Ranitidine (Lexi-Drugs Multinational)

Drug Shortages: US

One or more forms of this drug may be in short supply or unavailable. Refer to the following for additional

information:
ASHP: http://www.ashp.org/menu/DrugShortages

Pronunciation

(ra NI ti deen)

Brand Names: US

Acid Reducer Maximum Strength [OTC] [DSC]; Acid Reducer [OTC]; Deprizine FusePaq; GoodSense Acid Reducer

[OTC]; Ranitidine Acid Reducer [OTC]; Zantac; Zantac 150 Maximum Strength [OTC]; Zantac 75 [OTC]; Zantac EFFERdose [DSC]; Zantac in
NaCl [DSC]

Brand Names: Canada

Acid Reducer; ACT Ranitidine; Apo-Ranitidine; Dom-Ranitidine; Myl-Ranitidine; Mylan-Ranitidine; PHL-

Ranitidine; PMS-Ranitidine; RAN-Ranitidine; Ranitidine Injection, USP; Riva-Ranitidine; Sandoz-Ranitidine; Teva-Ranitidine; Zantac; Zantac 75;
Zantac Maximum Strength Non-Prescription

Brand Names: International

Acicard (TW); Acidex (AR); Aciflux (CL, LI); Aciloc (BF, BJ, CI, CZ, ET, GH, GM, GN, IN, KE, LR, MA,

ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TW, TZ, UG, VN, ZM, ZW); Acloral (MX); Acran (ID); Aldin (IN); Alquen (ES); Anistal (DO, GT, HN,
NI, SV); Antagonin (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM, ZW); Antak (BR); ApoRanitidine (NZ); Ardoral (ES); Arnetin (MY); Artonil (SE); Atural (PE); Ausran (AU); Azantac (FR, MX); Bindazac (MT); Consec (IN); Contracid
(PH); Danitin (PH); Diciran (LK); Doranit (ID); Eltidine (KR); Entac (LK); Ezopta (GR); Galidrin (MX); Gastrial (AR); Gastridin (ID); Gastril (MY);
Gastrone (PH); Gastrosedol (AR); Hexal Ranitic (AU); Hexer (ID); Histac (BF, BH, BJ, CI, ET, GH, GM, GN, HU, IN, JO, KE, KW, LR, MA, ML, MR,
MU, MW, NE, NG, SC, SD, SL, SN, TH, TN, TZ, UG, ZM, ZW); Histak (UA, ZA); Huma-Ranidine (HU); Hyzan (HK); Iqfadina (MX); Junizac (DE);
Locid (KR); Lumeran (HK); Lydin (IN); Nadine (AE, BH, CY, EG, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Neoceptin-R (SG); Nipodur (MT);
Nitidin (PY); Pepiture (LK); Peptoran (HR); Ponaltin (KR); Ptinolin (GR); Pylorid (HR, HU, LU, PH); R-Loc (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA,
ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM, ZW); Radinat (EC); Ranacid (BH, JO, KW, LB, SA); Randin (AE, BH, CY, EG, IQ, IR, JO,
KW, LB, LY, OM, QA, SA, SY, YE); Rani 2 (AU); Ranial (IN); Raniben (IT); Raniberl (CZ, LV); Ranicux (DE); Ranidil (IT); Ranidin (ES); Ranidine
(TH); Ranigast (LV); Ranimex (FI); Ranin (ID, TH); Ranione (KR); Ranipin (VN); Raniplex (FR); Ranisan (AE, BH, CY, CZ, EG, IQ, IR, JO, KW, LB,
LY, OM, QA, SA, SY, YE); Ranisen (MX); Ranitab (EC); Ranital (CZ, HR); Ranitic (LU); Ranitidin-B (HU); Ranitin-150 (ET, ZW); Ranix (HR); Ranoxyl
Heartburn Relief (AU); Rantac (AE, BH, CY, EG, IN, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Rantacid (FI); Rantag (AE, QA, SA); Rantak (UA);
Rantin (ID); Ratic (HK, TH); Ratinal (ID); Raxide (PH); Ribotine (KR); RND (TW); Rolan (AE, BH, CY, EG, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY,
YE); Rynyt (UA); Sostril (DE); Tanidina (ES); Taural (AR, CR, DO, GT, HN, NI, PA, SV); Tyran (ID); Ulcaid (AU, ZA); Ulceran (HU, PE, ZW); Ulcex
(IT); Ulcin (PH); Ulcinorm (VN); Ulciran (PY); Ulcodin (HR); Ulcosan (CZ); Ulsal (AT); Ulticer (HK); Ultran (PH); Umaren (HU); Verlost (GR);
Vesyca (SG); Vizerul (AR); Weichilin (TW); Weidos (TW); Wontac (ET); X'Tac (MY); Xanidine (SG, TH); Xanomel (HU); Xantid (LK); Xeradin (ID);
Zantac (AE, AU, BB, BE, BF, BG, BH, BJ, BM, BS, BZ, CI, CN, CO, CR, CY, CZ, DK, DO, EC, EE, EG, ES, ET, FI, GB, GH, GM, GN, GR, GT, GY, HK, HN,
HU, ID, IE, IL, IQ, IR, IS, IT, JM, JO, KE, KR, KW, LB, LI, LK, LR, LT, LU, LY, MA, ML, MR, MT, MU, MW, MY, NE, NG, NI, NL, NO, NZ, OM, PA, PE, PH,
PK, PL, PR, PT, PY, QA, RO, RU, SA, SC, SD, SE, SI, SL, SN, SR, SV, SY, TH, TN, TR, TT, TW, TZ, UG, UY, VE, VN, YE, ZA, ZM, ZW); Zantadin (ID);
Zantic (CH, DE); Zendhin (HK, MY); Zerdin (PH); Zinetac (IN); Zydac (AE, LI, QA); Zylium (BR); Zynol (ZW)

Anatomic Therapeutic Chemical (ATC) Classification

A02BA02

Pharmacologic Category

Histamine H2 Antagonist

Dosing: Adult
Duodenal ulcer:
Oral: Treatment: 150 mg twice daily, or 300 mg once daily after the evening meal or at bedtime; maintenance of healing: 150 mg once
daily at bedtime
IM: 50 mg every 6 to 8 hours
IV:
Intermittent bolus or infusion: 50 mg every 6 to 8 hours (if increased doses are necessary utilize more frequent administration

up to a maximum of 400 mg/day).

Continuous IV infusion: 6.25 mg/hour
Erosive esophagitis: Oral: Treatment: 150 mg 4 times daily; maintenance of healing: 150 mg twice daily
Gastric ulcer, benign: Oral: 150 mg twice daily; maintenance of healing: 150 mg once daily at bedtime
Gastroesophageal reflux disease (GERD): Oral: 150 mg twice daily
Heartburn prevention or relief (OTC labeling): Oral:
Prevention: 75 to 150 mg 30 to 60 minutes before eating food or drinking beverages that cause heartburn (maximum: 2 doses/day);
do not use for more than 14 days
Relief of symptoms: 75 mg to 150 mg up to twice daily (maximum: 2 doses/day); do not use for more than 14 days
Pathological hypersecretory conditions:
Oral: 150 mg twice daily; adjust dose or frequency as clinically indicated; doses of up to 6 g/day have been used in patients with
severe disease
IM: 50 mg every 6 to 8 hours
IV:
Continuous IV infusion: 6.25 mg/hour
Continuous infusion for Zollinger-Ellison: Initial: 1 mg/kg/hour; measure gastric acid output at 4 hours, if >10 mEq or if patient is
symptomatic, increase dose in increments of 0.5 mg/kg/hour; doses of up to 2.5 mg/kg/hour (or 220 mg/hour) have been
used
Intermittent bolus or infusion: 50 mg every 6 to 8 hours (if increased doses are necessary utilize more frequent administration
up to a maximum of 400 mg/day).
Patients not able to take oral medication:
IM: 50 mg every 6 to 8 hours
IV:
Intermittent bolus or infusion: 50 mg every 6 to 8 hours (if increased doses are necessary utilize more frequent administration
up to a maximum of 400 mg/day)
Continuous IV infusion: 6.25 mg/hour
Anaphylaxis, adjunct therapy (off-label use): IV: 50 mg/dose; should not be used as monotherapy or as first line therapy (AAAAI/ACAAI
[Lieberman 2010])
Premedication to prevent taxane hypersensitivity (off-label use): IV: 50 mg administered 30 minutes prior to paclitaxel administration
(along with dexamethasone and diphenhydramine) (Lee 2009)
Stress ulcer prophylaxis, ICU patients (off-label use) (ASHP 1999): Note: Intended for patients with associated risk factors (eg,
coagulopathy, mechanical ventilation for >48 hours, severe sepsis); discontinue use once risk factors have resolved. The Surviving
Sepsis Campaign guidelines suggest the use of proton pump inhibitors rather than H2 antagonist therapy (Dellinger 2013).
Oral, nasogastric (NG) tube: 150 mg twice daily; may administer a 300 mg loading dose prior to maintenance dosing (Pemberton
1993)
IV: Intermittent bolus: 50 mg every 6 to 8 hours (Cook 1998; Geus 1993)
* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric
Dosing: Pediatric

Refer to adult dosing (use caution with dose selection).

Duodenal ulcer:
Oral:
Treatment:
Infants, Children, and Adolescents 16 years: 4 to 8 mg/kg/day divided twice daily; maximum: 300 mg/day
Adolescents >16 years: Refer to adult dosing
Maintenance of healing:
Infants, Children, and Adolescents 16 years: 2 to 4 mg/kg once daily; maximum: 150 mg/day
Adolescents >16 years: Refer to adult dosing.
IM: Adolescents >16 years: Refer to adult dosing.
IV:
Infants, Children, and Adolescents 16 years: 2 to 4 mg/kg/day divided every 6 to 8 hours; maximum dose: 50 mg/dose
Adolescents >16 years: Refer to adult dosing.
Gastric ulcer: Oral:
Treatment:
Infants, Children, and Adolescents 16 years: 4 to 8 mg/kg/day divided twice daily; maximum: 300 mg/day
Adolescents >16 years: Refer to adult dosing
Maintenance of healing:
Infants, Children, and Adolescents 16 years: 2 to 4 mg/kg once daily; maximum: 150 mg/day
Adolescents >16 years: Refer to adult dosing.
Gastroesophageal reflux disease (GERD) or erosive esophagitis: Oral:
Infants, Children, and Adolescents 16 years: 5 to 10 mg/kg/day divided twice daily; maximum: 300 mg/day
Adolescents >16 years: Refer to adult dosing.
Heartburn prevention or relief (OTC labeling):
Prevention: Children 12 years and Adolescents: Oral: 75 to 150 mg 30 to 60 minutes before eating food or drinking beverages that
cause heartburn (maximum: 2 doses/day); do not use for more than 14 days
Relief of symptoms: Children 12 years and Adolescents: Oral: 75 to 150 mg up to twice daily (maximum: 2 doses/day); do not use
for more than 14 days
Patients not able to take oral medication:
Infants, Children, and Adolescents <16 years: IV: 2 to 4 mg/kg/day divided every 6 to 8 hours; maximum dose: 50 mg/dose
Adolescents 16 years: IV: Refer to adult dosing.
Pathological hypersecretory conditions: Adolescents >16 years: Refer to adult dosing.
Anaphylaxis, adjunct therapy (off-label use): Infants, Children, and Adolescents: IV: 1 mg/kg/dose; maximum dose: 50 mg/dose; Note:
Should not be used as monotherapy or as first line therapy (AAAAI/ACAAI [Lieberman 2010])

Dosing: Renal Impairment

Adults:
CrCl 50 mL/minute: No dosage adjustment necessary.
CrCl <50 mL/minute:

Oral: 150 mg every 24 hours; adjust dose cautiously if needed

IV: 50 mg every 18 to 24 hours; adjust dose cautiously if needed
Hemodialysis: Adjust dosing schedule so that dose is scheduled to coincide with the end of hemodialysis.
Stress ulcer prophylaxis (ASHP 1999): CrCl <50 mL/minute:
Oral, nasogastric (NG) tube: 150 mg 1 to 2 times daily
IV: Intermittent bolus: 50 mg every 12 to 24 hours
Pediatrics (Aronoff 2007):
Oral: Based on a usual dose of 2 to 6 mg/kg/day divided every 8 to 12 hours
GFR >50 mL/minute/1.73 m2: No dosage adjustment necessary.
GFR 30 to 50 mL/minute/1.73 m2: 2 mg/kg/dose every 12 hours
GFR 10 to 29 mL/minute/1.73 m2: 1 mg/kg/dose every 12 hours
GFR <10 mL/minute/1.73 m2: 1 mg/kg/dose every 24 hours
Hemodialysis: 1 mg/kg/dose every 24 hours
Peritoneal dialysis: 1 mg/kg/dose every 24 hours
Continuous renal replacement therapy: 2 mg/kg/dose every 12 hours
Parenteral (IV): Based on a usual dose of 2 to 4 mg/kg/day divided every 6 to 24 hours
GFR >50 mL/minute/1.73 m2: No dosage adjustment necessary.
GFR 30 to 50 mL/minute/1.73 m2: 1 mg/kg/dose every 12 hours
GFR 10 to 29 mL/minute/1.73 m2: 0.5 mg/kg/dose every 12 hours
GFR <10 mL/minute/1.73 m2: 0.5 mg/kg/dose every 24 hours
Hemodialysis: 0.5 mg/kg/dose every 24 hours
Peritoneal dialysis: 0.5 mg/kg/dose every 24 hours
Continuous renal replacement therapy: 1 mg/kg/dose every 12 hours

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturers labeling; use with caution.

Calculations
Creatinine Clearance by Cockcroft-Gault
Creatinine Clearance by Cockcroft-Gault (SI units)
Creatinine Clearance by Cockcroft-Gault with IBW
Creatinine Clearance by Cockcroft-Gault with IBW (SI units)
Creatinine Clearance by Jelliffe
Creatinine Clearance by Sanaka
Glomerular Filtration Rate by Abbreviated MDRD
Glomerular Filtration Rate by Abbreviated MDRD (SI units)
Glomerular Filtration Rate by MDRD
Glomerular Filtration Rate by MDRD (IDMS-Traceable SCr)
Glomerular Filtration Rate by MDRD (SI units)

Use: Labeled Indications

Oral:
Duodenal ulcer: Short-term treatment of active duodenal ulcer and maintenance therapy after the healing of acute ulcers.
Erosive esophagitis: Treatment of endoscopically diagnosed erosive esophagitis; for the maintenance of healing of erosive
esophagitis.
Gastric ulcer: Short-term treatment of active, benign gastric ulcer and maintenance therapy after the healing of acute ulcer.
Gastroesophageal reflux disease: Treatment of gastroesophageal reflux disease (GERD).
Pathological hypersecretory conditions: Treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome,
systemic mastocytosis).
Heartburn (OTC only): Relief and prevention of heartburn associated with acid indigestion and sour stomach.
Injection:
Duodenal ulcers: Indicated in some hospitalized patients with intractable duodenal ulcers.
Pathological hypersecretory conditions: Indicated in some hospitalized patients with pathological hypersecretory conditions (eg,
Zollinger-Ellison).
Patients not able to take oral medication: As an alternative to the oral dosage form for short-term use in patients who are unable to
take oral medication.
* See Uses in AHFS Essentials for additional information.

Use: Off-Label
Anaphylaxis, adjunct therapy Level of Evidence [G]
Based on guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of
Allergy, Asthma & Immunology (ACAAI) for the diagnosis and management of anaphylaxis, ranitidine may be used as adjunctive
treatment, although should not be used as monotherapy or as first line therapy of anaphylaxis.
Premedication to prevent taxane hypersensitivity Level of Evidence [C]
Clinical experience suggests the utility of ranitidine (with dexamethasone and diphenhydramine) in reducing the incidence of
hypersensitivity related to conventional paclitaxel administration (Lee 2009). Additional data may be necessary to further define
the role of ranitidine for prevention of taxane hypersensitivity reactions.
Stress ulcer prophylaxis Level of Evidence [G]
Available guidelines support the use of ranitidine as a first-line agent for the prevention of stress ulceration in certain
populations (eg, general ICU population, head and thermal injury patients, severely septic patients). Optimal candidates for
stress ulcer prophylaxis are dependent upon the risk factors present, as well as the clinical situation of the patient. Access Full
Off-Label Monograph

Level of Evidence Definitions

Level of Evidence Scale
A - Consistent evidence from well-performed randomized, controlled trials or overwhelming evidence of some other form (eg,
results of the introduction of penicillin treatment) to support the off-label use. Further research is unlikely to change
confidence in the estimate of benefit.
B - Evidence from randomized, controlled trials with important limitations (inconsistent results, methodological flaws, indirect or
imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an
impact on confidence in the estimate of benefit and risk and may change the estimate.
C - Evidence from observational studies (eg, retrospective case series/reports providing significant impact on patient care),
unsystematic clinical experience, or from potentially flawed randomized, controlled trials (eg, when limited options exist for
condition). Any estimate of effect is uncertain.

G - Use has been substantiated by inclusion in at least one evidence-based or consensus-based clinical practice guideline.

Clinical Practice Guidelines

Anaphylaxis
AAAAI/ACAAI, Diagnosis and Management of Anaphylaxis, September 2010
Critical Care:
Surviving Sepsis Campaign: International Guidelines for the Management of Severe Sepsis and Septic Shock: 2012, February 2013.
Gastroesophageal Reflux Disease:
AGA Medical Position Statement on the Management of Gastroesophageal Reflux Disease, October 2008
Helicobacter pylori Infection:
ACG Guideline on the Management of Helicobacter pylori Infection, August 2007

Usual Infusion Concentrations: Adult

IV infusion: 50 mg in 50 mL (concentration: 1 mg/mL) or 500 mg in 250 mL

(concentration: 2 mg/mL) of D5W or NS

Usual Infusion Concentrations: Pediatric

Administration: IM
Administration: IV

IV infusion: 0.5 mg/mL

No dilution is needed.
IV must be diluted; may be administered intermittent bolus, intermittent IV infusion, or continuous IV infusion

Intermittent bolus: Manufacturer recommends a maximum rate of administration of 10 mg/minute (infuse over at least 5 minutes);
however, in adults may also be administered at a maximum rate of 25 mg/minute (or over 2 minutes) if necessary (Coursin 1988;
Goelzer 1988; Smith 1987).
Intermittent IV infusion: Administer over a maximum rate of 2.5 to 3.5 mg/minute (infuse over at least 15 to 20 minutes)
Continuous IV infusion: Administer at a rate of 6.25 mg/hour; for Zollinger-Ellison patients, administer at a rate of 1 mg/kg/hour
(infusion rates as high as 220 mg/hour have been used).

Administration: Injectable Detail

Dietary Considerations

pH: 6.7 to 7.3 (25 mg/mL solution in vial)

Some products may contain phenylalanine and/or sodium. Oral dosage forms may be taken with or

without food.

Storage/Stability
Capsules, tablets: Store between 20C and 25C (68F and 77F). Protect from light. Protect from moisture.
Injection: Store intact vials between 4C and 25C (39F to 77F); excursion permitted to 30C (86F). Protect from light; do not freeze.
Avoid excessive heat (brief exposure up to 40C does not affect the product). Undiluted solution is a clear, colorless to yellow color;
slight darkening does not affect potency. Stable for 48 hours at room temperature when diluted for infusion in commonly used IV
solutions (eg, NS, D5W, D10W, Ringer's lactate injection, sodium bicarbonate 5% injection).
Suspension (Deprizine FusePaq): Store unused kit between 15C and 30C (59F and 86F); store reconstituted suspension between 2C
and 8C (36F and 46F). The final suspension is stable for 8 weeks.
Syrup: Store between 4C and 25C (39F and 77F). Protect from light.

Preparation for Administration

Continuous infusion: Dilute in D5W or other compatible IV solution; for Zollinger-Ellison patients, dilute in D5W or other compatible IV
solution to a maximum concentration of 2.5 mg/mL.
Intermittent bolus injection: Dilute in NS or other compatible IV solution to a maximum concentration of 2.5 mg/mL (20 mL).

Intermittent infusion: Dilute in D5W or other compatible IV solution to a maximum concentration of 0.5 mg/mL (100 mL).
IM: No dilution necessary.

Compatibility
Stable in D51/2NS, D5W, D10W, fat emulsion 10%, LR, NS, sodium bicarbonate 5%; for injection, do not add other medications to premixed
bag; variable compatibility (consult detailed reference) in D5LR, TPN.
Y-site administration:
Compatible: Acyclovir, alcohol (ethyl), aldesleukin, allopurinol, amifostine, aminophylline, amsacrine, anidulafungin, atracurium,
aztreonam, bivalirudin, cefazolin, cefepime, cefoxitin, ceftazidime, ciprofloxacin, cisatracurium, cisplatin, cladribine,
cyclophosphamide, cytarabine, dexmedetomidine, diltiazem, dobutamine, docetaxel, dopamine, doripenem, doxapram,
doxorubicin, doxorubicin liposome, enalaprilat, epinephrine, esmolol, etoposide phosphate, fenoldopam, fentanyl, filgrastim,
fluconazole, fludarabine, foscarnet, furosemide, gallium nitrate, gemcitabine, granisetron, heparin, hetastarch in lactate
electrolyte injection (Hextend), hydromorphone, idarubicin, labetalol, linezolid, lorazepam, melphalan, meperidine, methotrexate,
midazolam, milrinone, morphine, nicardipine, nitroglycerin, norepinephrine, ondansetron, ondansetron with paclitaxel, oxaliplatin,
paclitaxel, pancuronium, pemetrexed, piperacillin, piperacillin/tazobactam, procainamide, propofol, remifentanil, sargramostim,
tacrolimus, telavancin, teniposide, theophylline, thiopental, thiotepa, tigecycline, vecuronium, vinorelbine, warfarin, zidovudine.
Incompatible: Amphotericin B cholesteryl sulfate complex, hetastarch in sodium chloride 0.9%, insulin (regular), pantoprazole.
Variable (consult detailed reference): Drotrecogin alfa, TPN.

Medication Safety Issues

Sound-alike/look-alike issues:
Ranitidine may be confused with amantadine, rimantadine
Zantac may be confused with Xanax, Zarontin, Zofran, ZyrTEC

Contraindications
Hypersensitivity to ranitidine or any component of the formulation
OTC labeling: When used for self-medication (OTC), do not use if trouble or pain when swallowing food, vomiting with blood, or bloody or
black stools, allergic to ranitidine or other acid reducers. Do not use with other acid reducers. Do not use 150 mg tablet with kidney
disease without medical advice.
Documentation of allergenic cross-reactivity for histamine H2 antagonists is limited. However, because of similarities in chemical
structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions
Concerns related to adverse effects:
Confusion: Rare cases of reversible confusion have been associated with ranitidine; usually elderly or severely ill patients, or in
patients with renal or hepatic impairment.
Hepatic effects: Elevation in ALT levels has occurred with higher doses (100 mg) or prolonged IV therapy (5 days); monitor ALT
levels daily for the remainder of treatment.
Vitamin B12 deficiency: Prolonged treatment (2 years) may lead to vitamin B12 malabsorption and subsequent vitamin B12
deficiency. The magnitude of the deficiency is dose-related and the association is stronger in females and those younger in age
(<30 years); prevalence is decreased after discontinuation of therapy (Lam 2013).
Disease-related concerns:
Gastric malignancy: Relief of symptoms does not preclude the presence of a gastric malignancy.
Hepatic impairment: Use with caution in patients with hepatic impairment (ranitidine undergoes hepatic metabolism).

 Porphyria: Avoid use in patients with a history of acute porphyria; may precipitate attacks.
Renal impairment: Ranitidine is primarily excreted renally; dosage adjustment is recommended in patients with renal impairment.
Concurrent drug therapy issues:
Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring,
and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Special populations:
Children: Use of gastric acid inhibitors, including proton pump inhibitors and H2 blockers, has been associated with an increased
risk for development of acute gastroenteritis and community-acquired pneumonia in pediatric patients (Canani 2006).
Dosage form specific issues:
Injection: Rapid administration has been associated with bradycardia (rare), usually in patients with predisposing risk factors for
cardiac rhythm disorders. Do not exceed the recommended IV administration rate(s).
Syrup: May contain up to 7.5% alcohol.
Other warnings/precautions:
OTC labeling: When used for self-medication (OTC), notify health care provider before use if any of the following are present:
Frequent chest pain; frequent wheezing particularly with heartburn; nausea/vomiting; unexplained weight loss; stomach pain;
heartburn longer than 3 months; heartburn with light-headedness, sweating, or dizziness; chest pain or shoulder pain with
shortness of breath; sweating or pain that spreads to arms, neck, or shoulders; light-headedness. Stop use and notify health care
provider if heartburn continues, worsens, or lasts longer than 14 days.
* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

Ulcer healing rates and incidence of adverse effects are similar in the elderly, when compared to

younger patients; dosing adjustments not necessary based on age alone. Always adjust dose based upon creatinine clearance. Serum halflife is increased to 3-4 hours in elderly patients. H2 blockers are the preferred drugs for treating PUD in the elderly due to cost and ease of
administration. These agents are no less or more effective than any other therapy. The preferred agents, due to side effects and drug
interaction profile and pharmacokinetics are ranitidine, famotidine, and nizatidine. Treatment for PUD in the elderly is recommended for 12
weeks since their lesions are larger; therefore, take longer to heal. This drug is substantially cleared renally, and elderly, having decreased
renal function in general, should be monitored closely for adverse effects, especially CNS.

Pregnancy Risk Factor: US

Pregnancy Considerations

Adverse events were not observed in animal reproduction studies. Ranitidine crosses the placenta

(Armentano, 1989). Histamine H2 antagonists have been evaluated for the treatment of gastroesophageal reflux disease (GERD) as well as
gastric and duodenal ulcers during pregnancy. If needed, ranitidine is the agent of choice (Cappell 2003; Richter 2003). Histamine H2
antagonists may be used for aspiration prophylaxis prior to cesarean delivery (ASA 2007).

Breast-Feeding Considerations

Ranitidine is excreted into breast milk. The manufacturer recommends that caution be

exercised when administering ranitidine to nursing women. Peak milk concentrations of ranitidine occur ~5.5 hours after the dose (case
report) (Kearns, 1985).

Pregnancy & Lactation, In-Depth

Ranitidine

Briggs' Drugs in Pregnancy & Lactation

Ranitidine

Adverse Reactions

Frequency not defined.

Cardiovascular: Asystole, atrioventricular block, bradycardia (with rapid IV administration), premature ventricular beats, tachycardia,

vasculitis
Central nervous system: Agitation, dizziness, depression, hallucinations, headache, insomnia, malaise, mental confusion, somnolence,
vertigo
Dermatologic: Alopecia, erythema multiforme, rash
Endocrine & metabolic: Prolactin levels increased
Gastrointestinal: Abdominal discomfort/pain, constipation, diarrhea, nausea, necrotizing enterocolitis (VLBW neonates; Guillet, 2006),
pancreatitis, vomiting
Hematologic: Acquired immune hemolytic anemia, acute porphyritic attack, agranulocytosis, aplastic anemia, granulocytopenia, leukopenia,
pancytopenia, thrombocytopenia
Hepatic: Cholestatic hepatitis, hepatic failure, hepatitis, jaundice
Local: Transient pain, burning or itching at the injection site
Neuromuscular & skeletal: Arthralgia, involuntary motor disturbance, myalgia
Ocular: Blurred vision
Renal: Acute interstitial nephritis, serum creatinine increased
Respiratory: Pneumonia (causal relationship not established)
Miscellaneous: Anaphylaxis, angioneurotic edema, hypersensitivity reactions (eg, bronchospasm, fever, eosinophilia)
* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

Histamine H2 Antagonist Allergy

Metabolism/Transport Effects

Substrate of CYP1A2 (minor), CYP2C19 (minor), CYP2D6 (minor), OCT2, P-glycoprotein; Note:

Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP1A2 (weak), CYP2D6 (weak)

Drug Interactions

Open Interactions

ARIPiprazole: CYP2D6 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased
aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy and/or
indication. Consult full interaction monograph for specific recommendations. Risk C: Monitor therapy
Atazanavir: H2-Antagonists may decrease the serum concentration of Atazanavir. Management: Specific dose limitations and
administration guidelines exist; consult full interaction monograph or atazanavir prescribing information. Risk D: Consider therapy
modification
Bosutinib: H2-Antagonists may decrease the serum concentration of Bosutinib. Management: Administer histamine H2 receptor
antagonists more than 2 hours before or after bosutinib. Risk D: Consider therapy modification
BuPROPion: May increase the serum concentration of OCT2 Substrates. Risk C: Monitor therapy
Cefditoren: H2-Antagonists may decrease the serum concentration of Cefditoren. Management: Concomitant use of cefditoren with H2antagonists and antacids is not recommended. Consider alternative methods to control acid reflux (eg, diet modification) or
alternative antimicrobial therapy if use of H2-antagonists can not be avoided. Risk D: Consider therapy modification
Cefpodoxime: H2-Antagonists may decrease the absorption of Cefpodoxime. Separate oral doses by at least 2 hours. Risk C: Monitor
therapy
Cefuroxime: H2-Antagonists may decrease the absorption of Cefuroxime. Separate oral doses by at least 2 hours. Risk C: Monitor therapy
Cysteamine (Systemic): H2-Antagonists may diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy
Dabrafenib: H2-Antagonists may decrease the serum concentration of Dabrafenib. Risk C: Monitor therapy

Dasatinib: H2-Antagonists may decrease the absorption of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib
administration) can be used in place of H2-antagonists if some acid-reducing therapy is needed. Risk X: Avoid combination
Delavirdine: H2-Antagonists may decrease the serum concentration of Delavirdine. Management: Chronic therapy with H2-antagonists
should be avoided in patients who are being treated with delavirdine. The clinical significance of short-term H2-antagonist therapy
with delavirdine is uncertain, but such therapy should be undertaken with caution. Risk X: Avoid combination
Dexmethylphenidate: H2-Antagonists may increase the absorption of Dexmethylphenidate. Specifically, H2-antagonists may interfere with
the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption
(early) and decreased delayed absorption. Risk C: Monitor therapy
Doxofylline: Ranitidine may increase the serum concentration of Doxofylline. Risk C: Monitor therapy
Erlotinib: H2-Antagonists may decrease the serum concentration of Erlotinib. Management: Avoid H2-antagonists in patients receiving
erlotinib when possible. If concomitant treatment cannot be avoided, erlotinib should be dosed once daily, 10 hours after and at least
2 hours before H2-antagonist dosing. Risk D: Consider therapy modification
Fosamprenavir: H2-Antagonists may decrease the serum concentration of Fosamprenavir. Cimetidine may also inhibit the metabolism of
the active metabolite amprenavir, making its effects on fosamprenavir/amprenavir concentrations difficult to predict. Risk C: Monitor
therapy
Gefitinib: H2-Antagonists may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or
after administration of a histamine H2-antagonist, and closely monitor clinical response to gefitinib. Risk D: Consider therapy
modification
Indinavir: H2-Antagonists may decrease the serum concentration of Indinavir. Risk C: Monitor therapy
Iron Salts: H2-Antagonists may decrease the absorption of Iron Salts. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Gluconate;
Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk C: Monitor therapy
Itraconazole: H2-Antagonists may decrease the serum concentration of Itraconazole. Management: When this combination is used, the
itraconazole should be administered with a cola beverage (8 ounces). Itraconazole oral suspension may be less sensitive to this
interaction. Monitor patient response to itraconazole closely. Risk D: Consider therapy modification
Ketoconazole (Systemic): H2-Antagonists may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer
oral ketoconazole at least 2 hours prior to use of any H2-receptor antagonist. Monitor patients closely for signs of inadequate clinical
response to ketoconazole. Risk D: Consider therapy modification
Ledipasvir: H2-Antagonists may decrease the serum concentration of Ledipasvir. Risk D: Consider therapy modification
Lumacaftor: May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. Lumacaftor may increase the serum
concentration of P-glycoprotein/ABCB1 Substrates. Risk C: Monitor therapy
Mesalamine: H2-Antagonists may diminish the therapeutic effect of Mesalamine. Histamine H2-Antagonist-mediated increases in
gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products.
Management: Consider avoiding concurrent administration of high-dose histamine H2-receptor antagonists with sustained-release
mesalamine products. Risk D: Consider therapy modification
Methylphenidate: H2-Antagonists may increase the absorption of Methylphenidate. Specifically, H2-antagonists may interfere with the
normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early)
and decreased delayed absorption. Risk C: Monitor therapy
Multivitamins/Minerals (with ADEK, Folate, Iron): H2-Antagonists may decrease the serum concentration of Multivitamins/Minerals (with
ADEK, Folate, Iron). Specifically, the absorption of iron may be impaired by H2-antagonists. Risk C: Monitor therapy
Nelfinavir: H2-Antagonists may decrease the serum concentration of Nelfinavir. Concentrations of the active M8 metabolite may also be
reduced. Risk C: Monitor therapy
Nilotinib: H2-Antagonists may decrease the serum concentration of Nilotinib. Management: The nilotinib dose should be given 10 hours
after or 2 hours before the H2 receptor antagonist in order to minimize the risk of a significant interaction. Risk D: Consider therapy
modification
PAZOPanib: H2-Antagonists may decrease the serum concentration of PAZOPanib. Management: Avoid the use of histamine H2-

antagonists in combination with pazopanib. Strategies to minimize the expected interaction between these agents (eg, dose
separation) have not been investigated. Risk X: Avoid combination
P-glycoprotein/ABCB1 Inducers: May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inducers
may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in
large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
P-glycoprotein/ABCB1 Inhibitors: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors
may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in
large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
Posaconazole: H2-Antagonists may decrease the serum concentration of Posaconazole. Management: Avoid concurrent use of oral
suspension with H2-antagonists whenever possible. Monitor patients closely for decreased antifungal effects if this combination is
used. Delayed-release posaconazole tablets may be less likely to interact. Risk D: Consider therapy modification
Prasugrel: Ranitidine may decrease serum concentrations of the active metabolite(s) of Prasugrel. Risk C: Monitor therapy
Procainamide: Ranitidine may increase the serum concentration of Procainamide. Ranitidine may also increase the concentration of the
active N-acetyl-procainamide (NAPA) metabolite. Risk C: Monitor therapy
Ranolazine: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. Risk C: Monitor therapy
Rilpivirine: H2-Antagonists may decrease the serum concentration of Rilpivirine. Management: Administer histamine H2 receptor
antagonists at least 12 hours before or 4 hours after rilpivirine. Risk D: Consider therapy modification
Risedronate: H2-Antagonists may increase the serum concentration of Risedronate. This applies specifically to delayed-release
risedronate. Risk X: Avoid combination
Saquinavir: H2-Antagonists may increase the serum concentration of Saquinavir. Risk C: Monitor therapy
Sulfonylureas: Ranitidine may increase the serum concentration of Sulfonylureas. Risk C: Monitor therapy
TiZANidine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of TiZANidine. Management: Avoid these combinations
when possible. If combined use cannot be avoided, initiate tizanidine at an adult dose of 2 mg and increase in 2-4 mg increments
based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Risk D: Consider therapy
modification
Varenicline: H2-Antagonists may increase the serum concentration of Varenicline. Management: Monitor for increased varenicline
adverse effects with concomitant use of cimetidine or other H2-antagonists, particularly in patients with severe renal impairment.
International product labeling recommendations vary. Consult appropriate labeling. Risk C: Monitor therapy
Warfarin: Ranitidine may increase the serum concentration of Warfarin. Risk C: Monitor therapy

Food Interactions

Prolonged treatment (2 years) may lead to malabsorption of dietary vitamin B12 and subsequent vitamin B12

deficiency (Lam 2013).

Test Interactions

False-positive urine protein using Multistix.

Monitoring Parameters

AST, ALT, serum creatinine; occult blood with GI bleeding, signs/symptoms of peptic ulcer disease;

when used to prevent stress-related GI bleeding, measure the intragastric pH and try to maintain pH >4; when used for Zollinger-Ellison
syndrome, monitor gastric acid secretion (goal: <10 mEq/hour); signs of confusion

Nursing: Physical Assessment/Monitoring

Use caution in presence of renal impairment; dosage adjustment may be

necessary. Monitor for CNS changes (depression, hallucinations, confusion, malaise), rash, and GI disturbance.

Dosage Forms Considerations

Deprizine FusePaq is a compounding kit for the preparation of an oral suspension. Refer to manufacturer's labeling for compounding
instructions.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

[DSC] = Discontinued product

Capsule, Oral:
Generic: 150 mg, 300 mg
Solution, Injection:
Zantac: 50 mg/2 mL (2 mL); 150 mg/6 mL (6 mL); 1000 mg/40 mL (40 mL) [contains phenol]
Generic: 50 mg/2 mL (2 mL); 150 mg/6 mL (6 mL); 1000 mg/40 mL (40 mL)
Solution, Intravenous [preservative free]:
Zantac in NaCl: 50 mg (50 mL [DSC])
Suspension Reconstituted, Oral:
Deprizine FusePaq: 22.4 mg/mL (250 mL) [contains sodium benzoate]
Syrup, Oral:
Zantac: 15 mg/mL (480 mL [DSC]) [contains alcohol, usp, butylparaben, propylparaben, saccharin sodium; peppermint flavor]
Generic: 15 mg/mL (10 mL, 473 mL, 474 mL, 480 mL); 75 mg/5 mL (473 mL, 480 mL [DSC]); 150 mg/10 mL (10 mL)
Tablet, Oral:
Acid Reducer: 75 mg, 150 mg
Acid Reducer: 150 mg [sodium free, sugar free]
Acid Reducer: 75 mg [DSC] [sugar free]
Acid Reducer Maximum Strength: 150 mg [DSC] [sugar free; contains fd&c yellow #6 (sunset yellow)]
GoodSense Acid Reducer: 75 mg [gluten free]
Ranitidine Acid Reducer: 75 mg
Zantac 75: 75 mg
Zantac: 150 mg, 300 mg
Zantac 150 Maximum Strength: 150 mg
Zantac 150 Maximum Strength: 150 mg [sodium free, sugar free; contains brilliant blue fcf (fd&c blue #1); mint flavor]
Generic: 75 mg, 150 mg, 300 mg
Tablet Effervescent, Oral:
Zantac EFFERdose: 25 mg [DSC] [contains aspartame, sodium benzoate]

Generic Available (US)

May be product dependent

Pricing: US
Capsules (Ranitidine HCl Oral)
150 mg (60): $91.27
300 mg (30): $82.30
Solution (Ranitidine HCl Injection)
50 mg/2 mL (2 mL): $3.74
150 mg/6 mL (6 mL): $8.69
Solution (Zantac Injection)

50 mg/2 mL (2 mL): $3.99

150 mg/6 mL (6 mL): $9.26
1000 mg/40 mL (40 mL): $60.54
Suspension (reconstituted) (Deprizine FusePaq Oral)
22.4 mg/mL (250 mL): $510.00
Syrup (Ranitidine HCl Oral)
15 mg/mL (480 mL): $350.00
Tablets (Ranitidine HCl Oral)
75 mg (30): $6.79
150 mg (100): $156.20
300 mg (30): $87.90
Tablets (Zantac 150 Maximum Strength Oral)
150 mg (50): $16.99
Tablets (Zantac 75 Oral)
75 mg (30): $8.99
Tablets (Zantac Oral)
150 mg (60): $398.46
300 mg (30): $361.63
Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of the brand and/or generic
product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or
adjudicate any prices for reimbursement or purchasing functions. Pricing data is updated monthly.

Genes of Interest
ATP-Binding Cassette, Sub-Family B (MDR/TAP), Member 1

Mechanism of Action

Competitive inhibition of histamine at H2-receptors of the gastric parietal cells, which inhibits gastric acid

secretion, gastric volume, and hydrogen ion concentration are reduced. Does not affect pepsin secretion, pentagastrin-stimulated intrinsic
factor secretion, or serum gastrin.

Pharmacodynamics/Kinetics
Absorption: Oral: 50%; IM: Rapid
Distribution: Vd: Minimally penetrates the blood-brain barrier
Infants, Children, and Adolescents: IV, Oral: 1 to 2.3 L/kg
Adults: Normal renal function: ~1.4 L/kg; CrCl 25 to 35 mL/minute: 1.76 L/kg
Protein binding: ~15%
Metabolism: Hepatic (minor) to N-oxide, S-oxide, and N-desmethyl metabolites
Bioavailability: Oral tablets: ~50%; IM: 90% to 100%
Half-life elimination:
Neonates (receiving ECMO): IV: 6.6 hours

Infants, Children, and Adolescents: IV: 1.7 to 2.4 hours

Adults:
Oral: Normal renal function: 2.5 to 3 hours; Elderly: 3 to 4 hours
IV: Normal renal function: 2 to 2.5 hours; CrCl 25 to 35 mL/minute: 4.8 hours; Elderly: 3.1 hours
Time to peak, serum: Oral: 2 to 3 hours; IM: 15 minutes
Excretion: Urine (as unchanged drug): Oral: 30%, IV: 70%; feces (as metabolites)

Local Anesthetic/Vasoconstrictor Precautions

Effects on Dental Treatment
Effects on Bleeding

No information available to require special precautions

No significant effects or complications reported

No information available to require special precautions

Related Information
Beers Criteria Potentially Inappropriate Medications for Geriatrics

Index Terms

Ranitidine Hydrochloride

References
American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated
report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology. 2007;106(4):843-863.[PubMed
17413923]
Armentano G, Bracco PL, Di Silverio C. Ranitidine in the treatment of reflux oesophagitis in pregnancy. Clin Exp Obstet Gynecol.
1989;16(4):130-133.[PubMed 2627742]
Aronoff GR, Bennett WM, Berns JS, et al, eds. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed.
Philadelphia, PA: American College of Physicians; 2007.
ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and Approved by the ASHP Board of
Directors on November 14, 1998, Am J Health Syst Pharm, 1999, 56(4):347-79. [PubMed 10690219]
Balestrazzi P, Gregori G, Bernasconi S, et al, Bradycardia and Neurologic Disorders Associated With Ranitidine in a Child, Am J Dis Child,
1985, 139(5):442.[PubMed 3984961]
Blumer JL, Rothstein FC, Kaplan BS, et al, Pharmacokinetic Determination of Ranitidine Pharmacodynamics in Pediatric Ulcer Disease, J
Pediatr, 1985, 107(2):301-6. [PubMed 4020560]
Canani RB, Cirillo P, Roggero P, et al; Working Group on Intestinal Infections of the Italian Society of Pediatric Gastroenterology,
Hepatology and Nutrition (SIGENP). Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and communityacquired pneumonia in children. Pediatrics. 2006;117(5):e817-e820.[PubMed 16651285]
Cappell MS. Gastric and duodenal ulcers during pregnancy. Gastroenterol Clin North Am. 2003;32(1):263-308.[PubMed 12635419]
Chey WD and Wong B, American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection, Am J
Gastroenterol, 2007 102(8):1808-25.[PubMed 17608775]
Cook D, Guyatt G, Marshall J, et al, A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in
Patients Requiring Mechanical Ventilation. Canadian Critical Care Trials Group, N Engl J Med, 1998, 338(12):791-7. [PubMed 9504939]
Coursin DB, Farin-Rusk C, Springman SR, et al, The Hemodynamic Effects of Intravenous Cimetidineversus Ranitidine in Intensive Care
Unit Patients: A Double-Blind, Prospective, Cross-Over Study, Anesthesiology, 1988, 69(6):975-8.[PubMed 3057942]
Dellinger RP, Levy MM, Rhodes A, et al, Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic
Shock, 2012, Crit Care Med, 2013, 41(2):580-637.[PubMed 23353941]
Deprizine FusePaq (ranitidine) [prescribing information]. Camarillo, CA: Fustion Pharmaceuticals; no date.

Eddleston JM, Booker PD, and Green JR, Use of Ranitidine in Children Undergoing Cardiopulmonary Bypass, Crit Care Med, 1989,
17(1):26-9. [PubMed 2909317]
Fennerty MD and Higbee M, Drug Therapy of Gastrointestinal Disease, Geriatric Pharmacology, Bressler R and Katz MD, eds, New York,
NY: McGraw-Hill, 1993, 585-608.
Fontana M, Massironi E, Rossi A, et al, Ranitidine Pharmacokinetics in Newborn Infants, Arch Dis Child, 1993, 68(5 Spec No):602-3.
[PubMed 8323366]
Freeman HJ, Ranitidine-Associated Interstitial Nephritis in a Patient With Celiac Sprue, Can J Gastroenterol, 1988, 2:35.
Goelzer SL, Farin-Rusk C, and Coursin DB, Ranitidine Produces Minimal Hemodynamic Depression in Stable Intensive Care Unit Patients:
A Double-Blind, Prospective Study, Crit Care Med, 1988, 16(1):8-10.[PubMed 3276451]
Geus WP, Vinks AA, Smith SJ, et al, Comparison of Two Intravenous Ranitidine Regimens in a Homogeneous Population of Intensive
Care Unit Patients, Aliment Pharmacol Ther, 1993, 7(4):451-7.[PubMed 8218759]
Guillet R, Stoll BJ, Cotten CM, et al, "Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth
Weight Infants," Pediatrics, 2006, 117(2):137-42.[PubMed 16390920]
Kahrilas PJ, Shaheen NJ, Vaezi MF, et al, American Gastroenterological Association Medical Position Statement on the Management of
Gastroesophageal Reflux Disease, Gastroenterology, 2008, 135(4):1383-91.[PubMed 18789939]
Kearns GL, McConnell RF Jr, Trang JM, Kluza RB. Appearance of ranitidine in breast milk following multiple dosing. Clin Pharm.
1985;4(3):322-324.[PubMed 4039999]
Kelly KL, Ranitidine Cross-Reactivity in the EMIT D.A.U. Monocolonal Amphetamine/Methamphetamine Assay, Clin Chem, 1990,
36(7):1391-2.[PubMed 2372968]
Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency.
JAMA. 2013;310(22):2435-2422.[PubMed 24327038]
Lee C, Gianos M, Klaustermeyer WB. Diagnosis and management of hypersensitivity reactions related to common cancer chemotherapy
agents. Ann Allergy Asthma Immunol. 2009;102(3):179-187; quiz 187-189, 222.[PubMed 19354063]
Lehmann AB, Reversible Chorea Due to Ranitidine and Cimetidine, Lancet, 1988, 2(8603):158.[PubMed 2899203]
Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update
[published correction appears in J Allergy Clin Immunol. 2010;126(6):1104]. J Allergy Clin Immunol. 2010;126(3):477-480.[PubMed
20692689]
Lopez-Herce J, Albajara L, Codoceo R, et al, Ranitidine Prophylaxis in Acute Gastric Mucosal Damage in Critically Ill Pediatric Patients,
Crit Care Med, 1988, 16(6):591-93. [PubMed 3371023]
Maack DK and Spiller HA, Rare Dystonic Reaction From Accidental Overdose of Ranitidine in a 3 Month Old, Vet Hum Toxicol, 1993,
35:343.
Miralles ES, Nunez M, del Olmo N, et al, Ranitidine-Related Toxic Epidermal Necrolysis in a Patient With Idiopathic Thrombocytopenic
Purpura, J Am Acad Dermatol, 1995, 32(1):133-4. [PubMed 7822507]
Morris DL, Markham SJ, Beechey A, et al, Ranitidine-Bolus or Infusion Prophylaxis for Stress Ulcer, Crit Care Med, 1988, 16(3):229-32.
[PubMed 3277779]
Ohsawa T, Masuhara K, and Hirata W, Reversal of Ranitidine-Induced Hypergastrinemia by Cimetidine, Ann Pharmacother, 1994,
28(11):1303. [PubMed 7849349]
Pemberton LB, Schaefer N, Goehring L, et al, Oral Ranitidine as Prophylaxis for Gastric Stress Ulcers in Intensive Care Unit Patients:
Serum Concentrations and Cost Comparisons, Crit Care Med, 1993, 21(3):339-42.[PubMed 8440101]
Ranitidine capsules and tablets [prescribing information]. Princeton, NJ: Sandoz; February 2014.
Ranitidine syrup [prescribing information]. Cranbury, NJ: Sun Pharmaceutical Industries; April 2015.
Richter JE, Gastroesophageal Reflux Disease During Pregnancy, Gastroenterol Clin North Am, 2003, 32(1):235-61.[PubMed 12635418]

Roberts CJ, Clinical Pharmacokinetics of Ranitidine, Clin Pharmacokinet, 1984, 9(3):211-21. [PubMed 6329583]
Romaguera C, Grimalt F, and Vilaplana J, Epidemic of Occupational Contact Dermatitis From Ranitidine, Contact Dermatitis, 1988,
18(3):177-8. [PubMed 2966715]
Smith CL, Bardgett DM, and Hunter JM, Haemodynamic Effects of the I.V. Administration of Cimetidine or Ranitidine in the Critically Ill
Patient: A Double-Blind Prospective Study, Br J Anaesth, 1987, 59(11):1397-1402.[PubMed 3689613]
Souza Lima MA, Hepatitis Associated With Ranitidine, Ann Intern Med, 1984, 101(2):207-8. [PubMed 6331240]
Todd P, Norris P, Hawk JL, et al, Ranitidine-Induced Photosensitivity, Clin Exp Dermatol, 1995, 20(2):146-8.[PubMed 8565251]
Zantac 150 tablets (ranitidine) [prescribing information]. Ridgefield, CT: Boehringer Ingelheim; July 2014.
Zantac 150 and 300 tablets (ranitidine) [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; February 2015.
Zantac 75 tablets (ranitidine) [prescribing information]. Ridgefield, CT: Boehringer Ingelheim; January 2015.
Zantac injection (ranitidine) [prescribing information]. Cary, NC: Covis Pharmaceuticals; June 2013.

Copyright 1978-2016 Lexicomp All Rights Reserved

1100 Terex Road | Hudson, OH 44236