug interactions compared to cimetidine.

Evidence-Based Information: The 2008 Surviving Sepsis Campaign guidelines recommend that stress ulcer prophylaxis using an H₂ blocker (Grade 1A) or proton pump inhibitor (Grade 1B) be given to patients with severe sepsis to prevent upper GI bleed. Benefit of prevention of upper GI bleed must be weighed against potential effect of increased stomach pH on development of ventilator-associated pneumonia.

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause drowsiness or dizziness

Mental Health: Effects on Psychiatric Treatment

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; concurrent use with diazepam may reduce diazepam's effectiveness

Nursing: Physical Assessment/Monitoring

Use caution in presence of renal or hepatic impairment; dosage adjustment may be necessary. Assess potential for interactions with other pharmacological agents patient may be taking (eg, increased or decreased levels/effects and toxicity). See administration details according to formulation and purpose for use. Evaluate results of laboratory tests, therapeutic effectiveness, and adverse reactions (eg, asystole, bradycardia, PVCs, tachycardia, CNS changes [depression, hallucinations, confusion, malaise], rash, gynecomastia, GI disturbance, hepatic failure). Teach patient appropriate use, possible side effects/appropriate interventions, and adverse symptoms to report.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule 150 mg, 300 mg

Infusion, premixed in 1/2NS [preservative free]:

Zantac®: 50 mg (50 mL)

Injection, solution: 25 mg/mL (2 mL, 6 mL, 40 mL)

Zantac®: 25 mg/mL (2 mL, 6 mL, 40 mL) [contains phenol 0.5% as preservative]

Syrup: 15 mg/mL (5 mL, 10 mL, 473 mL)

Zantac®: 15 mg/mL (473 mL) [contains ethanol 7.5%; peppermint flavor]

Tablet: 75 mg [OTC], 150 mg, 300 mg

Zantac®: 150 mg, 300 mg

Zantac 75®: 75 mg

Zantac 150®: 150 mg

Tablet, for solution, oral [effervescent]:

Zantac® EFFERdose®: 25 mg [contains phenylalanine 2.81 mg/tablet, sodium 1.33 mEq/tablet, sodium benzoate]

Pricing: U.S. (www.drugstore.com)

Capsules (Ranitidine HCl)

150 mg (60): $42.99

300 mg (30): $30.99

Syrup (Ranitidine HCl)

15 mg/mL (30): $29.99

Syrup (Zantac)

15 mg/mL (300): $224.88

Tablet, effervescent (Zantac EFFERdose)

25 mg (60): $218.32

Tablets (Ranitidine HCl)

150 mg (90): $17.99

300 mg (30): $14.99

Tablets (Zantac)

150 mg (60): $236.71

300 mg (30): $218.33

Tablets (Zantac 75)

75 mg (4): $12.99

75 mg (10): $7.99

75 mg (20): $7.99

75 mg (30): $17.99

75 mg (60): $28.99

References

“ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and Approved by the ASHP Board of Directors on November 14, 1998,” Am J Health Syst Pharm, 1999, 56(4):347-79.

Balestrazzi P, Gregori G, Bernasconi S, et al, “Bradycardia and Neurologic Disorders Associated With Ranitidine in a Child,” Am J Dis Child, 1985, 139(5):442.

Blumer JL, Rothstein FC, Kaplan BS, et al, “Pharmacokinetic Determination of Ranitidine Pharmacodynamics in Pediatric Ulcer Disease,” J Pediatr, 1985, 107(2):301-6.

Cook D, Guyatt G, Marshall J, et al, “A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation. Canadian Critical Care Trials Group,” N Engl J Med, 1998, 338(12):791-7.

Dellinger RP, Levy MM, Carlet JM, et al, “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008,” Intensive Care Med, 2008, 34(1):17-60. Available at http://www.survivingsepsis.org/system/files/images/2008_20International_20SSC_20Guidelines_1_.pdf

Eddleston JM, Booker PD, and Green JR, “Use of Ranitidine in Children Undergoing Cardiopulmonary Bypass,” Crit Care Med, 1989, 17(1):26-9.

Fennerty MD and Higbee M, “Drug Therapy of Gastrointestinal Disease,” Geriatric Pharmacology, Bressler R and Katz MD, eds, New York, NY: McGraw-Hill, 1993, 585-608.

Fontana M, Massironi E, Rossi A, et al, “Ranitidine Pharmacokinetics in Newborn Infants,” Arch Dis Child, 1993, 68(5 Spec No):602-3.

Freeman HJ, “Ranitidine-Associated Interstitial Nephritis in a Patient With Celiac Sprue,” Can J Gastroenterol, 1988, 2:35.

Lehmann AB, “Reversible Chorea Due to Ranitidine and Cimetidine,” Lancet, 1988, 2(8603):158.

Lopez-Herce J, Albajara L, Codoceo R, et al, “Ranitidine Prophylaxis in Acute Gastric Mucosal Damage in Critically Ill Pediatric Patients,” Crit Care Med, 1988, 16(6):591-93.

Maack DK and Spiller HA, “Rare Dystonic Reaction From Accidental Overdose of Ranitidine in a 3 Month Old,” Vet Hum Toxicol, 1993, 35:343.

Miralles ES, Nunez M, del Olmo N, et al, “Ranitidine-Related Toxic Epidermal Necrolysis in a Patient With Idiopathic Thrombocytopenic Purpura,” J Am Acad Dermatol, 1995, 32(1):133-4.

Morris DL, Markham SJ, Beechey A, et al, “Ranitidine-Bolus or Infusion Prophylaxis for Stress Ulcer,” Crit Care Med, 1988, 16(3):229-32.

Ohsawa T, Masuhara K, and Hirata W, “Reversal of Ranitidine-Induced Hypergastrinemia by Cimetidine,” Ann Pharmacother, 1994, 28(11):1303.

Richter JE, “Gastroesophageal Reflux Disease During Pregnancy,” Gastroenterol Clin North Am, 2003, 32(1):235-61.

Roberts CJ, “Clinical Pharmacokinetics of Ranitidine,” Clin Pharmacokinet, 1984, 9(3):211-21.

Romaguera C, Grimalt F, and Vilaplana J, “Epidemic of Occupational Contact Dermatitis From Ranitidine,” Contact Dermatitis, 1988, 18(3):177-8.

Souza Lima MA, “Hepatitis Associated With Ranitidine,” Ann Intern Med, 1984, 101(2):207-8.

Todd P, Norris P, Hawk JL, et al, “Ranitidine-Induced Photosensitivity,” Clin Exp Dermatol, 1995, 20(2):146-8.

International Brand Names

• Aceptin (PH)
• Acidex (AR)
• Aciflux (CN)
• Aciloc (BF, BJ, CI, CZ, ET, GH, GM, GN, IN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW)
• Acloral (MX)
• Aldin (ID, IN)
• Antagonin (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW)
• Antak (BR)
• Apo-Ranitidine (NZ, PL)
• Arnetin (MY)
• Artonil (SE)
• Atural (PE)
• Ausran (AU)
• Azantac (FR, MX)
• Consec (IN)
• Cudin (KP)
• Danitin (PH)
• Eltidine (KP)
• Eu-Ran (PH)
• Ezopta (GR)
• Galidrin (MX)
• Gastoren (PL)
• Gastrial (AR)
• Gastridin (ID)
• Gastrone (PH)
• Gastrosedol (AR)
• Hexal Ranitic (AU)
• Hexal Ranitic Forte (AU)
• Hexer (ID)
• Histac (BF, BJ, CI, ET, GH, GM, GN, HU, IN, KE, LR, MA, ML, MR, MU, MW, MY, NE, NG, PL, SC, SD, SG, SL, SN, TH, TN, TZ, UG, ZA, ZM, ZW)
• Histac EVT (MY)
• Histak (ZA)
• Huma-Ranidine (HU)
• Hyzan (HK, SG)
• Iqfadina (MX)
• Junizac (DE)
• Locid (KP)
• Lydin (IN)
• Nadine (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE)
• Neoceptin-R (SG)
• Novo-Ranidine (PL)
• Peptoran (HR)
• Ponaltin (KP)
• Ptinolin (GR)
• Pylorid (HR, HU, LU, PL)
• R-Loc (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW)
• Radinat (EC)
• Radine (PH)
• Ragastin (PL)
• Randin (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE)
• Rani 2 (AU)
• Ranial (IN)
• Raniben (IT)
• Raniberl (CZ, PL)
• Ranibeta (AU)
• Ranic (PL)
• Ranicux (DE)
• Ranidil (IT)
• Ranidin (ES)
• Ranidine (TH)
• Raniflux (AU)
• Ranigasan (PL)
• Ranigast (PL)
• Ranihexal (AU)
• Ranilex (ID)
• Ranimax (PL)
• Ranimex (FI)
• Ranin (ID)
• Raniplex (FR)
• Raniratio (PL)
• Ranisan (AE, BH, CY, CZ, EG, IL, IQ, IR, JO, KW, LB, LY, OM, PL, QA, SA, SY, YE)
• Ranisen (MX)
• Ranitab (PH)
• Ranital (CZ, HR, PL)
• Ranitic (LU)
• Ranitidin-B (HU)
• Ranitidine (PL)
• Ranitin (PL)
• Ranitine (PL)
• Ranitydyna (PL)
• Ranoxyl Heartburn Relief (AU)
• Rantac (AE, BH, CY, EG, IL, IN, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE)
• Rantacid (FI)
• Rantagon (PL)
• Rantin (ID)
• Ratic (TH)
• Ratinal (ID)
• Raxide (PH)
• Ribotine (KP)
• Riflux (PL)
• RND (TW)
• Rolan (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE)
• Solvertyl (PL)
• Sostril (DE)
• Tanidina (ES)
• Taural (AR)
• Tricker-150 (ID)
• Ulcaid (ZA)
• Ulceran (HU, PE)
• Ulceranin (ID)
• Ulcerit (BR)
• Ulcex (IT)
• Ulcin (PH)
• Ulcodin (HR)
• Ulcosan (CZ)
• Ulran (PL)
• Ulsal (AT)
• Ulticer (HK)
• Ultran (PH, PL)
• Umaren (HU)
• Utac (TH)
• Verlost (GR)
• Vizerul (AR)
• Weichilin (TW)
• Weidos (TW)
• X'Tac (MY)
• Xanidine (SG, TH)
• Xanomel (HU)
• Zantac (AE, AU, BB, BE, BF, BG, BH, BJ, BM, BS, BZ, CI, CL, CO, CR, CY, CZ, DK, DO, EE, EG, ET, FI, GB, GH, GM, GN, GR, GT, GY, HK, HN, HU, ID, IE, IL, IQ, IR, IT, JM, JO, KE, KP, KW, LB, LR, LU, LY, MA, ML, MR, MU, MW, MY, NE, NG, NI, NL, NO, OM, PA, PE, PH, PK, PL, PT, PY, QA, SA, SC, SD, SE, SL, SN, SR, SV, SY, TH, TN, TT, TW, TZ, UG, UY, VE, YE, ZA, ZM, ZW)
• Zantadin (ID)
• Zantic (CH, DE)
• Zendhin (HK, MY)
• Zerdin (PH)
• Zinetac (IN)

Lexi-Comp.com

Last full review/revision November 2009

Content last modified November 2009