Ranitidine, prophylaxis

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 being used as prophylaxis against steroid-induced gastric or duodenal ulcers. The clinician will need to decide if this needs to continue based on patients previous medical history. 

A 27-year-old man with an 8-day history of dysphagia and retrosternal pain was taking doxycycline prophylaxis and occasional terfenadine (doses not stated). He recalled no problems with taking any of his doxycycline prophylaxis. He had an esophagoscopy, which showed a 1 cm esophageal ulcer. He improved with ranitidine. 

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). ... 

Cimetidine raises serum dapsone ievels, and may reduce methaemoglobinaemia due to dapsone. Cimetidine, ranitidine and omeprazole do not appear to affect the outcome of dapsone prophylaxis against Pneumocystis pneumonia. The absorption of dapsone does not appear to be altered by nizatidine-induced increases in gastric pH. 

An established interaction. Cimetidine and ranitidine are not suitable drugs for prophylaxis of the gastrointestinal adverse effects of tolazoline in children. Other H2-receptor antagonists would be expeeted to behave similarly. 

Observational studies Stress ulcer prophylaxis with ranitidine has been associated with an increased risk of ventilator-associated pneumonia. The use of proton pump inhibitors has also been linked to an increased risk of community-acquired pneumonia, and pantoprazole is commonly used in stress ulcer prophylaxis. In a retrospective observational study the database of a cardiothoracic surgery unit was used to identify all patients who had received stress ulcer prophylaxis with pantoprazole or ranitidine 887 patients met the inclusion criteria [66% Nosocomial pneumonia was... 

Miano TA, Reichert MG, Houle TT, MacGregor DA, Kincaid EH, Bowton DL. Nosocomial pneumonia risk and stress ulcer prophylaxis. A comparison of pantoprazole vs ranitidine in car-diothoradc surgery patients. Chest 2009 136 440-7. 

Levy MJ, Seelig CB, Robinson NJ, et al Comparison of omeprazole and ranitidine for stress ulcer prophylaxis. Dig Dis Sci 1997 42 1255-1259. 

Prod hom G, Leuenberger P, Koerfer J, et al. Nosocomial pneumonia In mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. Ann Intern Med 1994 120 653-662. 

These considerations led to a clinical programme of research comparing omeprazole with placebo, ranitidine and misoprostol for prophylaxis, healing and maintenance of NSAID-associated ulcers and multiple erosions. 

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