page73
RANITIDINE
Indications
see under Dose,
other conditions where
reduction of gastric acidity is beneficial (see notes
above and section 1.9.4)
Cautions
see notes above; also acute porphyria;
interactions: Appendix 1 (histamine H
2
-antagonists)
and notes above
Renal impairment
use half normal dose if eGFR less
than 50 mL/minute/1.73 m
2
Pregnancy
manufacturer advises avoid unless essen-
tial,
but not known to be harmful
Breast-feeding
significant amount present in milk,
but not known to be harmful
Side-effects
see notes above;
less commonly
blurred
vision;
also reported pancreatitis,
involuntary move-
ment disorders, interstitial nephritis,
alopecia
Dose
. By mouth,
benign gastric and duodenal ulceration,
chronic episodic dyspepsia,
ADULT
and
CHILD
over 12
years, 150 mg twice daily
or
300 mg at night for 4–8
weeks in benign gastric and duodenal ulceration, up
to 6 weeks in chronic episodic dyspepsia, and up to 8
weeks in NSAID-associated ulceration (in duodenal
ulcer 300 mg can be given twice daily for 4 weeks to
achieve a higher healing rate);
CHILD
3–12 years,
(benign gastric and duodenal ulceration) 2–4 mg/kg
(max.
150 mg) twice daily for 4–8 weeks
Prophylaxis of NSAID-associated gastric or duodenal
ulcer [unlicensed dose],
ADULT
and
CHILD
over 12
years, 300 mg twice daily
Gastro-oesophageal reflux disease,
ADULT
and
CHILD
over 12 years,
150 mg twice daily
or
300 mg at night
for up to 8 weeks or if necessary 12 weeks (moderate
to severe, 600 mg daily in 2–4 divided doses for up to
12 weeks); long-term treatment of healed gastro-
oesophageal reflux disease, 150 mg twice daily;
CHILD
3–12 years, 2.5–5 mg/kg (max.
300 mg) twice daily
Gastric acid reduction (prophylaxis of acid aspiration)
in obstetrics,
ADULT
and
CHILD
over 12 years, by mouth,
150 mg at onset of labour, then every 6 hours; surgical
procedures,
by intramuscular
or
slow intravenous
injection,
50 mg 45–60 minutes before induction of
anaesthesia (intravenous injection diluted to 20 mL
and given over at least 2 minutes),
or
by mouth,
150 mg 2 hours before induction of anaesthesia and
also when possible on the preceding evening
. By intramuscular injection,
50 mg every 6–8 hours
. By slow intravenous injection,
ADULT
and
CHILD
over
12 years, 50 mg diluted to 20 mL and given over at
least 2 minutes;
may be repeated every 6–8 hours
. Prophylaxis of stress ulceration [unlicensed dose],
ADULT
and
CHILD
over 12 years,
by slow intravenous
injection over at least 2 minutes,
50 mg diluted to
20 mL every 8 hours (may be changed to 150 mg
twice daily by mouth when oral feeding commences)
Ranitidine
(Non-proprietary) A
Tablets
,
ranitidine (as hydrochloride) 150 mg,
net
price 60-tab pack = £1.97;
300 mg,
30-tab pack =
£2.17
Brands include
Ranitic
c
Effervescent tablets
,
ranitidine (as hydrochloride)
150 mg,
net price 60-tab pack = £18.04;
300 mg,
30-
tab pack = £17.03.
Label:
13
Excipients
may include sodium (check with supplier)
Oral solution
,
ranitidine (as hydrochloride) 75 mg/
5 mL,
net price 100 mL = £7.44,
300 mL = £19.61
Excipients
may include alcohol (check with supplier)
Note
Ranitidine can be sold to the public for
adults
and
children over 16 years (provided packs do not contain more
than 2 weeks’ supply) for the short-term symptomatic relief of
heartburn, dyspepsia, and hyperacidity, and for the prevention
of these symptoms when associated with consumption of food
or drink (max.
single dose 75 mg, max.
daily dose 300 mg)
Injection
,
ranitidine (as hydrochloride) 25 mg/mL,
net price 2-mL amp = 54p
Zantac
c
(GSK) A
Tablets
, f/c, ranitidine (as hydrochloride) 150 mg, net
price 60-tab pack = £1.30;
300 mg,
30-tab pack =
£1.30
Syrup
,
sugar-free,
ranitidine (as hydrochloride)
75 mg/5 mL,
net price 300 mL = £20.76
Excipients
include alcohol 8%
Injection
,
ranitidine (as hydrochloride) 25 mg/mL,
net price 2-mL amp = 57p
1.3.2
Selective antimuscarinics
Pirenzepine is a selective antimuscarinic drug which
was used for
the treatment
of
gastric and duodenal
ulcers. It has been discontinued.
1.3.3
Chelates and complexes
Tripotassium dicitratobismuthate is a bismuth chelate
effective in healing gastric and duodenal ulcers. For the
role of
tripotassium dicitratobismuthate in a
Helico-
bacter pylori
eradication regimen for those who have
not responded to first-line regimens,
see section 1.3.
The bismuth content of
tripotassium dicitratobismuth-
ate is low but absorption has been reported; encephalo-
pathy (described with older high-dose bismuth prepara-
tions) has not been reported.
Sucralfate may act by protecting the mucosa from acid-
pepsin attack in gastric and duodenal
ulcers.
It
is a
complex of aluminium hydroxide and sulphated sucrose
but has minimal
antacid properties.
It should be used
with caution in patients under intensive care (impor-
tant: reports of bezoar formation, see Bezoar Formation
below)
TRIPOTASSIUM
DICITRATOBISMUTHATE
Indications
benign gastric and duodenal ulceration;
see also
Helicobacter pylori
infection,
section 1.3
Cautions
see notes above; interactions: Appendix 1
(tripotassium dicitratobismuthate)
Renal impairment
avoid in severe impairment
Pregnancy
manufacturer advises avoid on theoretical
grounds
Breast-feeding
no information available
Side-effects
may darken tongue and blacken faeces;
less commonly
nausea,
vomiting,
diarrhoea,
consti-
pation,
rash,
and pruritus reported
BNF 61
1.3.2 Selective antimuscarinics
53
1
Gastro-intestinal system