Ranitidine adverse effects

Pantoprazole 20 mg/day and ranitidine 300 mg/day for 12 months have been compared in the relief of symptoms in a multicenter, randomized, double-blind trial in 307 patients with symptomatic gastro-esophageal reflux disease in primary care (3). Symptom control was significantly more effective and faster with pantoprazole than ranitidine. Adverse effects were similar in the two groups the most common adverse effects were headache, diarrhea, nausea, constipation, and vomiting. 

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. 

CARBAMAZEPINE H2 RECEPTOR BLOCKERS -CIMETIDINE, FAMOTIDINE, RANITIDINE t plasma concentrations of phenytoin and risk of adverse effects including phenytoin toxicity, bone marrow depression and skin reactions Inhibition of metabolism via CYP2C9 and CYP2C19 Use alternative acid suppression (e.g. ranitidine) or warn patients that effects last about 1 week. Consider monitoring carbamazepine levels, and adjust dose as necessaiy... 

BZDs (NOT LORAZEPAM OR TEMAZEPAM) H2 RECEPTOR BLOCKERS -CIMETIDINE, RANITIDINE t efficacy and adverse effects of BZD, e.g. sedation Cimetidine is an inhibitor of CYP3A4, CYP2D6, CYP2C19 and CYP1A2 Not clinically significant for most patients. Conflicting information for some BZDs. Monitor more closely, and i dose if necessary... 

CHLOROQUINE H2 RECEPTOR BLOCKERS -CIMETIDINE t efficacy and adverse effects of chloroquine Inhibition of metabolism and excretion Consider ranitidine as an alternative or take cimetidine at least 2 hours after chloroquine... 

CIMETIDINE, RANITIDINE ANAESTHETICS-LOCAL -LIDOCAINE 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... 

CIMETIDINE, RANITIDINE ANTIARRHYTHMICS-AMIODARONE, FLECAINIDE, MEXILETINE, PROCAINAMIDE, PROPAFENONE Likely t plasma concentrations of these antiarrhythmics and risk of adverse effects Cimetidine inhibits CYP2D6-mediated metabolism of flecainide, mexiletine, procainamide and propafenone. Ranitidine is a much weaker CYP2D6 inhibitor. Cimetidine is a potent inhibitor of organic cation transport in the kidney, and the elimination of procainamide is impaired Monitor PR and BP at least weekly until stable. Warn patients to report symptoms of hypotension (lightheadedness, dizziness on standing, etc.). Consider alternative acid suppression therapy... 

CIMETIDINE FAMOTIDINE NIZATIDINE, RANITIDINE BRONCHODILATORS -THEOPHYLLINE t efficacy and adverse effects, including seizures. There is conflicting information associated with ranitidine, famotidine and nizatidine Inhibition of metabolism via CYP1A2, cimetidine being the best known inhibitor Use alternative acid suppression, e.g. a proton pump inhibitor (not omeprazole or lansoprazole) or monitor closely considerable patient variation. Check levels on day 3 and then at 1 week. A 30-50% i dose of theophylline may be required. For doses <400 mg/day, the interaction may not be clinically significant... 

RANITIDINE TRIPOTASSIUM DICITRATOBISMUTHATE t adverse effects of tripotassium dicitratobismuthate t absorption Do not use together for more than 16 weeks. Bismuth salicylate and subnitrate do not interact... 

Ranitidine 300 mg bd and omeprazole 20 mg bd have been compared as components of triple therapies (combining them with either amoxicillin plus clarithromycin or amoxicillin plus metronidazole) in 320 patients with H. pylori (5). Omeprazole and ranitidine combined with two antibiotics for 1 week were equally effective in eradicating H. pylori. This result questions the role of profound acid suppression in eradication. There was no difference in the reported adverse effects, which included nausea, vomiting, diarrhea, metallic taste, skin rashes, and headache. 

The overall safety record of the currently marketed agents, particularly cimetidine and ranitidine, which have had extensive worldwide use, is excellent, and in practice safety issues seldom affect drug choice (1), except perhaps when it is necessary to avoid interactions with phenytoin, theophylline, or warfarin. Surveillance studies, which have been going on for a quarter of a century (including 10-year studies in many patients, mainly involving cimetidine and ranitidine), have failed to detect any serious adverse effects other than those recognized by 1980, or any adverse effect on mortality (2). 

Pantoprazole 40 mg/day and ranitidine 150 mg bd for 8 weeks have been compared in the treatment of grades II and III reflux esophagitis in a randomized, double-bhnd trial in 256 patients (1). Symptom rehef and healing rates were significantly better with pantoprazole. The incidences of adverse effects were similar in the two groups the most commonly reported were diarrhea and somnolence with pantoprazole (2-3%) and headache, diarrhea, dizziness, increases in liver enzymes, and pruritus (2 %) with ranitidine. 

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). 

Lansoprazole 30 mg/day, lansoprazole 15 mg/day, and ranitidine 150 mg/day have been compared in a randomized, double-bhnd, multicenter trial in the prevention of relapse of duodenal ulcer and symptom control over 12 months in 359 patients (25). Both doses of lansoprazole were superior to ranitidine. There was no significant difference between the two lansoprazole groups, although there was a trend in favor of lansoprazole 30 mg/day. There were no differences in adverse effects profiles in the three groups. The adverse effects included diarrhea, abdominal pain, viral infections, headache, and vomiting. 

Rare adverse cardiac effects have been reported secondary to ranitidine. These effects may be either due to direct ranitidine blockade of cardiac H2 receptors or due to potentiation of acetylcholine activity on the heart by ranitidine-induced inhibition of acetylcholinesterases. Ranitidine-induced hepatic injury is thought to be secondary to an idiosyncratic reaction or a hypersensitivity reaction. 

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