Version July 2023
Note : As of April 2020, all prescription (including oral and injectable) and OTC ranitidine formulations have been withdrawn from the US market.
Duodenal ulcer:
Oral: Treatment: 150 mg twice daily, or 300 mg once daily after the evening meal or at bedtime; maintenance of healing: 150 mg once daily at bedtime.
IM: 50 mg every 6 to 8 hours.
IV:
Intermittent bolus or infusion: 50 mg every 6 to 8 hours (if increased doses are necessary utilize more frequent administration up to a maximum of 400 mg/day).
Continuous IV infusion: 6.25 mg/hour.
Gastric ulcer, benign: Oral: 150 mg twice daily; maintenance of healing: 150 mg once daily at bedtime.
Gastroesophageal reflux disease: Oral: 150 mg twice daily.
Heartburn prevention or relief (OTC labeling): Oral:
Prevention: 75 to 150 mg 30 to 60 minutes before eating food or drinking beverages that cause heartburn (maximum: 2 doses/day); do not use for more than 14 days.
Relief of symptoms: 75 mg to 150 mg up to twice daily (maximum: 2 doses/day); do not use for more than 14 days.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
CrCl ≥50 mL/minute: No dosage adjustment necessary.
CrCl <50 mL/minute:
Oral: 150 mg every 24 hours; adjust dose cautiously if needed (frequency of dosing may be increased to every 12 hours or further with caution).
IV: 50 mg every 18 to 24 hours; adjust dose cautiously if needed
Hemodialysis: Adjust dosing schedule so that dose is scheduled to coincide with the end of hemodialysis.
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.
(For additional information see "Ranitidine (United States: Withdrawn from market): Pediatric drug information")
Note : As of April 2020, all prescription (including oral and injectable) and OTC ranitidine formulations have been withdrawn from the US market.
Duodenal or gastric ulcer:
Treatment:
Infants, Children, and Adolescents ≤16 years:
Oral: 4 to 8 mg/kg/day divided twice daily; maximum daily dose: 300 mg/day.
IV: 2 to 4 mg/kg/day divided every 6 to 8 hours; maximum dose: 50 mg/dose.
Adolescents >16 years:
Oral:
Duodenal ulcer: 150 mg twice daily or 300 mg once daily after the evening meal or at bedtime.
Gastric ulcer: 150 mg twice daily.
IV, IM: 50 mg every 6 to 8 hours.
Maintenance:
Infants, Children, and Adolescents ≤16 years: Oral: 2 to 4 mg/kg/day once daily; maximum daily dose: 150 mg/day.
Adolescents >16 years: Oral: 150 mg once daily at bedtime.
Erosive esophagitis:
Infants, Children, and Adolescents ≤16 years: Oral: 5 to 10 mg/kg/day divided twice daily; maximum dose: 150 mg/dose.
Adolescents >16 years: Oral:
Treatment: 150 mg 4 times daily.
Maintenance: 150 mg twice daily.
GI bleed or stress ulcer; prophylaxis: Limited data available; dosing regimens variable:
Intermittent IV infusion:
Infants: 2 to 6 mg/kg/day divided every 8 hours (ASHP 1999; Crill 1999).
Children and Adolescents: 2 to 6 mg/kg/day divided every 6 hours; maximum daily dose: 300 mg/day (ASHP 1999; Crill 1999; Yildizdas 2002).
Continuous IV infusion: Infants, Children, and Adolescents: Initial: 0.15 to 0.5 mg/kg/dose for 1 dose, followed by infusion of 0.08 to 0.2 mg/kg/hour (2 to 5 mg/kg/day) (Gal 2007; Lugo 2001; Osteyee 1994).
Gastroesophageal reflux disease: Note: Guidelines recommend a 4- to 8-week treatment course; if improvement seen after 4 to 8 weeks, consider possible wean; if no response after 4 to 8 weeks, reevaluate diagnosis and consider referral to pediatric GI specialist (NASPGHAN/ESPGHAN [Rosen 2018]).
Infants, Children, and Adolescents: Oral: 5 to 10 mg/kg/day in 2 to 3 divided doses; maximum daily dose: 300 mg/day (AAP [Lightdale 2013]; NASPGHAN/ESPGHAN [Rosen 2018]).
Heartburn: OTC labeling: Note: Do not use for more than 14 days.
Prevention: Children ≥12 years and Adolescents: Oral: 75 to 150 mg 30 to 60 minutes before eating food or drinking beverages which cause heartburn; maximum daily dose: 2 doses/day.
Relief of symptoms: Children ≥12 years and Adolescents: Oral: 75 to 150 mg twice daily; maximum daily dose: 2 doses/day.
Pathological hypersecretory conditions (eg, Zollinger-Ellison): Note: Proton pump inhibitors are the preferred agents (Kliegman 2020).
Adolescents >16 years:
Oral: 150 mg twice daily; adjust dose or frequency as clinically indicated; doses of up to 6 g/day have been used.
Continuous IV infusion: Initial: 1 mg/kg/hour; measure gastric acid output at 4 hours, if >10 mEq/hour 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.
Anaphylaxis, adjunct therapy: Note: Should not be used as monotherapy or as first-line therapy (AAAAI/ACAAI [Campbell 2014]; iCAALL [Simons 2014]; WAO [Simons 2015]).
Infants, Children, and Adolescents: IV: 1 mg/kg/dose; maximum dose: 50 mg/dose (AAAAI/ACAAI [Lieberman 2010]; Canadian Paediatric Society [Cheng 2011]).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Infants, Children, and Adolescents (Aronoff 2007):
Oral: Based on a usual dose of 2 to 6 mg/kg/day divided every 8 to 12 hours.
GFR >50 mL/minute/1.73 m2: No adjustment required.
GFR 30 to 50 mL/minute/1.73 m2: 2 mg/kg/dose every 12 hours.
GFR 10 to 29 mL/minute/1.73 m2: 1 mg/kg/dose every 12 hours.
GFR <10 mL/minute/1.73 m2: 1 mg/kg/dose every 24 hours.
Hemodialysis: 1 mg/kg/dose every 24 hours.
Peritoneal dialysis: 1 mg/kg/dose every 24 hours.
Continuous renal replacement therapy: 2 mg/kg/dose every 12 hours.
Parenteral (IV): Based on a usual dose of 2 to 4 mg/kg/day divided every 6 to 24 hours.
GFR >50 mL/minute/1.73 m2: No adjustment required.
GFR 30 to 50 mL/minute/1.73 m2: 1 mg/kg/dose every 12 hours.
GFR 10 to 29 mL/minute/1.73 m2: 0.5 mg/kg/dose every 12 hours.
GFR <10 mL/minute/1.73 m2: 0.5 mg/kg/dose every 24 hours.
Hemodialysis: 0.5 mg/kg/dose every 24 hours.
Peritoneal dialysis: 0.5 mg/kg/dose every 24 hours.
Continuous renal replacement therapy: 1 mg/kg/dose every 12 hours.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Refer to adult dosing (use caution with dose selection).
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral:
Zantac C: 150 mg, 300 mg [contains soybean lecithin]
Solution, Injection:
Generic: 25 mg/mL ([DSC])
Solution, Oral:
Generic: 15 mg/mL (300 mL)
Tablet, Oral:
Generic: 150 mg, 300 mg
As of April 2020, all prescription (including oral and injectable) and OTC ranitidine formulations have been withdrawn from the US market.
Injection may be administered IM or IV:
IM: Injection is administered undiluted
IV: Must be diluted; may be administered intermittent bolus or intermittent IV infusion
Intermittent bolus: Manufacturer recommends a maximum rate of administration of 10 mg/minute (infuse over at least 5 minutes); however, in adults may also be administered at a maximum rate of 25 mg/minute (or over 2 minutes) if necessary (Coursin 1988; Goelzer 1988; Smith 1987).
Intermittent IV infusion: Administer over a maximum rate of 2.5 to 3.5 mg/minute (infuse over at least 15 to 20 minutes)
Oral: Administer with meals and/or at bedtime.
Parenteral:
IV: Must be diluted prior to administration; may be administered IV push, intermittent IV infusion, or continuous IV infusion.
Intermittent IV infusion: Preferred over IV push to decrease risk of bradycardia; infuse over 15 to 20 minutes.
IV push: Manufacturer recommends administering over a period of at least 5 minutes, not to exceed 10 mg/minute (4 mL/minute).
Continuous IV infusion: Administer at ordered rate; titration may be necessary for some conditions.
IM: Administer undiluted.
Intermittent bolus injection: 50 mg diluted in NS or other compatible IV solution to a maximum concentration of 2.5 mg/mL (20 mL).
Intermittent IV infusion: 50 mg diluted in D5W or other compatible IV solution to a maximum concentration of 0.5 mg/mL (100 mL).
IV infusion: 0.5 mg/mL
Oral:
Gastroesophageal reflux disease: Treatment of gastroesophageal reflux disease (GERD).
Heartburn (OTC only): Relief and prevention of heartburn associated with acid indigestion and sour stomach.
Peptic ulcer disease: Treatment of active duodenal or gastric ulcers.
Injection:
Patients not able to take oral medication: As an alternative to the oral ranitidine dosage form for short-term (eg, GERD, peptic ulcer disease) use in patients who are unable to take oral medication.
RaNITIdine may be confused with amantadine, riMANTAdine
Zantac may be confused with Xanax, Zarontin, Zofran, ZyrTEC
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined.
Cardiovascular: Asystole, atrioventricular block, bradycardia (with rapid IV administration), tachycardia, vasculitis, ventricular premature contractions
Central nervous system: Agitation, confusion, dizziness, depression, drowsiness, hallucination, headache, insomnia, involuntary motor activity, malaise, vertigo
Dermatologic: Alopecia, erythema multiforme, injection site pruritus (transient), skin rash
Endocrine & metabolic: Acute porphyria, increased serum prolactin
Gastrointestinal: Abdominal distress, abdominal pain, constipation, diarrhea, nausea, necrotizing enterocolitis (very low weight neonates; Guillet 2006), pancreatitis, vomiting
Hematologic & oncologic: Agranulocytosis, aplastic anemia, granulocytopenia, hemolytic anemia (immune; acquired), leukopenia, pancytopenia, thrombocytopenia
Hepatic: Cholestatic hepatitis, hepatic failure, hepatitis, jaundice
Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reaction (eg, bronchospasm, eosinophilia, fever)
Local: Burning sensation at injection site (transient), pain at injection site (transient)
Neuromuscular & skeletal: Arthralgia, myalgia
Ophthalmic: Blurred vision
Renal: Acute interstitial nephritis, increased serum creatinine
Respiratory: Pneumonia (causal relationship not established)
Hypersensitivity to ranitidine or any component of the formulation
OTC labeling: When used for self-medication (OTC), do not use if trouble or pain when swallowing food, vomiting with blood, or bloody or black stools, allergic to ranitidine or other acid reducers. Do not use with other acid reducers. Do not use 150 mg tablet with kidney disease without medical advice.
Documentation of allergenic cross-reactivity for histamine H2 antagonists is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.
Concerns related to adverse effects:
• Confusion: Rare cases of reversible confusion have been associated with ranitidine; usually elderly or severely ill patients, or in patients with renal or hepatic impairment.
• Hepatic effects: Elevation in ALT levels has occurred with higher doses (≥100 mg) or prolonged IV therapy (≥5 days); monitor ALT levels daily for the remainder of treatment.
• Vitamin B12 deficiency: Prolonged treatment (≥2 years) may lead to vitamin B12 malabsorption and subsequent vitamin B12 deficiency. The magnitude of the deficiency is dose-related and the association is stronger in females and those younger in age (<30 years); prevalence is decreased after discontinuation of therapy (Lam 2013).
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 (ranitidine undergoes hepatic metabolism).
• Porphyria: Avoid use in patients with a history of acute porphyria; may precipitate attacks.
• Renal impairment: Ranitidine is primarily excreted renally; dosage adjustment is recommended in patients with renal impairment.
Special populations:
• Children: Use of gastric acid inhibitors, including proton pump inhibitors and H2 blockers, has been associated with an increased risk for development of acute gastroenteritis and community-acquired pneumonia in pediatric patients (Canani 2006).
Dosage form specific issues:
• Injection: Rapid administration has been associated with bradycardia (rare), usually in patients with predisposing risk factors for cardiac rhythm disorders. Do not exceed the recommended IV administration rate(s).
• Syrup: May contain up to 7.5% alcohol.
Other warnings/precautions:
• OTC labeling: When used for self-medication (OTC), notify health care provider before use if any of the following are present: Frequent chest pain; frequent wheezing particularly with heartburn; nausea/vomiting; unexplained weight loss; stomach pain; heartburn longer than 3 months; heartburn with light-headedness, sweating, or dizziness; chest pain or shoulder pain with shortness of breath; sweating or pain that spreads to arms, neck, or shoulders; light-headedness. Stop use and notify health care provider if heartburn continues, worsens, or lasts longer than 14 days.
Use of gastric acid inhibitors, including proton pump inhibitors and H2 blockers, has been associated with an increased risk for development of acute gastroenteritis and community-acquired pneumonia in pediatric patients 4 to 36 months (Canani 2006). A large epidemiological study has suggested an increased risk for developing pneumonia in patients receiving H2 receptor antagonists; however, a causal relationship with ranitidine has not been demonstrated. A cohort analysis including over 11,000 neonates reported an association of H2 blocker use and an increased incidence of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) neonates (Guillet 2006). An approximate six-fold increase in mortality, NEC, and infection (ie, sepsis, pneumonia, urinary tract infection) was reported in patients receiving ranitidine in a cohort analysis of 274 VLBW neonates (Terrin 2012). Routine use in preterm infants is not recommended (AAP [Eichenwald 2018]). Gastric acid suppression medications, including H2 blockers, have also been associated with an increase in Clostridioides difficile infection (CDI) and recurrent CDI in pediatric patients (Nylund 2014).
Substrate of CYP1A2 (minor), CYP2C19 (minor), CYP2D6 (minor), OCT1, OCT2, P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acalabrutinib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Acalabrutinib. Management: Give acalabrutinib capsules 2 hours before a histamine H2 receptor antagonist (H2RA). No action is required if acalabrutinib tablets are coadministered with H2RAs. Risk D: Consider therapy modification
Atazanavir: Histamine H2 Receptor Antagonists may decrease the serum concentration of Atazanavir. Management: Specific dose limitations and administration guidelines exist; consult full interaction monograph or atazanavir prescribing information. Risk D: Consider therapy modification
Belumosudil: Histamine H2 Receptor Antagonists may decrease the serum concentration of Belumosudil. Risk C: Monitor therapy
Bosutinib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Bosutinib. Management: Administer histamine H2 receptor antagonists more than 2 hours before or after bosutinib. Risk D: Consider therapy modification
Cefditoren: Histamine H2 Receptor Antagonists may decrease the serum concentration of Cefditoren. Risk X: Avoid combination
Cefpodoxime: Histamine H2 Receptor Antagonists may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Histamine H2 Receptor Antagonists may decrease the absorption of Cefuroxime. Separate oral doses by at least 2 hours. Risk X: Avoid combination
Cysteamine (Systemic): Histamine H2 Receptor Antagonists may diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy
Dacomitinib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Dacomitinib. Management: Administer dacomitinib at least 6 hours before or 10 hours after an histamine H2-receptor antagonist (H2RA). Risk D: Consider therapy modification
Dasatinib: Histamine H2 Receptor Antagonists may decrease the absorption of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of H2-antagonists if some acid-reducing therapy is needed. Risk X: Avoid combination
Delavirdine: Histamine H2 Receptor Antagonists may decrease the serum concentration of Delavirdine. Risk X: Avoid combination
Doxofylline: RaNITIdine (Withdrawn from US Market) may increase the serum concentration of Doxofylline. Risk C: Monitor therapy
Enoxacin: Histamine H2 Receptor Antagonists may decrease the absorption of Enoxacin. Risk C: Monitor therapy
Erlotinib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Erlotinib. Management: Avoid H2-antagonists in patients receiving erlotinib when possible. If concomitant treatment cannot be avoided, erlotinib should be dosed once daily, 10 hours after and at least 2 hours before H2-antagonist dosing. Risk D: Consider therapy modification
Fosamprenavir: Histamine H2 Receptor 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: Histamine H2 Receptor Antagonists may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or 6 hours after administration of a histamine H2 receptor antagonist (H2RA), and closely monitor clinical response to gefitinib. Risk D: Consider therapy modification
GlipiZIDE: RaNITIdine (Withdrawn from US Market) may increase the serum concentration of GlipiZIDE. Risk C: Monitor therapy
GlyBURIDE: RaNITIdine (Withdrawn from US Market) may enhance the hypoglycemic effect of GlyBURIDE. Risk C: Monitor therapy
Indinavir: Histamine H2 Receptor Antagonists may decrease the serum concentration of Indinavir. Risk C: Monitor therapy
Infigratinib: Histamine H2 Receptor Antagonists may decrease serum concentrations of the active metabolite(s) of Infigratinib. Histamine H2 Receptor Antagonists may decrease the serum concentration of Infigratinib. Management: Avoid coadministration of infigratinib with histamine receptor antagonists (H2RAs) or other gastric acid-lowering agents. If H2RAs cannot be avoided, administer infigratinib 2 hours before or 10 hours after administration of H2RAs. Risk D: Consider therapy modification
Itraconazole: Histamine H2 Receptor Antagonists may increase the serum concentration of Itraconazole. Histamine H2 Receptor Antagonists may decrease the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any histamine H2 receptor antagonists (H2RAs). Exposure to Tolsura brand itraconazole may be increased by H2RAs; consider itraconazole dose reduction. Risk D: Consider therapy modification
Ketoconazole (Systemic): Histamine H2 Receptor Antagonists may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer ketoconazole with an acidic beverage (eg, non-diet cola) and monitor for reduced efficacy if concomitant use with a H2RA is required. Increases in ketoconazole dose may be required. Risk D: Consider therapy modification
Ledipasvir: Histamine H2 Receptor Antagonists may decrease the serum concentration of Ledipasvir. Management: Administer H2 receptor antagonist doses less than or comparable to famotidine 40 mg twice daily simultaneously or 12 hours prior to ledipasvir. The effect of administering H2 receptor antagonists at other time intervals is unknown and not recommended. Risk D: Consider therapy modification
Levoketoconazole: Histamine H2 Receptor Antagonists may decrease the absorption of Levoketoconazole. Risk X: Avoid combination
Lomitapide: RaNITIdine (Withdrawn from US Market) may increase the serum concentration of Lomitapide. Management: Patients taking lomitapide 10 mg/day or more should decrease the lomitapide dose by half with concurrent ranitidine; the lomitapide dose may then be increased to a max adult dose of 30 mg/day (patients on lomitapide 5 mg/day may continue that dose). Risk D: Consider therapy modification
Lumacaftor and Ivacaftor: May decrease the serum concentration of RaNITIdine (Withdrawn from US Market). Lumacaftor and Ivacaftor may increase the serum concentration of RaNITIdine (Withdrawn from US Market). Risk C: Monitor therapy
Multivitamins/Minerals (with ADEK, Folate, Iron): Histamine H2 Receptor Antagonists may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be impaired by H2-antagonists. Risk C: Monitor therapy
Nelfinavir: Histamine H2 Receptor Antagonists may decrease serum concentrations of the active metabolite(s) of Nelfinavir. Histamine H2 Receptor Antagonists may decrease the serum concentration of Nelfinavir. Concentrations of the active M8 metabolite may also be reduced. Risk C: Monitor therapy
Neratinib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Neratinib. Specifically, histamine H2 receptor antagonists may reduce neratinib absorption. Management: Administer neratinib at least 2 hours before or 10 hours after administration of a histamine H2 receptor antagonist to minimize the impact of this interaction. Risk D: Consider therapy modification
Nilotinib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Nilotinib. Management: The nilotinib dose should be given 10 hours after or 2 hours before the H2 receptor antagonist in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Octreotide: Histamine H2 Receptor Antagonists may decrease the serum concentration of Octreotide. Risk C: Monitor therapy
PAZOPanib: Histamine H2 Receptor Antagonists may decrease the serum concentration of PAZOPanib. Risk X: Avoid combination
Pexidartinib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Pexidartinib. Management: Administer pexidartinib 2 hours before or 10 hours after histamine H2 receptor antagonists. Risk D: Consider therapy modification
Posaconazole: Histamine H2 Receptor Antagonists may decrease the serum concentration of Posaconazole. Management: Avoid concurrent use of oral suspension with H2-antagonists whenever possible. Monitor patients closely for decreased antifungal effects if this combination is used. Delayed-release posaconazole tablets may be less likely to interact. Risk D: Consider therapy modification
Procainamide: RaNITIdine (Withdrawn from US Market) 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
Rilpivirine: Histamine H2 Receptor Antagonists may decrease the serum concentration of Rilpivirine. Management: Administer histamine H2 receptor antagonists (H2RAs) at least 12 hours before or 4 hours after oral rilpivirine. Risk D: Consider therapy modification
Risedronate: Histamine H2 Receptor Antagonists may increase the serum concentration of Risedronate. This applies specifically to delayed-release risedronate. Risk X: Avoid combination
Saquinavir: Histamine H2 Receptor Antagonists may increase the serum concentration of Saquinavir. Management: Consider alternatives to this combination for patients taking the Invirase formulation of saquinavir. No action beyond standard clinical care measures is required for patients taking the Fortovase formulation of saquinavir. Risk D: Consider therapy modification
Secretin: Histamine H2 Receptor Antagonists may diminish the diagnostic effect of Secretin. Specifically, use of H2-Antagonists may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of histamine H2-antagonists (H2RAs) and secretin. Discontinue H2RAs at least 2 days prior to secretin administration. Risk D: Consider therapy modification
Selpercatinib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Selpercatinib. Management: Coadministration of selpercatinib and H2 receptor antagonists should be avoided. If coadministration cannot be avoided, selpercatinib should be administered 2 hours before or 10 hours after H2 receptor antagonists. Risk D: Consider therapy modification
Sotorasib: Histamine H2 Receptor Antagonists may decrease the serum concentration of Sotorasib. Risk X: Avoid combination
Sparsentan: Histamine H2 Receptor Antagonists may decrease the serum concentration of Sparsentan. Risk X: Avoid combination
Triazolam: RaNITIdine (Withdrawn from US Market) may increase the serum concentration of Triazolam. Risk C: Monitor therapy
Velpatasvir: Histamine H2 Receptor Antagonists may decrease the serum concentration of Velpatasvir. Risk C: Monitor therapy
Warfarin: RaNITIdine (Withdrawn from US Market) may increase the serum concentration of Warfarin. Risk C: Monitor therapy
Prolonged treatment (≥2 years) may lead to malabsorption of dietary vitamin B12 and subsequent vitamin B12 deficiency (Lam 2013).
Ranitidine crosses the placenta (Armentano 1989).
Ranitidine is excreted into breast milk (Riley 1982).
Some products may contain phenylalanine and/or sodium. Oral dosage forms may be taken with or without food.
AST, ALT, serum creatinine; occult blood with GI bleeding, signs/symptoms of peptic ulcer disease; when used to prevent stress-related GI bleeding, measure the intragastric pH and try to maintain pH >4; when used for Zollinger-Ellison syndrome, monitor gastric acid secretion (goal: <10 mEq/hour); signs of confusion
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.
Absorption: Oral: 50%; IM: Rapid
Distribution: Vd: Minimally penetrates the blood-brain barrier
Infants, Children, and Adolescents: IV, Oral: 1 to 2.3 L/kg
Adults: Normal renal function: ~1.4 L/kg; CrCl 25 to 35 mL/minute: 1.76 L/kg
Protein binding: ~15%
Metabolism: Hepatic (minor) to N-oxide, S-oxide, and N-desmethyl metabolites
Bioavailability: Oral tablets: ~50%; IM: 90% to 100%
Half-life elimination:
Neonates (receiving ECMO): IV: 6.6 hours
Infants, Children, and Adolescents: IV: 1.7 to 2.4 hours
Adults:
Oral: Normal renal function: 2.5 to 3 hours; Elderly: 3 to 4 hours
IV: Normal renal function: 2 to 2.5 hours; CrCl 25 to 35 mL/minute: 4.8 hours; Elderly: 3.1 hours
Time to peak, serum: Oral: 2 to 3 hours; IM: ≤15 minutes
Excretion: Urine (as unchanged drug): Oral: 30%, IV: 70%; feces (as metabolites)
Altered kidney function: Plasma half-life, clearance, and volume of distribution are all altered in proportion to creatinine clearance.
Hepatic function impairment: Plasma half-life, clearance, and volume of distribution are all altered in proportion to creatinine clearance.
Pediatric: In pediatric cardiac failure, clearance may be reduced. In a prospective population pharmacokinetic study of critically ill pediatric patients (n=78; age range: 15 days to 15.51 years), cardiac failure/surgery was found to reduce clearance by a factor of 0.463 (Hawwa 2013).
Older adult: Total clearance is lowered.
Capsules (raNITIdine HCl Oral)
150 mg (per each): $1.52
300 mg (per each): $2.74
Solution (raNITIdine HCl Injection)
50 mg/2 mL (per mL): $7.73
150 mg/6 mL (per mL): $7.74
1000 mg/40 mL (per mL): $7.16
Solution (Zantac Injection)
50 mg/2 mL (per mL): $9.90
Syrup (raNITIdine HCl Oral)
15 mg/mL (per mL): $0.74
Tablets (raNITIdine HCl Oral)
75 mg (per each): $0.07
150 mg (per each): $1.48 - $1.75
300 mg (per each): $2.69 - $3.22
Tablets (Zantac 150 Maximum Strength Oral)
150 mg (per each): $0.34
Tablets (Zantac 75 Oral)
75 mg (per each): $0.30
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