What is Ranitidine used for?

Ranitidine Clinical Uses

Ranitidine is an H2-receptor antagonist used primarily for treating peptic ulcer disease (duodenal and gastric ulcers), gastroesophageal reflux disease (GERD), erosive esophagitis, and pathological hypersecretory conditions like Zollinger-Ellison syndrome. 1

Primary FDA-Approved Indications

Ranitidine is indicated for the following conditions 1:

• Duodenal ulcer: Short-term treatment (most heal within 4 weeks) and maintenance therapy at reduced dosage after healing 1
• Gastric ulcer: Short-term treatment of active, benign gastric ulcer (most heal within 6 weeks) and maintenance therapy after healing 1
• GERD: Symptomatic relief commonly occurs within 24 hours with ranitidine 150 mg twice daily 1
• Erosive esophagitis: Treatment and maintenance of healing, with symptomatic relief within 24 hours using ranitidine 150 mg four times daily 1
• Pathological hypersecretory conditions: Including Zollinger-Ellison syndrome and systemic mastocytosis 1

Comparative Efficacy and Clinical Context

Ranitidine is significantly less effective than proton pump inhibitors (PPIs) for acid-related disorders and should not be considered first-line therapy when PPIs are available. 2

• PPIs are more effective than H2-receptor antagonists for symptom control and healing of erosive esophagitis, with Grade Ia evidence 2
• Ranitidine develops tachyphylaxis within 6 weeks of treatment, limiting long-term effectiveness 3, 2
• Standard doses of ranitidine reduce duodenal but not gastric ulcers when used with NSAIDs 2

Specific Clinical Scenarios Where Ranitidine May Be Preferred

Patients on Dual Antiplatelet Therapy

• Ranitidine does not interfere with clopidogrel's antiplatelet activity, unlike some PPIs that inhibit CYP2C19 4, 2
• Ranitidine interacts weakly with cytochrome P-450, while famotidine and nizatidine have no interaction 4

Pediatric GERD

• FDA recommends ranitidine 5-10 mg/kg/day divided in 2-3 doses for children 1 month to 16 years 3
• The American Academy of Pediatrics recommends starting with ranitidine for mild, intermittent GERD symptoms in pediatric patients 3, 2
• Side effects are very rare in children 3
• For moderate to severe symptoms or erosive esophagitis in children, PPIs are more effective 3

Short Bowel Syndrome and High Fecal Output Conditions

• Ranitidine has immunomodulatory properties that reduce water-electrolyte losses in short bowel syndrome 3
• Continuous ranitidine infusion at lower dosages is more efficient than intermittent infusion 3
• Effective for decreasing gastric hypersecretion in patients with enterostomy for chronic intestinal pseudo-obstruction syndrome 3
• Intravenous administration at 10-15 mg/kg/day is indicated when enteral administration is impossible or ineffective 3

Preoperative Aspiration Prophylaxis

• The American Society of Anesthesiologists recommends ranitidine may be used preoperatively in patients at increased risk of pulmonary aspiration 5
• Oral ranitidine effectively reduces gastric volume and acidity during the perioperative period 5
• Should not be routinely administered to patients without apparent increased aspiration risk 5

Gastro-Esophageal Reflux Cough

• Ranitidine 300 mg daily for 2 weeks improved cough in 54% of patients with reflux-related cough 3, 5
• Full acid suppression for reflux cough may require combining twice daily PPIs with nocturnal H2 antagonists 3, 5

Dosing and Administration

Standard Adult Dosing 1:

• Duodenal ulcer: 150 mg twice daily or 300 mg at bedtime
• Gastric ulcer: 150 mg twice daily
• GERD: 150 mg twice daily
• Erosive esophagitis: 150 mg four times daily
• Maintenance therapy: 150 mg at bedtime

Pediatric Dosing 3:

• GERD: 5-10 mg/kg/day divided in 2-3 doses
• Short bowel syndrome: 10-15 mg/kg/day via continuous infusion

Important Clinical Caveats

• Ranitidine is 4 to 10 times more potent than cimetidine on a weight basis 6
• Unlike cimetidine, ranitidine has no antiandrogenic effects and does not alter hepatic drug metabolism 6, 7
• Gastrointestinal side effects occur in approximately 1-3% of patients 5
• CNS side effects are less common with ranitidine than cimetidine 5
• Dosage adjustments necessary in renal insufficiency, seizure disorders, or certain psychiatric disorders 5
• The development of tachyphylaxis within 6 weeks makes ranitidine unsuitable for long-term continuous therapy 3, 2

Historical Note on H. pylori Eradication

• In 1997, the European Helicobacter Pylori Study Group stated that no recommendation could be made regarding ranitidine's role in H. pylori eradication due to insufficient data 4
• Current standard practice uses PPI-based triple therapy for H. pylori eradication, not H2-receptor antagonists 4