NSAIDs Ranitidine

Hepatitis with cholestasis Chlorpromazine, tricyclics, erythromycin, flucloxacillin, co-amoxiclav, ACE inhibitors, phenytoin, NSAIDs, ranitidine, propafenone, ketoconazole, azathioprine, gold salts, penicillamine... 

Refer to Chapter 14 on gastroesophageal reflux disease for more information on the PPIs. The PPI omeprazole is superior to both ranitidine and misoprostol for preventing recurrence of NSAID-associated PUD. In one study, omeprazole 20 mg daily was compared to misoprostol 200 meg twice daily for NSAID-associated PUD prevention. At 6 months, the omeprazole-treated group had significantly fewer ulcers than those taking misoprostol. Furthermore, more patients discontinued ulcer prophylaxis in the misoprostol group due to adverse events.26... 

Another study randomized patients requiring NSAID prophylaxis to either omeprazole 20 mg daily or ranitidine 150 mg twice daily.19 At 6 months, more patients who received omeprazole (72%) than ranitidine (59%) were in ulcer-free remission (p = 0.004). Omeprazole was also more efficacious in preventing GU recurrence than ranitidine (5.2% versus 16.3% p less than 0.01). Adverse drug events were similar in the two groups. 

Ranitidine is a histamine receptor antagonist. It acts essentially on the H2 receptor and blocks acid production. Ranitidine is used in the treatment and prevention of ulcers, NSAID-induced ulcers, Zollinger-Ellison syndrome and gastro-oesophageal reflux disease. 

While taking a NSAID for arthritis, a 65-year-old man developed a gastric ulcer. He was prescribed ranitidine for 8 weeks. This drug binds a receptor located where ... 

Geriatric Considerations-Summary Adjust dose based on creatinine clearance. Not effective in preventing NSAID-induced gastric ulceration and bleeding proton pump inhibitors should be used for this indication instead. Anticholinergic adverse effects have been observed in older adults taking ranitidine. 

Many oncologists co-prescribe ranitidine and dexamethasone due to the gastric irritant effect of corticosteroids which can lead to dyspepsia, particularly if a patient is also concurrently receiving other gastrointestinal irritants such as non-steroidal anti-inflammatory drugs (NSAIDs). 

Cephalosporins Cimetidine Furosemide NSAIDs Probenecid Ranitidine Tetracycline Various anticancer ... 

Yeomans ND, Tulassay Z, Juhasz L, Racz I, Howard JM, van Rensburg CJ, SwanneU AJ, Hawkey CJ. A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. Acid Suppression Trial Ranitidine versus Omeprazole for NSAID-asso-ciated Ulcer Treatment (ASTRONAUT) Study Group. N Engl J Med 1998 338(ll) 719-26. 

Standard PPI dosages (e.g., omeprazole 20 mg/day and lansoprazole 30 mg/day) reduce the risk of NSAID-induced gastric ulcer and duodenal ulcer. " In a large comparative multicenter trial, omeprazole 20 mg/day was superior to ranitidine 150 mg twice daily in preventing NSAID-induced gastroduodenal ulcers. Two randomized controlled trials have compared PPIs with misoprostol and placebo. 

Most of these interactions between the NSAIDs and cimetidine, famotidine, nizatidine or ranitidine appear to be of no particular clinical importance. The general relevance of the isolated case of increased lomoxicam levels and severe gastric irritation with ranitidine is uncertain, but probably small. The H2-receptor antagonists as a group may protect the gastric mucosa from the irritant effects of the NSAIDs and concurrent use may therefore be advantageous. 

Delhotal-Landes B, Flouvat B, Liote F, Abel L, Meyer P, Vinceneux P, Carbon C. Pharmacokinetic interactions between NSAIDs (indomethacin or sulindac) and H2-receptor antagonists (cimetidine or ranitidine) inhuman volunteers, Clin Pharmacol TTier (1988) 44,442-52. 

The clearance of a single oral dose of sodium valproate was reduced in 6 patients by 2 to 17% after a 4-week course of cimetidine, but was not affected by ranitidine. It seems doubtful if the interaction between valproate and cimetidine is of clinical importance. However, a case of fatal hyperammonaemia in a patient with systemic lupus erythematosus was speculated to have been induced by valproate, and the authors also considered that the concurrent use of cimetidine and aspirin (see Valproate + Aspirin or NSAIDs , p.575) may have contributed. The general importance of this case is unknown. 

NSAIDs. The levels of protection under such circumstances range between 75% and 90%, and the frequency of significant gastrointestinal complications is reduced by 40%. The widespread use of misoprostol, however, is somewhat limited by its tendency to cause diarrhea and abdominal pain in a significant proportion of patients. Such side effects, however, need to be weighed against the consequences of a complication of mucosal ulceration. Ranitidine therapy has also been demonstrated to be effective in healing NSAID-induced ulcers and is particularly effective if the NSAID is withdrawn. 

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