Ranitidine
Place in Therapy
Based on an extensive review of the literature, it appears
that over-the-counter (OTC) ranitidine can be used as an effective,
first-line treatment in the management of mild symptoms of gastroesophageal
reflux disease (GERD), along with lifestyle modification1,2.
Ranitidine is a Histamine-2 Receptor Antagonist (H2RA), and works by inhibiting the gastric acid secretions that cause the symptoms of GERD1. Though most of the studies examining ranitidine, as well as H2RAs in general, focus on the use of prescription doses and conclude that proton pump inhibitors are more effective in providing relief of GERD symptoms, there are several pieces of primary, secondary, and tertiary literature that show the efficacy of low OTC doses of ranitidine in treating mild to moderate symptoms1,3. These studies have shown that ranitidine is effective both in the prevention of postprandial GERD symptoms when used as a single 75 mg dose 30 to 60 minutes prior to a provocative meal, and in providing relief of GERD symptoms when used as needed over a period of 2 weeks1,4,5. Additionally, while the symptomatic relief attained with H2RAs such as ranitidine is similar to that of antacids, its duration of action is longer and may last up to 10-12 hours1,3,6. Finally, based on the literature, H2RAs may be slightly more effective than other OTC agents in providing complete relief of symptomatic symptoms of GERD, and all four available H2RAs are considered to be interchangeable based on efficacy1,3.
Ranitidine is considered to be a relatively safe agent that is well tolerated in most population1,6. The most common side effects associated with its use include abdominal pain, constipation, diarrhea, and headache6,7. Ranitidine may however be less preferred than famotidine in the treatment of the elderly population due to its higher anticholinergic activity8.
In summary, ranitidine can be used as an OTC product for the prevention and treatment of mild episodic GERD symptoms in patients who are over the age of 16 and experience less than 3 episodes per week1,7,9. However, if symptoms are severe or persist beyond 2 weeks with no adequate relief, the patient should be assessed by a physician and considered for initiation of prescription therapy1,3,7.
References
1. Tran T, Lowry AM, and El-serag HB. Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies. Aliment Pharmacol Ther 2006; 25:143-153.
2. Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. UpToDate. Sep 22, 2011. Accessed on March 09 2012 from: www.uptodate.com
3. DeVault KR and Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190-200.
4. Galmiche JP et al. On-demand treatment of gastro-oesophageal reflux symptoms: a comparison of ranitidine 75 mg with cimetidine 200 mg or placebo. Aliment Pharmacol Ther 1998; 12:909-917.
5. Ciociola AA, Pappa KA, and Sirgo MA. Nonprescription doses of ranitidine are effective in the relief of episodic heartburn. American Journal of Therapeutics 2001; 8:399-408.
6. Micromedex Healthcare Series. Ranitidine Hydrocholride. Greenwood Village, CO: Thomson Reuters (Healthcare) Inc. 2010. Accessed on March 08 2012 from: www.thomsonhc.com/micromedex2
7. e-CPS. Zantac product monograph. Canadian Pharmacists Association 2012. Accessed on March 08 2012 from: www.e-therapeutics.ca
8. Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008;56:1333-41.
9. Thompson P. Patient Self Care. 2nd ed. Chapter 33: Dyspepsia and GERD. Canadian Pharmacists Association: Canada; 2010.
Ranitidine is a Histamine-2 Receptor Antagonist (H2RA), and works by inhibiting the gastric acid secretions that cause the symptoms of GERD1. Though most of the studies examining ranitidine, as well as H2RAs in general, focus on the use of prescription doses and conclude that proton pump inhibitors are more effective in providing relief of GERD symptoms, there are several pieces of primary, secondary, and tertiary literature that show the efficacy of low OTC doses of ranitidine in treating mild to moderate symptoms1,3. These studies have shown that ranitidine is effective both in the prevention of postprandial GERD symptoms when used as a single 75 mg dose 30 to 60 minutes prior to a provocative meal, and in providing relief of GERD symptoms when used as needed over a period of 2 weeks1,4,5. Additionally, while the symptomatic relief attained with H2RAs such as ranitidine is similar to that of antacids, its duration of action is longer and may last up to 10-12 hours1,3,6. Finally, based on the literature, H2RAs may be slightly more effective than other OTC agents in providing complete relief of symptomatic symptoms of GERD, and all four available H2RAs are considered to be interchangeable based on efficacy1,3.
Ranitidine is considered to be a relatively safe agent that is well tolerated in most population1,6. The most common side effects associated with its use include abdominal pain, constipation, diarrhea, and headache6,7. Ranitidine may however be less preferred than famotidine in the treatment of the elderly population due to its higher anticholinergic activity8.
In summary, ranitidine can be used as an OTC product for the prevention and treatment of mild episodic GERD symptoms in patients who are over the age of 16 and experience less than 3 episodes per week1,7,9. However, if symptoms are severe or persist beyond 2 weeks with no adequate relief, the patient should be assessed by a physician and considered for initiation of prescription therapy1,3,7.
References
1. Tran T, Lowry AM, and El-serag HB. Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies. Aliment Pharmacol Ther 2006; 25:143-153.
2. Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. UpToDate. Sep 22, 2011. Accessed on March 09 2012 from: www.uptodate.com
3. DeVault KR and Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190-200.
4. Galmiche JP et al. On-demand treatment of gastro-oesophageal reflux symptoms: a comparison of ranitidine 75 mg with cimetidine 200 mg or placebo. Aliment Pharmacol Ther 1998; 12:909-917.
5. Ciociola AA, Pappa KA, and Sirgo MA. Nonprescription doses of ranitidine are effective in the relief of episodic heartburn. American Journal of Therapeutics 2001; 8:399-408.
6. Micromedex Healthcare Series. Ranitidine Hydrocholride. Greenwood Village, CO: Thomson Reuters (Healthcare) Inc. 2010. Accessed on March 08 2012 from: www.thomsonhc.com/micromedex2
7. e-CPS. Zantac product monograph. Canadian Pharmacists Association 2012. Accessed on March 08 2012 from: www.e-therapeutics.ca
8. Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008;56:1333-41.
9. Thompson P. Patient Self Care. 2nd ed. Chapter 33: Dyspepsia and GERD. Canadian Pharmacists Association: Canada; 2010.