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raNITIdine

Brand name: Zantac
Drug class: Histamine H2-Antagonists
- Antiulcer Agents
- Gastric Antisecretory Agents
VA class: GA301
Chemical name: N-[2-[[[-5-[(Dimethylamino)methyl]-2-furanyl]methyl]thio]ethyl]-N′-methyl-2-nitro-1,1-ethenediamine hydrochloride
CAS number: 66357-59-3

Warning

Special Alerts:

[Posted 04/01/2020]

ISSUE: The FDA announced it is requesting manufacturers to withdraw all prescription and over-the-counter (OTC) ranitidine drugs from the market immediately.

This is the latest step in an ongoing investigation of a contaminant known as N-Nitrosodimethylamine (NDMA) in ranitidine medications (commonly known by the brand name Zantac). NDMA is a probable human carcinogen (a substance that could cause cancer). FDA has determined that the impurity in some ranitidine products increases over time and when stored at higher than room temperatures may result in consumer exposure to unacceptable levels of this impurity. As a result of this immediate market withdrawal request, ranitidine products will not be available for new or existing prescriptions or OTC use in the U.S.

BACKGROUND: Ranitidine is a histamine-2 blocker, which decreases the amount of acid created by the stomach. Prescription ranitidine is approved for multiple indications, including treatment and prevention of ulcers of the stomach and intestines and treatment of gastroesophageal reflux disease.

RECOMMENDATION:

  • Consumers: The FDA is also advising consumers taking OTC ranitidine to stop taking any tablets or liquid they currently have, dispose of them properly and not buy more; for those who wish to continue treating their condition, they should consider using other approved OTC products.

  • Patients: Patients taking prescription ranitidine should speak with their health care professional about other treatment options before stopping the medicine, as there are multiple drugs approved for the same or similar uses as ranitidine that do not carry the same risks from NDMA. To date, the FDA's testing has not found NDMA in famotidine (Pepcid), cimetidine (Tagamet), esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec).

  • Consumers and Patients: In light of the current COVID-19 pandemic, the FDA recommends patients and consumers not take their medicines to a drug take-back location but follow the FDA's recommended steps, available at: [Web], which include ways to safely dispose of these medications at home.

For more information visit the FDA website at: [Web] and [Web].

Introduction

Histamine H2 receptor antagonist.1

Uses for raNITIdine

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Duodenal Ulcer

Short-term treatment of active duodenal ulcer (endoscopically or radiographically confirmed).1 2

Maintenance of healing and reduction in recurrence of duodenal ulcer.1 4 120 121 136 178

Pathologic GI Hypersecretory Conditions

Long-term treatment of Zollinger-Ellison syndrome, systemic mastocytosis, postoperative hypersecretion, “short-gut” syndrome.1 48 49 100 117

Gastric Ulcer

Short-term treatment of active benign gastric ulcer.1 4 44 45 80 84 119 140

Maintenance of healing and reduction in recurrence of gastric ulcer.1

Gastroesophageal Reflux (GERD)

Treatment of GERD to achieve acid suppression, control symptoms, and prevent complications.1 4 6 86 124 126 128 132 134 135 136 137 138 179 280

Treatment of erosive esophagitis (endoscopically diagnosed) in patients with GERD.1

Maintain healing and decrease recurrence of erosive esophagitis.1

Self-medication as initial therapy for less severe symptomatic GERD†.280

Short-term self-medication for treatment of heartburn (pyrosis) symptoms associated with acid indigestion and sour stomach in adults and adolescents ≥12 years of age.287

Short-term self-medication for prevention of heartburn symptoms associated with acid indigestion and sour stomach brought on by ingestion of certain foods and beverages in adults and children ≥12 years of age.287

Increasing Gastric pH in Neonates Undergoing Extracorporeal Membrane Oxygenation (ECMO)

May be useful for increasing gastric pH in neonates (<1 month of age) at risk for GI hemorrhage during ECMO†.b c

raNITIdine Dosage and Administration

Administration

Administered orally.1 118

Administered by IM or slow IV injection, or by intermittent or continuous IV infusion in hospitalized patients with pathologic GI hypersecretory conditions or intractable duodenal ulcer, or when oral therapy is not feasible.117 172

Administered by slow IV injection or intermittent IV infusion in children 1 month to 16 years of age for the treatment of duodenal ulcer.117 172 286

Administered by slow IV injection or intermittent or continuous IV infusion to decrease gastric pH in neonates <1 month of age receiving ECMO.117 172 286

Oral Administration

Administer antacids concomitantly as necessary for relief of pain.1

Dissolve each dose to be administered as 150-mg effervescent tablets in 180–240 mL (6–8 ounces) of water as directed prior to ingestion.1 Effervescent tablets should not be chewed, swallowed whole, or dissolved on the tongue.1

Dissolve each 25-mg effervescent tablet in ≥5 mL of water prior to administration.1 Allow tablet to completely dissolve before administering to the infant or child.1 May use a calibrated dropper or oral syringe to administer resultant solution in infants.1

Administer tablets for self-medication with a glass of water.287 288

IM Injection

May be administered undiluted.117

Intermittent Direct IV Injection

For solution and drug compatibility, see Compatibility under Stability.

Dilution

Dilute 50-mg dose to a concentration no greater than 2.5 mg/mL (i.e., total of 20 mL) with 0.9% sodium chloride injection or other compatible IV solution before direct IV injection.117 172

Rate of Administration

Inject the 20-mL diluted solution (containing 50 mg/20 mL) at rate ≤4 mL/minute (i.e., over at least 5 minutes).117 172

Intermittent IV Infusion

For solution and drug compatibility, see Compatibility under Stability.

Dilution

Dilute 50-mg dose to a concentration ≤0.5 mg/mL (i.e., 100 mL total) in 5% dextrose injection or other compatible IV solution.117 172

No additional dilution required for commercially available infusion solution (50 mg ranitidine in 50 mL of 0.45% sodium chloride).117

Rate of Administration

Infuse 50 mg/100 mL dilution at ≤5–7 mL/minute (i.e., over 15–20 minutes).117 172

Infuse commercially available infusion solution (50 mg in 50 mL of 0.45% sodium chloride) over 15–20 minutes.117

Continuous IV Infusion

For solution and drug compatibility, see Compatibility under Stability.

Dilution

Dilute 150 mg in 250 mL of 5% dextrose injection or other compatible IV solution.91 117 172

Dilute to concentration ≤2.5 mg/mL in 5% dextrose injection or other compatible IV solution for Zollinger-Ellison syndrome or other pathologic GI hypersecretory conditions.91 117 172

Rate of Administration

Infuse 150 mg/250 mL dilution at 6.25 mg/hour over 24 hours.91 117 172

Infuse dilution for Zollinger-Ellison syndrome or other pathologic GI hypersecretory conditions at initial rate of 1 mg/kg per hour; adjust subsequent rate to individual requirements.91 117 172

Dosage

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Available as ranitidine hydrochloride; dosage expressed in terms of ranitidine.1 117 172

Pediatric Patients

Duodenal Ulcer
Treatment of Active Duodenal Ulcer
Oral

Children 1 month to 16 years of age: 2–4 mg/kg twice daily.1

Maximum 300 mg daily.1

IV

Children 1 month to 16 years of age: 2–4 mg/kg daily given as divided doses every 6–8 hours.117 172

Maximum 50 mg every 6–8 hours.117 172

Maintenance of Healing of Duodenal Ulcer
Oral

Children 1 month to 16 years of age: 2–4 mg/kg once daily.1

Maximum 150 mg daily.1

Gastric Ulcer
Treatment
Oral

Children 1 month to 16 years of age: 2–4 mg/kg twice daily.1

Maximum 300 mg daily.1

Maintenance of Healing of Gastric Ulcer
Oral

Children 1 month to 16 years of age: 2–4 mg/kg once daily.1

Maximum 150 mg daily.1

Gastroesophageal Reflux
Treatment of GERD
Oral

Children 1 month to 16 years of age: 5–10 mg/kg daily, usually administered as 2 equally divided doses.1

Treatment of Erosive Esophagitis
Oral

Children 1 month to 16 years of age: 5–10 mg/kg daily, usually administered as 2 equally divided doses.1

Self-medication for Heartburn
Oral

Children ≥12 years of age: 75 or 150 mg once or twice daily.287 288

Maximum 150 mg (as 75-mg tablets) or 300 mg (as 150-mg tablets) in 24 hours; maximum 2 weeks of continuous use as self-medication.287 288

Self-medication for Prevention of Heartburn
Oral

Children ≥12 years of age: 75 or 150 mg once or twice daily; administer 30–60 minutes before ingestion of causative food or beverage.287 288

Maximum 150 mg (as 75-mg tablets) or 300 mg (as 150-mg tablets) in 24 hours; maximum 2 weeks of continuous use as self-medication.287 288

Increase Gastric pH in Neonates Undergoing ECMO
IV

Neonates (<1 month of age) at risk for GI hemorrhage: Consider 2 mg/kg every 12–24 hours (or as continuous infusion).117 172

A dose of 2 mg/kg usually is sufficient to increase gastric pH to >4 for at least 15 hours.117 172

Adults

General Parenteral Dosage
Hospitalized Patients with Pathologic Hypersecretory Conditions or Intractable Duodenal Ulcer, or Short-term Use When Oral Therapy is not Feasible
IM

50 mg every 6–8 hours.117 172

Increase dosage when necessary by administering 50 mg more frequently.117 172

Maximum 400 mg daily.117 172

Intermittent Direct IV Injection

50 mg every 6–8 hours.117 172

Increase dosage when necessary by administering 50 mg more frequently.117 172

Maximum 400 mg daily.117 172

Intermittent IV Infusion

50 mg every 6–8 hours.117 172

Increase dosage when necessary by administering 50 mg more frequently.117 172

Maximum 400 mg daily.117 172

Continuous IV Infusion

150 mg/24 hours (6.25 mg/hour).117 172 See Pathologic GI Hypersecretory Conditions under Dosage.

Duodenal Ulcer
Treatment of Active Duodenal Ulcer
Oral

Usual dosage: 150 mg twice daily.1 118

Alternative: 300 mg daily after evening meal or at bedtime for optimum convenience and compliance.1 123 125 139 140

100 mg twice daily reported to be as effective in healing ulcers as 150 mg twice daily.1

Healing usually within 4 weeks; may occur in 2 weeks.124

Additional 4 weeks of therapy may be beneficial.1 91 124

Maintenance of Healing of Duodenal Ulcer
Oral

150 mg daily at bedtime.1 136 178

Gastric Ulcer
Oral

150 mg twice daily.1 118

Healing usually within 6 weeks.1

Maintenance of Gastric Ulcer Healing
Oral

150 mg daily at bedtime.1

Gastroesophageal Reflux
Treatment of GERD
Oral

150 mg twice daily.1 136 179

Treatment of Erosive Esophagitis
Oral

150 mg 4 times daily.1

Maintenance of Healing of Erosive Esophagitis
Oral

150 mg twice daily.1

Self-medication for Heartburn
Oral

75 mg or 150 mg once or twice daily.287 288

Maximum 150 mg (as 75-mg tablets) or 300 mg (as 150-mg tablets) in 24 hours; maximum 2 weeks of continuous use as self-medication.287 288

Self-medication for Prevention of Heartburn
Oral

75 or 150 mg once or twice daily; administer 30–60 minutes before ingestion of causative food or beverage.287 288

Maximum 150 mg (as 75-mg tablets) or 300 mg (as 150-mg tablets) in 24 hours; maximum 2 weeks of continuous use as self-medication.287 288

Pathologic GI Hypersecretory Conditions
Oral

150 mg twice daily; may administer more frequently, if needed.1 100

Adjust dosage according to patient response.1 100

Dosages up to 6 g daily have been used for severe disease.1 100

Continue as long as necessary.1 98 100

Continuous IV Infusion

Initiate at 1 mg/kg per hour.91 117 172

Titrate upward in 0.5 mg/kg per hour increments and redetermine gastric acid secretion if symptoms occur or gastric acid output is >10 mEq per hour after 4 hours.117 172

Dosages up to 2.5 mg/kg per hour and infusion rates up to 220 mg/hour have been used.117 172

Prescribing Limits

Pediatric Patients

Gastroesophageal Reflux
Self-medication for Heartburn
Oral

Adolescents ≥12 years of age: Maximum 150 mg (as 75-mg tablets) or 300 mg (as 150-mg tablets) in 24 hours; maximum 2 weeks of continuous use as self-medication.287 288

Self-medication for Prevention of Heartburn
Oral

Adolescents ≥12 years of age: Maximum 150 mg (as 75-mg tablets) or 300 mg (as 150-mg tablets) in 24 hours; maximum 2 weeks of continuous use as self-medication.287 288

Duodenal Ulcer
Treatment of Active Duodenal Ulcer
Oral

Children 1 month to 16 years of age: Maximum 300 mg daily.1

IV

Children 1 month to 16 years of age: Maximum 50 mg every 6–8 hours.117 172

Maintenance of Healing of Duodenal Ulcer:
Oral

Children 1 month to 16 years of age: Maximum 150 mg daily.1

Gastric Ulcer
Treatment of Gastric Ulcer
Oral

Children 1 month to 16 years of age: Maximum 300 mg daily.1

Maintenance of Healing of Gastric Ulcer
Oral

Children 1 month to 16 years of age: Maximum 150 mg daily.1

Adults

General Parenteral Dosage
Hospitalized Patients with Pathologic Hypersecretory Conditions or Intractable Duodenal Ulcer, or Short-term Use When Oral Therapy is not Feasible
IM

Maximum 400 mg daily.117 172

Maximum 50 mg per dose.117 172

Intermittent Direct IV

Maximum 400 mg daily.117 172

Maximum 50 mg per dose.117 172

Maximum concentration 2.5 mg/mL (50 mg/20 mL).117 172

Maximum injection rate: 4 mL/minute (i.e., over 5 minutes).117 172

Intermittent IV Infusion

Maximum 400 mg daily.117 172

Maximum 50 mg per dose.117 172

Maximum concentration 0.5 mg/mL (50 mg/100 mL).117 172

Maximum infusion rate: 5–7 mL/minute (100 mL over 15–20 minutes).117 172

Commercially available infusion solution (50 mg in 50 mL of 0.45% sodium chloride): over 15–20 minutes.117

Gastroesophageal Reflux
Self-Medication for Heartburn
Oral

Maximum 150 mg (as 75-mg tablets) or 300 mg (as 150-mg tablets) in 24 hours; maximum 2 weeks of continuous use as self-medication.287 288

Self-medication for Prevention of Heartburn
Oral

Maximum 150 mg (as 75-mg tablets) or 300 mg (as 150-mg tablets) in 24 hours; maximum 2 weeks of continuous use as self-medication.287 288

Duodenal Ulcer
Treatment of Active Duodenal Ulcer
Oral

Safety and efficacy for >8 weeks have not been established.1

Gastric Ulcer
Treatment of Active Benign Gastric Ulcer
Oral

Safety and efficacy for >6 weeks have not been established.1

Pathologic GI Hypersecretory Conditions
Continuous IV Infusion

Zollinger-Ellison Syndrome: Maximum concentration 2.5 mg/mL.91 117 172

Up to 2.5 mg/kg per hour or 220 mg/hour has been used.117 172

Special Populations

Renal Impairment

Clcr <50 mL/minute
Oral

150 mg once every 24 hours.1 If necessary, may cautiously increase dosage frequency to every 12 hours or more frequently.1

IM

50 mg every 18–24 hours.117 172 If necessary, may cautiously increase dosage frequency to every 12 hours or more frequently.117 172

Intermittent Direct IV

50 mg every 18–24 hours.117 172 If necessary, may cautiously increase dosage frequency to every 12 hours or more frequently.117 172

Intermittent IV Infusion

50 mg every 18–24 hours.117 172 If necessary, may cautiously increase dosage frequency to every 12 hours or more frequently.117 172

Continuous IV Infusion

Not evaluated.117 172

Hemodialysis

Decreases blood levels; administer at the end of hemodialysis.1 4 117 124 172

Geriatric Patients

Careful dosage selection recommended because of possible age-related decrease in renal function.a b c (See Geriatric Use under Cautions.)

Detailed Ranitidine dosage information

Cautions for raNITIdine

Contraindications

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Warnings/Precautions

General Precautions

Gastric Malignancy

Response to ranitidine does not preclude presence of gastric malignancy.1

Hepatic Effects

Discontinue immediately in patients with hepatitis.1 117 124 172 Occasional hepatotoxicity, rarely, hepatic failure and death have been reported.1 161 162 163 164 165 166 167 168 169 170 171 b c

Increased serum ALT concentrations have occurred with ≥5 days of histamine H2-receptor antagonist therapy at higher than recommended IV dosages.117 Monitor serum ALT from day 5 to end of therapy when ranitidine is administered IV at dosages ≥400 mg daily for ≥5 days.117

Cardiovascular Effects

Rapid IV administration: associated rarely with bradycardia.117 172 Avoid rapid administration.117 172

Acute Intermittent Porphyria

Ranitidine may precipitate acute porphyric attacks.1 117 172 Avoid use in such patients.1 117 172

Respiratory Effects

Administration of H2-receptor antagonists has been associated with an increased risk for developing certain infections (e.g., community-acquired pneumonia).283 284

Phenylketonuria

Zantac EFFERdose tablets for solution contain aspartame (NutraSweet), which is metabolized in the GI tract to provide 2.81 or 16.84 mg of phenylalanine per 25- or 150-mg tablet, respectively.1

Specific Populations

Pregnancy

Category B.1 117 172

Self-medication in pregnant women: Consult clinician before using.287 288

Lactation

Distributed into milk; use with caution.1 124

Self-medication in nursing women: Consult clinician before using.287 288

Pediatric Use

Oral: Safety and efficacy for erosive esophagitis healing maintenance or pathologic hypersecretory condition treatment not established in pediatric patients.1

Oral: Safety and efficacy not established in neonates (< 1 month of age).1

Oral: Safety and efficacy established in infants, children, and adolescents 1 month to 16 years of age for duodenal and gastric ulcer treatment and healing maintenance, GERD treatment, and erosive esophagitis treatment.1

Parenteral: Safety and efficacy not established in pediatric patients for treatment of pathologic hypersecretory conditions.117 172

Parenteral: Safety and efficacy established in infants, children, and adolescents 1 month to 16 years of age for duodenal ulcer treatment.117 172

Parenteral (IV) use in neonates (< 1 month of age) receiving extracorporeal membrane oxygenation (ECMO): Limited data in neonates suggest that ranitidine may be safe and useful to increase gastric pH in infants at risk of GI hemorrhage.117 172

Geriatric Use

No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.1 117 172

Use with caution due to greater frequency of decreased renal function observed in the elderly.1 117 172

Select dosage with caution; monitoring renal function may be useful.1 117 172

Hepatic Impairment

Use with caution.1 (See Hepatic Effects under Cautions.)

Renal Impairment

Use with caution; dosage adjustment necessary based on degree of renal impairment.1 (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Oral or parenteral therapy: Headache, sometimes severe.1 2 4 5 81 88 97 117 124 147 172

IM therapy: Transient pain at injection site.117 172

IV therapy: Transient local burning or itching.117 172

Interactions for raNITIdine

Binds weakly to hepatic CYP isoenzyme system in vitro.1 117 172

Affinity for CYP isoenzyme system is about 10% that of cimetidine; inhibition of CYP isoenzyme system is 2.4 times less than cimetidine.54 101

Does not inhibit CYP isoenzymes at recommended dosages.1 117 172

May minimally inhibit hepatic metabolism of some drugs,1 2 4 5 74 101 105 112 or affect bioavailability by another mechanism (e.g., pH-dependent absorption, altered volume of distribution).1 117 172

Specific Drugs, Foods, and Laboratory Tests

Drug, Food, or Test

Interaction

Comments

Acetaminophen

Dose-dependent inhibition of acetaminophen metabolism in vitro96 108

Alcohol

Moderate alcohol consumption by individuals receiving concurrent ranitidine unlikely to result in clinically important alterations of blood alcohol concentration and/or alcohol metabolism77 238 239 240 241 244 247

Controversy about psychomotor impairment potential;238 239 240 241 242 243 248 observe usual precautions about alcohol intake and hazardous tasks requiring mental alertness or physical coordination239 240 243

Antacids

Low doses (10–15 mEq HCl neutralizing capacity/10 mL) do not appear to decrease absorption or plasma concentrations of ranitidine1 2 4 5 6 38 76 Higher doses (e.g., 150 mEq HCl neutralizing capacity/30 mL) decrease absorption by 33%, decrease plasma concentrations, and AUC76

Atenolol

Atenolol pharmacokinetics apparently not affected72

Benzodiazepines (e.g., diazepam, lorazepam, midazolam, triazolam)

Diazepam AUC, mean half-life not substantially affected2

Lorazepam elimination half-life, volume of distribution, clearance unaffected106

Midazolam oral bioavailability may be increased by ranitidinef

Triazolam oral bioavailability may be increased by elevated gastric pH 1 117 124 172 clinical importance unknown1 b c

Observe carefully for signs of midazolam-induced respiratory and CNS depression; decrease midazolam dosage if requiredf

Food

Does not appear to decrease absorption or plasma concentrations of ranitidine1 2 4 5 6 38 76

Metoprolol

Increased metoprolol AUC, peak serum concentration, elimination half-life72 73

Multistix, test for urine protein

False positive1

Use sulfosalicylic acid reagent for urinary protein determinations while using ranitidine1

Nifedipine

Nifedipine AUC increased by 30%72

Phenytoin

Phenytoin serum concentrations unaffected107

Propantheline

Appears to delay absorption and increases peak serum concentrations of ranitidine; biovailability increased about 23% with concomitant administration2

Propranolol

Propranolol mean serum concentrations not substantially affected2 101

Smoking

Adversely affects duodenal ulcer healing and decreases ranitidine efficacy;67 87 number of cigarettes/day apparently does not influence healing rate67

Theophylline

Ranitidine apparently does not alter theophylline clearance71 105

Vitamin B12

Vitamin B12 malabsorption and deficiency may occur with long-term ranitidine therapy16

Warfarin

Increased or decreased PT reported1 91 117 122 172

Pharmacokinetic studies: up to 400 mg daily had no effect on warfarin clearance or PT1 91 117 122 172
Ranitidine drug interactions (more detail)

raNITIdine Pharmacokinetics

Absorption

Bioavailability

Rapidly absorbed after oral2 5 6 37 40 or IM117 administration.

Oral bioavailability: About 50%;1 2 4 5 6 39 42 88 139 similar in children 3.5–16 years of age.160

Oral: Peak plasma concentration attained within 2–3 hours in adults and geriatric patients and within 1.6–2 hours in children 1 month to 16 years of age.1

IM: about 90–100% absorption.117

Commercially available oral solution, effervescent tablets, and conventional tablets are bioequivalent.1

Duration

Following oral administration of a single 150-mg dose, substantial inhibition of gastric acid secretion reportedly continues for about 9.5 hours.5

In pediatric patients, oral administration of 6–10 mg/kg daily (in 2 or 3 divided doses), maintained gastric pH throughout the dosing interval.1

Following a single 150-mg oral dose, serum concentrations required to inhibit 50% of stimulated gastric acid secretion are maintained for up to 12 hours.1 4

IM or IV: Following a 50-mg dose, serum concentrations required to inhibit 50% of stimulated gastric acid secretion are maintained for 6–8 hours.117

Food

Food does not appear to substantially affect absorption or peak plasma concentrations.1 2 4 5 6 38

Special Populations

Oral: In geriatric individuals, AUC may be substantially increased.159

In individuals with cirrhosis, oral bioavailability appears to increase to about 70% and peak serum ranitidine concentrations appear to be higher because of reduced first-pass metabolism;2 6 42 considered minor, clinically unimportant.1

Distribution

Extent

Widely distributed throughout body.1 2 4 39 88 103 249

Distributed into CSF following oral administration;4 5 33 158 CSF concentrations in individuals with uninflamed meninges are about 3–5% of concurrent peak serum concentrations.4 5 33 158

Distributed into human milk;1 milk concentrations appear to be 25–100% of concurrent serum concentrations.4

Plasma Protein Binding

10–19%.1 2 4 39 88 103 249

Special Populations

In individuals with cirrhosis, minor but clinically unimportant alterations in distribution occur following oral administration.1

Elimination

Metabolism

Extensive first-pass metabolism after oral administration.1 2 4 5 6 39 42 88 103

Metabolized in the liver to ranitidine N-oxide, desmethyl ranitidine, and ranitidine S-oxide.1 2 3

Elimination Route

Excreted principally in urine.1 3 37 88

Following oral administration, excretion of unchanged ranitidine in urine is dose-dependent; about 16–36% (unchanged) is excreted in urine within 24 hours.1 3 37 43

Following oral administration, about 4% as ranitidine N-oxide, 1–2% as desmethyl ranitidine, and 1% as ranitidine S-oxide is excreted in urine within 24 hours.1 3 4 5 249

Most of the urinary excretion occurs within the first 6 hours after administration.4

The remainder of an orally administered dose is eliminated in feces.1 3

Following IV administration, approximately 70% is excreted in urine as unchanged drug.117

Half-life

Adults: Averages 1.7–3.2 hours1 2 4 5 6 37 39 40 41 88 103 104 159 and may be positively correlated with age.159

Children 3.5–16 years of age: Averages 1.8–2 hours (range: 1.4–2.9 hours).117 160 172

Neonates (<1 month of age): Averages 6.6 hours.117 172

Special Populations

In patients with renal impairment, plasma clearance appears to be decreased94 and elimination half-life prolonged.2 94

In patients with cirrhosis, minor but clinically unimportant alterations in half-life and reduced clearance occur following oral administration.1 42

In geriatric individuals, clearance appears to be reduced and half-life prolonged because of decreased renal function; although half-life reported to be 3–4 hours following oral or parenteral administration in geriatric patients, 1 117 172 in one clinical study it was about 6 hours following an oral 100-mg dose.42

Stability

Storage

Oral

Tablets and Tablets for Self-medication

Tablets: 15–30°C in tight, light resistant container.1 Replace cap securely after opening.1

Tablets for self-administration: 20–25°C.287 288

Tablets, Effervescent for Solution (foil-packaged)

2–30°C.1 157

Solution

4–30°C in tight, light resistant container.1 124 157

Parenteral

Injection

4–25°C; may be exposed to temperatures up to 30°C.172

Protect from light.117 157 172

Protect from freezing.117 157

Darkening of undiluted injection does not affect potency.117 172

Dilutions in most IV solutions: stable for up to 48 hours at room temperature.117 157 172

Injection for IV infusion only

2–25°C.117 157 Brief exposure to temperatures up to 40°C does not affect stability.117

Protect from light.117 157

Protect from freezing.117 157

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in sodium chloride 0.45%

Dextrose 5 or 10% in water

Fat emulsion 10%, IV

Ringer's injection, lactated

Sodium chloride 0.9%

Variable

Dextrose 5% in Ringer’s injection, lactated. (stable for 48 hours)117
Drug Compatibility
Admixture CompatibilityHID

Compatible

Acetazolamide sodium

Amikacin sulfate

Aminophylline

Chloramphenicol sodium succinate

Chlorothiazide sodium

Ciprofloxacin

Colistimethate sodium

Dexamethasone sodium phosphate

Digoxin

Dobutamine HCl

Dopamine HCl

Doxycycline hyclate

Epinephrine HCl

Erythromycin lactobionate

Fluconazole with ondansetron HCl

Flumazenil

Furosemide

Gentamicin sulfate

Heparin sodium

Isoproterenol HCl

Lidocaine HCl

Lincomycin HCl

Meropenem

Methylprednisolone sodium succinate

Midazolam HCl

Penicillin G potassium

Penicillin G sodium

Polymyxin B sulfate

Potassium chloride

Protamine sulfate

Quinidine gluconate

Sodium nitroprusside

Tobramycin sulfate

Vancomycin HCl

Zidovudine

Incompatible

Amphotericin B

Atracurium besylate

Cefoxitin sodium

Ceftazidime

Ethacrynate sodium

Insulin, regular

Phytonadione

Variable

Ampicillin sodium

Cefazolin sodium

Cefuroxime sodium

Clindamycin phosphate

Norepinephrine bitartrate
Y-Site CompatibilityHID

Compatible

Acyclovir sodium

Aldesleukin

Allopurinol sodium

Amifostine

Aminophylline

Anidulafungin

Atracurium besylate

Aztreonam

Bivalirudin

Cefazolin sodium

Cefoxitin sodium

Ceftaroline fosamil

Ceftazidime

Ciprofloxacin

Cisatracurium besylate

Cladribine

Clarithromycin

Dexmedetomidine HCl

Diltiazem HCl

Dobutamine HCl

Docetaxel

Dopamine HCl

Doripenem

Doxapram HCl

Doxorubicin HCl liposome injection

Enalaprilat

Epinephrine HCl

Esmolol HCl

Etoposide phosphate

Fenoldopam mesylate

Fentanyl citrate

Filgrastim

Fluconazole

Fludarabine phosphate

Foscarnet sodium

Furosemide

Gallium nitrate

Gemcitabine HCl

Granisetron HCl

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hydromorphone HCl

Idarubicin HCl

Labetalol HCl

Linezolid

Lorazepam

Melphalan HCl

Meperidine HCl

Midazolam HCl

Milrinone lactate

Morphine sulfate

Nicardipine HCl

Nitroglycerin

Norepinephrine bitartrate

Ondansetron HCl

Ondansetron HCl with paclitaxel

Oxaliplatin

Paclitaxel

Pancuronium bromide

Pemetrexed disodium

Piperacillin sodium–tazobactam sodium

Procainamide HCl

Propofol

Remifentanil HCl

Sargramostim

Tacrolimus

Telavancin HCl

Teniposide

Theophylline

Thiotepa

Tigecycline

Vecuronium bromide

Vinorelbine tartrate

Warfarin sodium

Zidovudine

Incompatible

Amphotericin B cholesteryl sulfate complex

Insulin, regular

Variable

Hetastarch in sodium chloride 0.9%

Actions

Advice to Patients

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

raNITIdine Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules, liquid-filled

150 mg (of ranitidine)*

raNITIdine Hydrochloride Capsules

300 mg (of ranitidine)*

raNITIdine Hydrochloride Capsules

Solution

75 mg (of ranitidine) per 5 mL

Zantac Syrup

GlaxoSmithKline

Tablets, film-coated

75 mg (of ranitidine)*

raNITIdine Hydrochloride Tablets

Zantac 75

Pfizer

150 mg (of ranitidine)*

Zantac

GlaxoSmithKline

Zantac Maximum Strength 150

GlaxoSmithKline

300 mg (of ranitidine)*

Zantac

GlaxoSmithKline

Tablets, for solution

25 mg (of ranitidine)

Zantac EFFERdose

GlaxoSmithKline

150 mg (of ranitidine)

Zantac EFFERdose

GlaxoSmithKline

Parenteral

Injection

25 mg (of ranitidine) per mL*

raNITIdine Injection

Zantac

GlaxoSmithKline

Injection, for preparation of IV admixtures

25 mg (of ranitidine) per mL (1 g) pharmacy bulk package

Zantac

GlaxoSmithKline
raNITIdine Hydrochloride in Sodium Chloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection

1 mg (of ranitidine) per mL (50 mg) in 0.45% Sodium Chloride

Zantac Premixed (in flexible plastic container)

GlaxoSmithKline

AHFS DI Essentials™. © Copyright 2022, Selected Revisions April 2, 2020. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. GlaxoSmithKline. Zantac (ranitidine hydrochloride) tablets, EFFERdose tablets and granules, and syrup prescribing information. Research Triangle Park, NC; 2004 Oct.

2. Glaxo Inc. Product monograph on Zantac. Research Triangle Park, NC; 1983 Apr.

3. Carey PF, Martin LE, Owen PE. Determination of ranitidine and its metabolites in human urine by reversed-phase ion-pair high-performance liquid chromatography. J Chromatogr. 1981; 225:161-8. http://www.ncbi.nlm.nih.gov/pubmed/6271798?dopt=AbstractPlus

4. Brogden RN, Carmine AA, Heel RC et al. Ranitidine: a review of its pharmacology and therapeutic use in peptic ulcer disease and other allied diseases. Drugs. 1982; 24:267-303. http://www.ncbi.nlm.nih.gov/pubmed/6128216?dopt=AbstractPlus

5. Helman CA, Tim LO. Pharmacology and clinical efficacy of ranitidine, a new H2-receptor antagonist. Pharmacotherapy. 1983; 3:185-92. http://www.ncbi.nlm.nih.gov/pubmed/6136952?dopt=AbstractPlus

6. Zeldis JB, Friedman LS, Isselbacher KJ. Ranitidine: a new H2-receptor antagonist. N Engl J Med. 1983; 309:1368-73. http://www.ncbi.nlm.nih.gov/pubmed/6314139?dopt=AbstractPlus

7. McCarthy DM. Ranitidine or cimetidine. Ann Intern Med. 1983; 99:551-3. http://www.ncbi.nlm.nih.gov/pubmed/6312863?dopt=AbstractPlus

8. Mignon M, Vallot T, Mayeur S et al. Ranitidine and cimetidine in Zollinger-Ellison syndrome. Br J Clin Pharmacol. 1980; 10:173-4. http://www.ncbi.nlm.nih.gov/pubmed/6107118?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1430043&blobtype=pdf

9. Lebert PA, MacLeod SM, Mahon WA et al. Ranitidine kinetics and dynamics. I. Oral dose studies. Clin Pharmacol Ther. 1981; 30:539-44. http://www.ncbi.nlm.nih.gov/pubmed/6269788?dopt=AbstractPlus

10. Lebert PA, Mahon WA, MacLeod SM et al. Ranitidine kinetics and dynamics. II. Intravenous dose studies and comparison with cimetidine. Clin Pharmacol Ther. 1981; 30:545-50. http://www.ncbi.nlm.nih.gov/pubmed/6269789?dopt=AbstractPlus

11. Robins AH, McFadyen ML. Effect of the new H2-receptor antagonist ranitidine on plasma prolactin levels in duodenal ulcer patients. J Pharm Pharmacol. 1981; 33:615-6. http://www.ncbi.nlm.nih.gov/pubmed/6117649?dopt=AbstractPlus

12. Weingart J, Kunert H, Ottenjann R. Stimulation of gastric acid secretion by intravenous amino acid infusion and its inhibition by H2-receptor antagonists ranitidine and cimetidine. Br J Clin Pharmacol. 1980; 10:174-5. http://www.ncbi.nlm.nih.gov/pubmed/6107119?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1430049&blobtype=pdf

13. Peden NR, Saunders JH, Wormsley KG. Inhibition of pentagastrin-stimulated and nocturnal gastric secretion by ranitidine: a new H2-receptor antagonist. Lancet. 1979; 1:690-2. http://www.ncbi.nlm.nih.gov/pubmed/85934?dopt=AbstractPlus

14. Sewing KF, Billian A, Malchow H. Comparative study with ranitidine and cimetidine on gastric secretion in normal volunteers. Gut. 1980; 21:750-2. http://www.ncbi.nlm.nih.gov/pubmed/6107265?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1419537&blobtype=pdf

15. Guslandi M, Ballarin E, Tittobello A. Gastric mucus secretion in ranitidine-treated patients. BMJ. 1981; 283:699. http://www.ncbi.nlm.nih.gov/pubmed/6269686?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1506962&blobtype=pdf

16. Yeomans ND, Hanson RG, Smallwood RA et al. Effect of chronic ranitidine treatment on secretion of intrinsic factor. BMJ. 1982; 285:264. http://www.ncbi.nlm.nih.gov/pubmed/6124297?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1499627&blobtype=pdf

17. Lohrmann A, Hotz J, EyBelein V et al. Effects of intraduodenal administration of ranitidine and cimetidine on secretion of gastric acid, pepsin, gastrin and pancreatic polypeptide in man. Gastroenterology. 1980; 78:1210.

18. Konturek SJ, Obtulowicz W, Kwiecien N et al. Comparison of ranitidine and cimetidine in the inhibition of histamine, sham-feeding, and meal-induced gastric secretion in duodenal ulcer patients. Gut. 1980; 21:181-6. http://www.ncbi.nlm.nih.gov/pubmed/6105116?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1420343&blobtype=pdf

19. Hansen WE, Bertl S. Inhibition of cholinesterases by ranitidine. Lancet. 1983; 1:235. http://www.ncbi.nlm.nih.gov/pubmed/6130261?dopt=AbstractPlus

20. Brittain RT, Jack D, Martin LE. Ranitidine and lower oesophageal sphincter pressure. Lancet. 1983; 1:418.

21. Thomas JM, Trotman IF, Misiewicz JJ. Ranitidine and lower oesophageal sphincter pressure. Lancet. 1983; 1:418.

22. Bertaccini G, Molina E, Bobblio P et al. Ranitidine increases lower oesophageal sphincter pressure in man. Ital J Gastroenterol. 1981; 13:149-50.

23. Baldi F, Ferrarini F, Barbara L. Ranitidine, reflux, and oesophageal motility. Lancet. 1983; 1:705-6. http://www.ncbi.nlm.nih.gov/pubmed/6132060?dopt=AbstractPlus

24. Feeley J, Guy E. Ranitidine also reduces liver blood flow. Lancet. 1982; 1:169. http://www.ncbi.nlm.nih.gov/pubmed/6119544?dopt=AbstractPlus

25. Nelis GF, Van De Meene JG. Comparative effect of cimetidine and ranitidine on prolactin secretion. Postgrad Med J. 1980; 56:478-80. http://www.ncbi.nlm.nih.gov/pubmed/6108555?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2425805&blobtype=pdf

26. Wang C, Wong KL, Lam KC et al. Ranitidine does not affect gonadal function in man. Br J Clin Pharmacol. 1983; 16:430-2. http://www.ncbi.nlm.nih.gov/pubmed/6313029?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1428021&blobtype=pdf

27. Delitala G, Devilla L, Pende A et al. Effects of the H2-receptor antagonist ranitidine on anterior pituitary hormone secretion in man. Eur J Clin Pharmacol. 1982; 22:207-11. http://www.ncbi.nlm.nih.gov/pubmed/6125393?dopt=AbstractPlus

28. Pasquali R, Corinaldesi R, Miglioli M et al. Effect of prolonged administration of ranitidine on pituitary and thyroid hormones, and their response to specific hypothalamic-releasing factors. Clin Endocrinol. 1981; 15:457-62.

29. Peden NR, Boyd EJ, Browning MC et al. Effects of two histamine H2-receptor blocking drugs on basal levels of gonadotrophins, prolactin, testosterone and oestradiol-17β during treatment of duodenal ulcer in male patients. Acta Endocrinol. 1981; 96:564-8. http://www.ncbi.nlm.nih.gov/pubmed/6259865?dopt=AbstractPlus

30. Boyd EJ, Peden NR, Browning MC et al. Clinical and endocrine aspects of treatment with ranitidine. Scand J Gastroenterol. 1981; 16(Suppl 69):81-3. http://www.ncbi.nlm.nih.gov/pubmed/6972085?dopt=AbstractPlus

31. Lombardo L. Reversible amenorrhoea after ranitidine treatment. Lancet. 1982; 1:224 (IDIS 145174)

32. Konturek SJ, Obtulowicz W, Kwiecien N et al. Effect of ranitidine, a new H2-antagonist, on gastric and pancreatic secretion in duodenal ulcer patients. Dig Dis Sci. 1980; 25:737-43. http://www.ncbi.nlm.nih.gov/pubmed/6107221?dopt=AbstractPlus

33. Walt RP, LaBrooy SJ, Augerinos A et al. Investigations on the penetration of ranitidine into the cerebrospinal fluid and a comparison of the effects of ranitidine and cimetidine on male sex hormones. Scand J Gastroenterol. 1981; 16(Suppl 69):19-23.

34. Henry DA, MacDonald IA, Kitchingman G et al. Cimetidine and ranitidine: comparison of effects on hepatic drug metabolism. Br Med J. 1980; 281:775-7. http://www.ncbi.nlm.nih.gov/pubmed/6107157?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1714006&blobtype=pdf

35. Jack D, Richard DA. Cimetidine and ranitidine. Lancet. 1982; 1:914.

36. Peden NR, Richards DA, Saunders JH et al. Pharmacologically effective plasma concentrations of ranitidine. Lancet. 1979; 2:199-20. http://www.ncbi.nlm.nih.gov/pubmed/89310?dopt=AbstractPlus

37. Van Hecken AM, Tjandramaga TB, Mullie A et al. Ranitidine: single dose pharmacokinetics and absolute bioavailability in man. Br J Clin Pharmacol. 1982; 195-200. (IDIS 157310)

38. McNeil JJ, Mihaly GW, Anderson A et al. Pharmacokinetics of the H2-receptor antagonist ranitidine in man. Br J Clin Pharmacol. 1981; 12:411-5. http://www.ncbi.nlm.nih.gov/pubmed/6117305?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1401817&blobtype=pdf

39. Garg DC, Weidler DJ, Baltodano N et al. Pharmacokinetics of ranitidine, a new histamine H2-receptor blocker. Clin Pharmacol Ther. 1981; 29:247-8.

40. Woodings EP, Dixon GT, Harrison C et al. Ranitidine–a new H2-receptor antagonist. Gut. 1980; 21:187-91. http://www.ncbi.nlm.nih.gov/pubmed/6105117?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1420359&blobtype=pdf

41. Mignon M, Chau NP, Nguyen-Phuoc BK et al. Ranitidine upon meal-induced gastric secretion: oral pharmacokinetics and plasma concentration effect relationships. Br J Clin Pharmacol. 1982; 14:187-93. http://www.ncbi.nlm.nih.gov/pubmed/6125203?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1427757&blobtype=pdf

42. Young CJ, Daneshmend TK, Roberts CJ. Effects of cirrhosis and aging on the elimination and bioavailability of ranitidine. Gut. 1982; 23:819-23. http://www.ncbi.nlm.nih.gov/pubmed/6126422?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1419822&blobtype=pdf

43. Strum WB. Ranitidine. JAMA. 1983; 250:1894-6. http://www.ncbi.nlm.nih.gov/pubmed/6312110?dopt=AbstractPlus

44. Witzel L, Wolberg SE. Peptic ulcer healing with ranitidine in cimetidine resistance. Lancet. 1982; 2:1224.

45. Feely J, Wormsley KG. H2-receptor antagonists–cimetidine and ranitidine. BMJ. 1983; 286:695-7. http://www.ncbi.nlm.nih.gov/pubmed/6130817?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1547117&blobtype=pdf

46. Walt RP, Trotman IF, Frost R et al. Comparison of twice-daily ranitidine with standard cimetidine treatment of duodenal ulcer. Gut. 1981; 22:319-22. http://www.ncbi.nlm.nih.gov/pubmed/6113192?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1419156&blobtype=pdf

47. Bonfils S, Mignon M, Vallot T et al. Use of ranitidine in the medical treatment of Zollinger-Ellison syndrome. Scand J Gastroenterol. 1981; 16(Suppl 69):119-21.

48. Danilewitz M, Ou Tim L, Hirschowitz B. Ranitidine suppression of gastric hypersecretion resistant to cimetidine. N Engl J Med. 1982; 306:20-2. http://www.ncbi.nlm.nih.gov/pubmed/6118836?dopt=AbstractPlus

49. Dawson J, Cockel R. Ranitidine in acute upper gastrointestinal haemorrhage. Br Med J. 1982; 285:476-7 (IDIS 155030) http://www.ncbi.nlm.nih.gov/pubmed/6286033?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1499289&blobtype=pdf

50. Nowak A, Sadlinski C, Gorka Z et al. Ranitidine in the treatment of acute upper gastrointestinal haemorrhage–a comparative study. Hepatogastroenterology. 1981; 28:267-9. http://www.ncbi.nlm.nih.gov/pubmed/6124495?dopt=AbstractPlus

51. Durrent JM, Strunin L. Comparative trial of the effect of ranitidine and cimetidine on gastric secretion in fasting patients at induction of anaesthesia. Can Anaesth Soc J. 1982; 29:446-50. http://www.ncbi.nlm.nih.gov/pubmed/6127150?dopt=AbstractPlus

52. Andrews AD, Brock-Utne JG, Downing JW. Protection against pulmonary acid aspiration with ranitidine. Anaesthesia. 1982; 37:22-5. http://www.ncbi.nlm.nih.gov/pubmed/6123277?dopt=AbstractPlus

53. Dobrilla G, Felder M, Chilovi F et al. Exacerbation of glaucoma associated with both cimetidine and ranitidine. Lancet. 1982; 1:1078. http://www.ncbi.nlm.nih.gov/pubmed/6122884?dopt=AbstractPlus

54. Rendic S, Alebic-Kolbah T, Kajfez F et al. Interaction of ranitidine with liver microsomes. Xenobiotica. 1982; 12:9-17. http://www.ncbi.nlm.nih.gov/pubmed/6124064?dopt=AbstractPlus

55. Hughes JD, Reed WD, Serjeant CS. Mental confusion associated with ranitidine. Med J Aust. 1983; 2:12-3. http://www.ncbi.nlm.nih.gov/pubmed/6306415?dopt=AbstractPlus

56. Barr GD, Piper DW. Possible ranitidine hepatitis. Med J Aust. 1981; 2:421. http://www.ncbi.nlm.nih.gov/pubmed/6275248?dopt=AbstractPlus

57. Shah RR. Symptomatic bradycardia in association with H2-receptor antagonists. Lancet. 1982; 2:1108. http://www.ncbi.nlm.nih.gov/pubmed/6127573?dopt=AbstractPlus

58. Jack D, Smith RN, Richards DA. Histamine H2 antagonists and the heart. Lancet. 1982; 2:1281. http://www.ncbi.nlm.nih.gov/pubmed/6128580?dopt=AbstractPlus

59. Shah RR. Histamine H2 antagonists and the heart. Lancet. 1982; 2:1281-2. http://www.ncbi.nlm.nih.gov/pubmed/6128580?dopt=AbstractPlus

60. Moebius UM. Ranitidine side-effects. Lancet. 1982; 2:1053-4. http://www.ncbi.nlm.nih.gov/pubmed/6127539?dopt=AbstractPlus

61. Tosi S, Cagnoli M. Painful gynaecomastia with ranitidine. Lancet. 1982; 2:160. http://www.ncbi.nlm.nih.gov/pubmed/6123872?dopt=AbstractPlus

62. Camarri E, Chirone E, Fanteria G et al. Ranitidine induced bradycardia. Lancet. 1982; 2:160. http://www.ncbi.nlm.nih.gov/pubmed/6123873?dopt=AbstractPlus

63. Jack D, Richards DA, Granata F. Side-effects of ranitidine. Lancet. 1982; 2:264-5. http://www.ncbi.nlm.nih.gov/pubmed/6124684?dopt=AbstractPlus

64. Jackson G, Upward JW. Cimetidine, ranitidine, and heart rate. Lancet. 1982; 2:265.

65. Liedberg G, Fletcher E, Davies J. Cimetidine, ranitidine, and heart rate. Lancet. 1982; 2:265.

66. Viana L. Probable case of impotence due to ranitidine. Lancet. 1983; 2:635-6. http://www.ncbi.nlm.nih.gov/pubmed/6136792?dopt=AbstractPlus

67. Korman MG, Hansky J, Merrett AC et al. Ranitidine in duodenal ulcer: incidence of healing and effect of smoking. Dig Dis Sci. 1982; 27:712-5. http://www.ncbi.nlm.nih.gov/pubmed/6284459?dopt=AbstractPlus

68. Elwood RJ, Hildebrand J, Dundee JW et al. Ranitidine influences the uptake of oral midazolam. Br J Clin Pharmacol. 1983; 15:743-5. http://www.ncbi.nlm.nih.gov/pubmed/6135440?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1427927&blobtype=pdf

69. Mashford ML, Harman PJ, Morphett BJ et al. Ranitidine does not affect chlormethiazole or indocyanine green disposition. Clin Pharmacol Ther. 1983; 34:231-3. http://www.ncbi.nlm.nih.gov/pubmed/6307580?dopt=AbstractPlus

70. Serlin MJ, Sibeon RG, Breckenridge AM. Lack of effect of ranitidine on warfarin action. Br J Clin Pharmacol. 1981; 12:791-4. http://www.ncbi.nlm.nih.gov/pubmed/6122462?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1401939&blobtype=pdf

71. Breen KJ, Bury R, Desmond PV et al. Effects of cimetidine and ranitidine on hepatic drug metabolism. Clin Pharmacol Ther. 1982; 31:297-300. http://www.ncbi.nlm.nih.gov/pubmed/6120774?dopt=AbstractPlus

72. Spahn H, Mutschler E, Kirch W et al. Influence of ranitidine on plasma metoprolol and atenolol concentrations. BMJ. 1983; 286:1546-7. http://www.ncbi.nlm.nih.gov/pubmed/6133576?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1547957&blobtype=pdf

73. Spahn H, Mutschler E, Kirch W et al. Influence of ranitidine on plasma metoprolol concentrations. BMJ. 1983; 287:838. http://www.ncbi.nlm.nih.gov/pubmed/6311317?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1549104&blobtype=pdf

74. Jack D, Mitchard M, Smith RN. Influence of ranitidine on plasma metoprolol concentrations. BMJ. 1983; 286:2064. http://www.ncbi.nlm.nih.gov/pubmed/6135484?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1548525&blobtype=pdf

75. Clark AJ, Bilous RW, Keen H. Ranitidine in insulin-dependent diabetes. Lancet. 1982; 2:883-4. http://www.ncbi.nlm.nih.gov/pubmed/6126747?dopt=AbstractPlus

76. Mihaly GW, Marino AT, Webster LK et al. High dose of antacid (Mylanta II) reduces bioavailability of ranitidine. BMJ. 1982; 285:998-9. http://www.ncbi.nlm.nih.gov/pubmed/6289961?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1500341&blobtype=pdf

77. Seitz HK, Bosche J, Czygan P et al. Increased blood ethanol levels following cimetidine but not ranitidine. Lancet. 1983; 1:760. http://www.ncbi.nlm.nih.gov/pubmed/6132098?dopt=AbstractPlus

78. Glaxo Inc. Product information data form. Research Triangle Park, NC; 1983 Jan.

79. Peden NR, Robertson AJ, Boyd EJ et al. Mitogen stimulation of peripheral blood lymphocytes of duodenal ulcer patients during treatment with cimetidine or ranitidine. Gut. 1982; 23:398-403. http://www.ncbi.nlm.nih.gov/pubmed/6281143?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1419678&blobtype=pdf

80. Colin-Jones DG. Ranitidine in the treatment of peptic ulceration. In: Riley AJ, Salmon PR, eds. Ranitidine: proceedings of an international symposium held in the context of the Seventh World Congress of Gastroenterology. Princeton: Excerpta Medica: 1982:16-29.

81. Simon B, Muller P, Dammann H-G. Safety profile of ranitidine. In: Riley AJ, Salmon PR, eds. Ranitidine: proceedings of an international symposium held in the context of the Seventh World Congress of Gastroenterology. Princeton: Excerpta Medica; 1982:181-9.

82. Lee HR, Gandolfi AJ, Sipes IG et al. Effect of histamine H2-receptors on fentanyl metabolism. Pharmacologist. 1982; 24:145.

83. Konturek SJ, Kwiecien N, Obtulowicz W et al. Cytoprotective effects of ranitidine. In: Misiewicz JJ, Wormsley KG, eds. The clinical use of ranitidine. Medicine Publishing Foundation Symposium Series 5. Oxford: Medicine Publishing Foundation; 1982:123-8.

84. Ryan FP. A comparison of ranitidine and placebo in the acute treatment of gastric ulcer. In: Misiewicz JJ, Wormsley KG, eds. The clinical use of ranitidine. Medicine Publishing Foundation Symposium Series 5. Oxford: Medicine Publishing Foundation; 1982:201-5.

85. Stage JG, Freis J, Nielsen OV. Ranitidine treatment of postoperative recurrent ulcers. In: Misiewicz JJ, Wormsley KG, eds. The clinical use of ranitidine. Medicine Publishing Foundation Symposium Series 5. Oxford: Medicine Publishing Foundation; 1982:275-80.

86. Sherbaniuk R, Wensel R, Trautman A et al. Ranitidine in the short-term management of symptomatic gastro-oesophageal reflux. In: Misiewicz JJ, Wormsley KG, eds. The clinical use of ranitidine. Medicine Publishing Foundation Symposium Series 5. Oxford: Medicine Publishing Foundation; 1982:283-92.

87. Merrett AC, Hansky J, Kormen MG et al. Ranitidine in duodenal ulcer: healing rate and effect of smoking. Aust N Z J Med. 1982; 12:107.

88. Gaginella TS, Bauman JH. Ranitidine hydrochloride. Drug Intell Clin Pharm. 1983; 17:873-85. http://www.ncbi.nlm.nih.gov/pubmed/6317325?dopt=AbstractPlus

89. McGonigle RJ, Williams LC, Amphlett GE et al. The pharmacokinetics of ranitidine in renal disease. In: Misiewicz JJ, Wormsley KG, eds. The clinical use of ranitidine. Medicine Publishing Foundation Symposium Series 5. Oxford: Medicine Publishing Foundation; 1982:41-7.

90. Sedman AJ. Cimetidine-drug interactions. Am J Med. 1984; 76:109-14. http://www.ncbi.nlm.nih.gov/pubmed/6140847?dopt=AbstractPlus

91. Glaxo Inc, Research Triangle Park, NC: Personal communication.

92. Reviewers’ comments (personal observations); 1984 Feb 22.

93. Anon. Drug interactions update. Med Lett Drugs Ther. 1984; 26:11-4. http://www.ncbi.nlm.nih.gov/pubmed/6690901?dopt=AbstractPlus

94. Meffin PJ, Grgurinovich N, Brooks PM et al. Ranitidine disposition in patients with renal impairment. Br J Clin Pharmacol. 1983; 16:731-4. http://www.ncbi.nlm.nih.gov/pubmed/6318787?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1428369&blobtype=pdf

95. Dunk AA, Jenkins WJ, Burroughs AK et al. The effect of ranitidine on the plasma clearance and hepatic extraction of indocyanine green in patients with chronic liver disease. Br J Clin Pharmacol. 1983; 16:117-20. http://www.ncbi.nlm.nih.gov/pubmed/6137230?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1427973&blobtype=pdf

96. Speeg KV, Christian DC, Mitchell MC. Ranitidine and acetaminophen hepatotoxicity. Ann Intern Med. 1984; 100:315. http://www.ncbi.nlm.nih.gov/pubmed/6318636?dopt=AbstractPlus

97. Cohen A, Fabre L. Tolerance to repeated intravenous doses of ranitidine HCl and cimetidine HCl in normal volunteers. Curr Ther Res. 1983; 34:475-82.

98. Jensen RT, Collen MJ, Pandol SJ et al. Cimetidine-induced impotence and breast changes in patients with gastric hypersecretory states. N Engl J Med. 1983; 308:883-7. http://www.ncbi.nlm.nih.gov/pubmed/6835285?dopt=AbstractPlus

99. Scarpignato C, Bertaccini G, Zimbaro G et al. Ranitidine delays gastric emptying of solids in man. Br J Clin Pharmacol. 1982; 13:252-3. http://www.ncbi.nlm.nih.gov/pubmed/6277357?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1401998&blobtype=pdf

100. Collen MJ, Howard JM, McArthur KE et al. Comparison of ranitidine and cimetidine in the treatment of gastric hypersecretion. Ann Intern Med. 1984; 100:52-8. http://www.ncbi.nlm.nih.gov/pubmed/6318628?dopt=AbstractPlus

101. Powell JR, Donn KH. The pharmacokinetic basis for H2-antagonist drug interactions: concepts and implications. J Clin Gastroenterol. 1983; 5(Suppl 1):95-113. http://www.ncbi.nlm.nih.gov/pubmed/6140286?dopt=AbstractPlus

102. Hirschowitz BI. Lessons from the U.S. multicenter trial of ranitidine treatment for duodenal ulcer. J Clin Gastroenterol. 1983; 5(Suppl 1):115-22. http://www.ncbi.nlm.nih.gov/pubmed/6317737?dopt=AbstractPlus

103. Bogues K, Dixon GT, Fowler P et al. Pharmacokinetics and bioavailability of ranitidine in humans. Br J Pharmacol. 1981; 73:275-6P.

104. Chau NP, Zech PY, Pozet N et al. Ranitidine kinetics in normal subjects. Clin Pharmacol Ther. 1982; 31:770-4. http://www.ncbi.nlm.nih.gov/pubmed/6280919?dopt=AbstractPlus

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