Ranitidine 150 mg,, a medication once commonly used to treat conditions related to excess stomach acid, was widely prescribed for its ability to decrease acid production. However, as of recent years, its use has been limited due to safety concerns. Despite this, understanding its uses, dosage, side effects, and warnings remains important, especially for those who may still be using the medication or those interested in its history and alternatives.
What is Ranitidine?
Ranitidine is an H2 receptor antagonist (H2 blocker) that works by reducing the amount of acid produced by the stomach. It was most commonly used to treat conditions such as gastroesophageal reflux disease (GERD), peptic ulcers, and Zollinger-Ellison syndrome, a condition where the stomach produces too much acid. Ranitidine was marketed under several brand names, including Zantac, and it was available in both prescription and over-the-counter forms.
In 2019, ranitidine faced significant scrutiny when traces of a probable carcinogen, N-Nitrosodimethylamine (NDMA), were detected in some formulations of the drug. As a result, many health agencies, including the U.S. Food and Drug Administration (FDA), recommended that ranitidine be withdrawn from the market, leading to its removal from shelves and the discontinuation of manufacturing in many countries.
Despite these developments, ranitidine’s mechanisms and previous uses still offer valuable insight into how it worked to manage various conditions.
Uses of Ranitidine
Ranitidine was commonly used for a variety of conditions associated with excessive stomach acid. These include:
Gastroesophageal Reflux Disease (GERD): GERD occurs when stomach acid frequently leaks into the esophagus, causing symptoms such as heartburn, chest pain, and regurgitation. Ranitidine was used to reduce stomach acid, helping to alleviate symptoms and prevent further damage to the esophagus.
Peptic Ulcers: Peptic ulcers are open sores that form on the inner lining of the stomach, small intestine, or esophagus, usually caused by an imbalance between stomach acid and the protective mechanisms in the stomach. Ranitidine helped promote healing by reducing stomach acid production, giving the ulcer time to heal.
Zollinger-Ellison Syndrome: This rare condition causes the stomach to produce too much acid, leading to ulcers and other complications. Ranitidine was used in high doses to control acid production in patients with this syndrome.
Prevention of Ulcers in Critically Ill Patients: Ranitidine was used in hospitalized patients at risk of developing stress ulcers, particularly those who were critically ill or on mechanical ventilation. This use helped reduce the risk of gastrointestinal bleeding associated with ulcers.
Heartburn and Acid Indigestion: Over-the-counter ranitidine was also used to relieve occasional heartburn and acid indigestion, common issues that arise after meals or from certain lifestyle habits.
Dosage of Ranitidine
The dosage of ranitidine varied depending on the condition being treated, the severity of symptoms, and the patient's age. For prescription forms, the following doses were typical:
For GERD: The standard dose was 150 mg to 300 mg daily, often divided into two doses (morning and evening). Some patients with more severe symptoms might have been prescribed higher doses.
For Peptic Ulcers: Typically, ranitidine was taken at 150 mg twice a day or 300 mg once a day, usually in the evening.
For Zollinger-Ellison Syndrome: Higher doses of ranitidine were used, often starting at 150 mg four times a day, depending on the individual’s response and the severity of the condition.
For Heartburn or Acid Indigestion (OTC Use): Over-the-counter doses of ranitidine were generally lower, such as 75 mg or 150 mg, taken as needed, usually not exceeding two doses per day for short-term relief.
Patients should follow their healthcare provider’s specific instructions, as dosages were often adjusted based on their individual health needs.
Side Effects of Ranitidine
As with any medication, ranitidine could cause side effects. Some were more common and less severe, while others were more serious. Below is a breakdown of these potential side effects:
Common Side Effects
Headache: A mild headache was a common side effect of ranitidine, usually resolving after the body adjusted to the medication.
Dizziness: Some patients reported feeling lightheaded or dizzy, especially when standing up quickly.
Constipation or Diarrhea: Changes in bowel habits, including mild constipation or diarrhea, were noted with ranitidine use.
Nausea or Vomiting: Gastrointestinal upset such as nausea and occasional vomiting could occur, especially if taken on an empty stomach.
Fatigue: Some patients reported feeling more tired or fatigued than usual when using ranitidine.
Serious Side Effects
Allergic Reactions: Some individuals might have had an allergic reaction to ranitidine, causing symptoms such as rash, itching, swelling (particularly of the face or throat), or difficulty breathing. This required immediate medical attention.
Liver Issues: Although rare, ranitidine has been associated with liver problems, including jaundice (yellowing of the skin or eyes), dark urine, or persistent abdominal pain. If these symptoms occur, medical attention should be sought immediately.
Blood Disorders: Serious but rare side effects included changes in blood cell counts, such as low red blood cells (anemia), white blood cells (leukopenia), or platelets (thrombocytopenia), which could lead to unusual bruising, infections, or fatigue.
Mental Confusion: In some cases, particularly in elderly patients or those with kidney or liver problems, ranitidine might cause confusion or hallucinations. If any mental changes occur, discontinuing the drug is usually advised.
Very Rare and Serious Side Effects
Lactic Acidosis: A rare but serious condition that can occur due to a buildup of lactic acid in the blood, leading to symptoms like muscle pain, difficulty breathing, and fatigue.
Heart Issues: In rare cases, ranitidine may be linked to heart issues, including abnormal heart rhythms or heart failure, particularly in people with existing heart conditions.
Warnings and Precautions
While ranitidine was generally well-tolerated, there were several important precautions and warnings:
Kidney or Liver Disease: Ranitidine should be used with caution in patients with pre-existing kidney or liver conditions. Dosage adjustments may be necessary, and regular monitoring of liver and kidney function was advised.
Pregnancy and Breastfeeding: Ranitidine was classified as a Category B drug for pregnancy, meaning it was generally considered safe for use during pregnancy. However, it should only be used when necessary and prescribed by a healthcare provider. It also passes into breast milk, so it should be used cautiously in breastfeeding women.
Drug Interactions: Ranitidine can interact with other medications, including warfarin, certain antifungals, and some anticonvulsants. It could affect the absorption and effectiveness of other drugs, so it’s important to inform your doctor about all medications being taken.
Discontinuation Due to Carcinogen Risk: As mentioned, ranitidine was removed from the market due to concerns about NDMA contamination, which is considered a potential carcinogen. This has led to significant changes in the way the drug is prescribed, with many healthcare providers now recommending alternatives for patients who need acid reduction.
Discontinuation of Use: Due to the potential risk of serious side effects like cancer, it is recommended that patients stop using ranitidine and seek alternatives, particularly if the drug was obtained over-the-counter.
Conclusion
Ranitidine was once a widely used medication for treating acid-related gastrointestinal conditions, from GERD to ulcers. However, its use has been significantly curtailed following concerns about safety due to the presence of NDMA, a substance that may increase the risk of cancer.
While ranitidine has a well-established history of effective use, its removal from the market has led to the development and use of safer alternatives, such as proton pump inhibitors (PPIs) like omeprazole and newer H2 blockers that do not carry the same risks. If you are currently using ranitidine or are considering alternatives, it is essential to consult with a healthcare provider to find a suitable solution for your health condition.
