Ranitidine Dosing in Pediatric Patients
For pediatric patients aged 1 month to 16 years with GERD or peptic ulcer disease, administer ranitidine at 5-10 mg/kg/day divided into 2-3 doses, with a maximum of 300 mg/day, as recommended by the American Academy of Pediatrics. 1
Standard Oral Dosing by Indication
Treatment of Active Ulcers (Duodenal and Gastric)
- Administer 2-4 mg/kg twice daily, with a maximum of 300 mg/day 2
- This dosing is FDA-approved and derived from adult clinical studies combined with pediatric pharmacokinetic data 2
Maintenance of Ulcer Healing
- Administer 2-4 mg/kg once daily, with a maximum of 150 mg/day 2
- Single daily dosing improves compliance while maintaining therapeutic efficacy 2
GERD and Erosive Esophagitis
- Administer 5-10 mg/kg/day divided into 2 doses 1, 2
- For erosive esophagitis specifically, the adult-equivalent dosing would suggest higher frequency, but pediatric data supports the 2-divided-dose approach 2
Intravenous Dosing for Critically Ill Children
Stress Ulcer Prophylaxis in PICU
- Administer a minimum of 3 mg/kg/day IV to achieve adequate gastric pH control (pH ≥4) 3
- The commonly cited 2-4 mg/kg/day range results in poor pH control in 36% of critically ill children 3
- For optimal prophylaxis, use 1.5 mg/kg IV every 6 hours (6 mg/kg/day total), which maintains gastric pH ≥4 in 80% of high-risk patients 4
Continuous Infusion Alternative
- Administer 0.1 mg/kg/hour as a continuous infusion for children undergoing cardiopulmonary bypass or other critical illness 5
- This produces mean gastric pH ≥5.3 within 3 hours and is safer than higher infusion rates 5
Special Populations
Neonates (Term vs Preterm)
- Preterm infants (<37 weeks): 0.5 mg/kg twice daily 6
- Term neonates: 1.5 mg/kg three times daily 6
- Preterm infants have prolonged drug effect and require significantly lower doses than term infants to maintain gastric pH >4 6
- Note: There is insufficient safety data for neonates <1 month of age to make formal FDA dosing recommendations 2
Anaphylaxis (Second-Line Therapy)
- Administer 1 mg/kg IM (maximum 50 mg) in combination with diphenhydramine 1, 7
- For IV administration: dilute in 20 mL D5W and administer over 5 minutes 1
- This is second-line therapy only; never administer as monotherapy for anaphylaxis 7
Renal Impairment
- For creatinine clearance <50 mL/min: reduce to 150 mg every 24 hours 2
- May increase frequency to every 12 hours if clinically necessary, but use caution 2
- Time dosing to coincide with end of hemodialysis when applicable 2
Formulation Considerations
- Ranitidine effervescent tablets (25 mg dissolved in 5 mL water) are preferred over peppermint-flavored syrup (15 mg/mL) based on taste acceptance studies 1, 8
- 71% of children aged 4-8 years preferred the effervescent formulation, which may improve compliance 8
Critical Pitfalls to Avoid
- Do not use the lower end of 2 mg/kg/day in critically ill children—this results in treatment failure in the majority of PICU patients 3
- Do not assume adult dosing translates to pediatric patients—neonates, particularly preterm infants, require dramatically different dosing due to altered pharmacokinetics 6
- Ranitidine develops tachyphylaxis within 6 weeks of continuous use and is less effective than PPIs for healing erosive esophagitis 1
- Monitor for decreased efficacy with continuous use and consider switching to PPI therapy if symptoms persist beyond 6 weeks 1