Introduction
Ranitidine is also sold by the brand name Zantac. It is one medication that has been used to manage and treat conditions where there is an overproduction of stomach acid for many generations. An H2 receptor antagonist reduces the formation of acid in the stomach’s mucosa. Since it has a minimal side effect profile and is easy to administer, ranitidine has also long been used as treatment for many gastrointestinal pathologies. However, recent safety issues brought regulatory attention and removal from the market in some instances. This article discusses the various types, forms, applications, safety issues, and substitutes for ranitidine.
Types of Ranitidine
Ranitidine was marketed in different preparations; each preparation was made with a specific goal in mind regarding patient needs and preferences. Mainly, the types of ranitidine differed by dose strength and administration form:
Prescription Ranitidine: This formulation was typically sold in higher dosage strengths, which commonly included 150 mg and 300 mg, and was primarily dispensed to treat more moderate or chronic symptomatology of acid-related disorders.
OTC Ranitidine: The OTC formulation typically was sold in more conservative dosage strengths like 75 mg and 150 mg and was often promoted for short-term relief of heartburn, acid indigestion, and sour stomach.
Extended-Release Ranitidine: This preparation provided more prolonged symptom control because the drug was released slowly, thereby providing for longer effective acid suppression.
Available Forms of Ranitidine
Ranitidine was manufactured in a variety of forms to meet the different needs and conditions of patients:
Tablets: Tablets were the most prescribed form, were also available over the counter, and were typically administered once or twice a day.
Soluble Tablets: Since these tablets were to be dissolved in water, they were also convenient for patients having problems swallowing the pills. This medication offered the user an alternative if he or she preferred the liquid form.
Liquid Syrup: Ranitidine was sometimes prescribed in liquid form because of its use with children, especially those patients suffering from difficulty swallowing. The patients who needed accurate, adjustable doses also have an alternative with this liquid medicine.
Injectable Form: Ranitidine was administered through injection in hospitals and clinics when the patient could not take the medication orally, intravenously, or intramuscularly.
Uses of Ranitidine
Ranitidine was prescribed to most patients with any illness associated with overproduction of stomach acid, such as
Gastroesophageal Reflux Disease (GERD): The drug had been extremely effective in managing GERD symptoms because it reduced the level of acidity and heartburn and reduced esophageal inflammation.
Peptic Ulcer Disease (PUD): It was used for gastric and duodenal ulcers. Ranitidine reduced quantities of acid within the stomach, which consequently healed ulceration sites and stopped the formation of new ulcers.
Zollinger-Ellison Syndrome: It is a rare condition involving excessive acid secretion due to tumors in the pancreas or duodenum. Ranitidine reduced the levels of acid in order to alleviate manifestations and complications of the disease.
Erosive Esophagitis: The medication ranitidine was prescribed for inflammation and erosion of the esophagus lining due to the acidic stomach.
Heartburn and Acid Indigestion: Ranitidine is available OTC when patients need relief from heartburn or acid indigestion, which can provide relatively rapid alleviation.
Action Mechanism
Ranitidine works by blocking the H2 receptors on the stomach lining. These receptors play a role in stimulating acid production when bound by histamine. With this process blocked, ranitidine effectively reduces the acidity inside the stomach as a whole, which is essential in healing damaged tissues and relieving their symptoms.
Side Effects and Safety Issues
Patients generally tolerated ranitidine well under the drug. Among the common side effects that patients experienced were headache, dizziness, constipation, or diarrhea. Rare but serious side effects were irregular heartbeat, blurred vision, or significantly lowered blood pressure.
NDMA contamination issues
In 2019, the U.S. Food and Drug Administration released that it was airing its worries over N-nitrosodimethylamine, a known carcinogen that allegedly had been discovered in several ranitidine products. NDMA may result from decomposition, especially if this occurs at high temperature or with the aid of long storage periods, under certain circumstances. The revelations brought a global recall of many ranitidine products and caused increased scrutiny over the safety of the drug.
Later, the FDA asked manufacturers to withdraw the products voluntarily back from the market and, in turn, informed patients and providers to consider alternative treatments. The crisis of NDMA contamination severely challenged the supply of ranitidine; manufacturers and other regulatory agencies were reevaluating much greater exposure risks created by the compound.
Alternatives for Ranitidine
Following withdrawal, patients and practitioners looked at alternative treatments for acid-related disease. Some drugs are equally effective and safe alternatives.
Other H2 receptor antagonists: Famotidine (Pepcid) and cimetidine (Tagamet) are other H2 receptor antagonists that work essentially like ranitidine. The presence of NDMA and the significant impact of famotidine on the reduction of secretion of stomach acids is what made the former a sought-after alternative.
Proton Pump Inhibitors: PPI’s encompass medications such as omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Protonix). PPIs tend to have a more significant impact by inhibiting the enzyme producing acid. PPIs are medicines primarily used to cure a variety of diseases, including GERD, peptic ulcers, and erosive esophagitis.
Antacids: The over-the-counter antacids in Tums, Mylanta, and others neutralize stomach acid, but this only provides temporary relief from heartburn. They do not last as long as the H2 blockers or PPIs but are okay if you get it only every now and then.
Lifestyle Changes: Apart from pharmacologic therapy, patients are sometimes advised to make lifestyle changes that might maximize the treatment of acid reflux disease and other symptoms. Such changes include taking small, frequent meals; avoiding foods that trigger symptoms like chocolate, citrus fruits, and fat-containing products; not lying down after eating; and maintaining a healthy weight.
Future of Ranitidine
The regulatory bodies have made stricter limits of NDMA levels and imposed conditions for the storage of drugs that are vulnerable to such contamination. Ranitidine is no longer on the market in extensive quantities, though studies for formulating and the process are in progress to minimize the possibility of NDMA formation.
With this research, some companies are developing alternatives that would allow patients to utilize some benefits without risks like those brought by ranitidine. Introducing safer and equally effective alternatives such as famotidine and PPIs has ensured that patients will continually have effective acid-suppressing medications available.
Conclusion
Ranitidine was an acid-suppressive medication under which patients have trusted managing countless acid-related gastrointestinal conditions for decades. But with the growing fears over NDMA contamination, it had to be pulled off the shelves in many countries and marked the beginning of reviewing the safety status of the drug.
Although the medicine shortage works in favor of the utilization of the other available medicines, the effectiveness and usability of ranitidine were huge during the time it was being used. The advancements in treatments for acid-related ailments represent continued study, safety for patients, and regulatory scrutiny in the pharmaceutical industry. For those in need of some relief from these acid-related illnesses, alternatives are still available, and patients are advised to consult with a physician as to the optimal treatment plan.
