Intravenous ranitidine

Sanders, A. B., and Moore, J. G. Intragastric pH and pharmacokinetics of intravenous ranitidine during sinusoidal and constant-rate infusions. Chronobiol. Int. 8 267—276, 1991. 

Sanders, W. Buchi, K.N. Moore, J.G. Bishop, A.L. Pharmacodynamics of intravenous ranitidine after bolus and continuous infusion in patients with healed duodenal ulcers. Clin. Pharmacol. Ther. 1989, 46 (5), 545-551. 

In renal impairment, the risk of adverse reactions with intravenous ranitidine is doubled (SEDA-18, 371). 

Connelly, J.F. Adjusting dosage intervals of intermittent intravenous ranitidine according to creatinine clearance Cost-minimization analysis. Hosp. Pharm. 1994, 29, 992, 998, 1001. 

Holt, R.T. Graves, L.J. Scheil, E. Reducing costs by adjusting dosage intervals for intravenous ranitidine. Am. J. Hosp. Pharm. 1990, 47, 2068-2069. 

H2-receptor antagonists are preferred for prophylaxis of SRMB. A large landmark study demonstrated that intravenous ranitidine was superior to oral sucralfate in preventing SRMB. Moreover, ranitidine did not increase the risk for nosocomial pneumonia, as the incidence of pneumonia was no different between the two treatment groups. In itself, critical illness places the patient at risk for nosocomial pneumonia. Also there are potential problems associated with sucralfate therapy (e.g., constipation, clogging tubes, hypophosphatemia, and drug interactions). ... 

Intravenous ranitidine is widely used as a prophylactic agent for stress ulcer-related bleeding in patients in intensive care units. The development of an integrated... 

These reports are similar to another, in which the tolazoline-induced reduction in pulmonary arterial pressure in a child was reversed when cime-tidine was given, for acute gastrointestinal haemorrhage. Another study in 12 children found that intravenous ranitidine 3 mg/kg abolished the tolazoline-induced reduction in pulmonary and systemic vascular. ... 

Eighteen healthy subjeets were given oral furosemide 40 mg one hour after intravenous ranitidine 50 mg or saline. The ranitidine inereased the AUC of furosemide by 28% and inereased the maximum serum levels by 31% The effeets of furosemide eould possibly be slightly inereased by ranitidine, but the elinieal importanee of this is probably small. No spe-eial preeautions seem neeessary. 

Nervous system A 26-year-old woman undergoing emergency cesarean delivery under spinal anesthesia with bupivacaine 10 mg was pre-medicated with intravenous ranitidine 50 mg and metoclopramide 10 mg, and received intramuscular diclofenac for postoperative analgesia [32 ]. Starting at 12 hours postoperatively she was given intravenous ondansetron 6 mg every 12 hours for nausea and vomiting. About 2 hours after the first dose she developed a severe headache, which persisted for over 90 hours and was characterized by aggravation of symptoms in coincidence with doses of ondansetron. The headache resolved completely a few hours after ondansetron withdrawal. 

Immunologic The incidence of anaphylactic reactions to ranitidine has been reported to be 0.3-0.7%. Two cases of anaphylactic shock have been attributed to intravenous ranitidine, in one case fatal. 

Hogan DL, McQuaid KR, Koss AAA, et al. Gastric acid suppression is greater during intravenous ranitidine infusion versus bolus injections of famotidine. Aliment Pharmacol Ther 1993 7(5) 537-541. 

Figure 3. Effects of intravenous cimetidine (a), intravenous ranitidine (b) or omeprazole (c) on gastric acid secretion in patients with ZES. a) and b) panels Effect of continuous infusion of either intravenous cimetidine (25 patients) or ranitidine (30 patients) on gastric acid secretion. BAO was determined in all patients at a time when they were not taking any antisecretory medications. The minimum infusion dose to reduce acid output below 10 mEq/h, the accepted level of control, in each patients is shown in parentheses in milligrams/kg/hour. c) Effect of an intravenous bolus dose of omeprazole on gastric acid secretion during the last hour before the next dose of drug in 20 patients with ZES is shown. BAO was determined on a previous occasion in all patients at a time when they were taking no antisecretory medications. The dotted line represents an acid output of 10 mEq/h, the accepted level of control. Figure was drawn from data in studies by Saeed et al. [69] (cimetidine) Vinayek et al. [68] (ranitidine) and Vinayek et al. [67] (omeprazole).

Intravenous histamine-2-receptor antagonists such as ranitidine, famotidine, and cimetidine are compatible with PN and can be added to the daily PN for prevention of stress-related mucosal damage and peptic ulcer disease. This provides a continuous acid suppression and reduces nursing time by avoiding intermittent scheduled infusions. 

Midazolam Hydrochloride Midazolam hydrochloride is incompatible with a number of drugs, and precipitation is observed, presumably due to a pH of 5 or more with dimenhydrinate, pentobarbitone sodium, perphenazine, frusemide, thiopentone, prochlorperazine edisylate, ranitidine hydrochloride, and various intravenous fluids.164 Solutions of midazolam hydrochloride should not be combined with Hartmann s solution, as the potency of midazolam may be affected.165... 

A 13-year-old girl with bipolar disorder and a history of adverse reactions to contrast media was given methylprednisolone (32 mg/day) and ranitidine (300 mg/day) before a CT scan of the head with intravenous contrast enhancement. One day after, she developed psychiatric symptoms, which were more severe than her initial symptoms, including extreme agitation and mental confusion. All medications were withdrawn and her symptoms resolved within 2 weeks. 

LIDOCAINE H2 RECEPTOR BLOCKERS -CIMETIDINE, RANITIDINE t efficacy and adverse effects of local anaesthetic, e.g. lightheadedness, paraesthesia Unknown for most local anaesthetics. Lidocaine t bioavailability Uncertain. Monitor more closely. No toxicity reported to date with bupiva-caine. If using intravenous lidocaine, monitor closely for symptoms of toxicity 1 dose may be required... 

Misiak PM, Eldon MA, Toothaker RD, Sedman AJ. Effects of oral cimetidine or ranitidine on the pharmacokinetics of intravenous enoxacin. J Clin Pharmacol 1993 33(l) 53-6. 

Rapid intravenous administration of ranitidine, cimetidine, or famotidine can precipitate cardiovascular complications, notably bradycardia, hypotension, and dysrhythmias (SEDA-20, 317). 

An effective carboplatin desensitization protocol has been reported in a child with hypersensitivity, allowing additional months of carboplatin treatment (248). After premedication with diphenhydramine, ranitidine, and methylprednisolone, eight dilutions of carboplatin (0.01-50.0 mg) were given intravenously at 15-minute intervals at a rate of 1 mg/minute. Subsequently, carboplatin 600 mg was given as a continuous infusion over 3 hours without adverse effects. Whether desensitization is generally suitable for overcoming allergic adverse events should be tested prospectively (249). 

Bradycardia occurred in a 4-day-old full-term male neonate 2 hours after the intravenous injection of ranitidine and resolved over 24 hours (5). 

After 7 days of antibiotic therapy with intravenous vancomycin, gentamicin, and ticarciUin + clavulanate for Pseudomonas aeruginosa and S. aureus sepsis, confluent erythematous-based vesicobuUae developed in a 65-year-old woman with subarachnoid hemorrhage secondary to a ruptured aneurysm (72). Other medications included ranitidine, glyceryl trinitrate, nimodipine, ferrous sulfate, and phenjrtoin. 

If refractory hypotension is present, administer cimetidine 300 mg or ranitidine 50 mg, intravenously over 3-5 min. 

All four Hj receptor antagonists are available as prescription and over-the-connter formnlations for oral administration. Intravenous and intramuscular preparations of cimetidine, ranitidine, and famotidine also are available. When the oral or nasogastric routes are not an option, these dmgs can be given in intermittent intravenous boluses or by continuous intravenous infusion. 

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