Ranitidine (Zantac) - Complete Drug Information

Ranitidine (Zantac) is an H2 receptor blocker that suppresses acid secretion by the stomach acid-secreting cells.

It is used to treat the following conditions:

  • Oral Ranitidine:

    • Gastroesophageal reflux disease:

      • It is used to treat gastroesophageal reflux disease (GERD).

    • Heartburn (OTC only):

      • It is used for relief and prevention of heartburn associated with acid indigestion and sour stomach.

    • Peptic ulcer disease:

      • It is used for the treatment of active duodenal or gastric ulcers.
  • Proton pump inhibitors (PPIs) are used as the standard of care for treatment of peptic ulcer disease (PUD) rather than H2 -receptor antagonists

Ranitidine Injection:

    • Patients not able to take oral medication:

      • It is used as an alternative to the oral ranitidine dosage form for short-term (eg, GERD, peptic ulcer disease) use in patients who are unable to take oral medication.

    • Off-Label Usage:

      • It is used for Adult Anaphylaxis or severe infusion reaction (an adjunct to epinephrine)
      • It is used for Aspiration prophylaxis in patients undergoing anesthesia;
      • It is used for chronic spontaneous urticaria, Infusion reaction, and as premedication.
      • It is used in mastocytosis;
      • It is used for stress ulcer prophylaxis in select critically ill patients

Ranitidine Dose in Adults

Off label dosage in the treatment of Anaphylaxis or severe infusion reaction (an adjunct to epinephrine) :

  • Do not use it for the initial or sole treatment of anaphylaxis because H 2-receptor antagonists do not treat airway obstruction or shock.
  • It gives an added benefit in anaphylaxis.
  • Some experts give ranitidine after epinephrine for additional relief of hives based upon clinical experience.
  • 50 mg intravenous is given as a single dose.

Dose in the treatment of Aspiration prophylaxis in patients undergoing anesthesia (off-label):

Can be considered in patients at high risk for aspiration

  • IV:
    • 50 mg as a single dose is given almost 40 to 60 minutes prior to induction of anesthesia
    • It may be given with a rapid-acting nonparticulate antacid (eg, oral sodium citrate and citric acid) and/or metoclopramide

Dose as an alternative agent in the treatment of chronic spontaneous urticaria (adjunct) (off-label):

It can be used as additional therapy if an insufficient response to full-dose H-1 antihistamine.

  • Oral:
    • 150 mg twice daily is given in combination with H-1 antihistamine
    • a trial of 2 to 4 weeks is suggested to see the response

Dosage in the treatment of Gastroesophageal reflux disease:

  • Initial therapy:

    • Mild and intermittent symptoms (less than 2 episodes/week), and no evidence of erosive esophagitis:

  • For more severe or frequent initial symptoms, with or without evidence of erosive esophagitis, a proton pump inhibitor (PPI) as initial therapy is used.

  • Oral:

    • 75 mg twice is given daily as needed
    • if symptoms persist after 2 - 4 weeks, then increase to 150 mg twice daily for 2 weeks;
    • if symptoms begin to improve, may continue therapy as needed.
    • If symptoms persist after 14 days of 150 mg twice daily, discontinue and consider PPI therapy.

  • Residual acid reflux symptoms despite maximal PPI therapy (adjunct):

    • Oral:
      • 150 mg once daily us given at bedtime in addition to PPI therapy
      • It may also administer ranitidine intermittently or on-demand with scheduled PPI.

  • OTC labeling (patient-guided therapy): Heartburn, mild intermittent symptoms:

    • Oral:
      • 75 to 150 mg is given up to twice daily when needed (maximum: 300 mg/day)
      • It may also be taken 30 to 60 minutes before meals or beverages that cause heartburn.

Dose in the treatment of Infusion reaction, premedication (adjunct) (off-label):

  • Typically given 30 to 60 minutes prior to infusion of certain chemotherapy agents or biologics
  • It is given in conjunction with an H antihistamine (eg, diphenhydramine) and glucocorticoids (refer to institutional protocols)
    • Oral:
      • 150 to 300 mg
    • IV:
      • 50 mg

Dose in the treatment of Mastocytosis (adjunct) (off-label):

  • Oral:

    • 150 mg every 12 hours is given to achieve GI symptom relief.
    • It is typically used in combination with other appropriate agents (eg, H-1 antihistamine and/or leukotriene inhibitor).

Dose in the treatment of stress ulcer prophylaxis in select critically ill patients (off-label):

For ICU patients with associated risk factors for GI bleeding (including coagulopathy, mechanical ventilation for >48 hours, history of GI ulceration or bleeding within the past year, extensive burns) & traumatic brain injury, stop prophylaxis once risk factors have resolved

  • Oral or via NG (nasogastric) tube alternative to enteral PPI:

    • 150 mg two times a day is given

  • IV:

    • 50 mg given every 6 to 8 hours

Ranitidine Dose in Childrens

Duodenal or gastric ulcer:

Oral:

  • Treatment:

    • Infants, Children, and Adolescents ≤16 years:
      • 4 to 8 mg/kg/day is given divided twice daily
      • The maximum daily dose is 300 mg/day

    • Adolescents >16 years:

      • Dose in Duodenal ulcer:

      • 150 mg twice daily or 300 mg once daily is given after the evening meal or at bedtime

      • Dose in Gastric ulcer:

        • 150 mg twice daily  given

    • Maintenance:

      • Infants, Children, and Adolescents ≤16 years:

        • 2 to 4 mg/kg/day once daily is given
        • The maximum daily dose is 150 mg/day

      • Adolescents >16 years:

        • 150 mg once daily given at bedtime

Intramuscular:

  • Adolescents >16 years:
    • 50 mg every 6 to 8 hours is given

Intravenous:

  • Infants, Children, and Adolescents ≤16 years:

    • 2 to 4 mg/kg/day divided every 6 to 8 hours is given
    • The maximum dose is 50 mg/dose

  • Adolescents >16 years:

    • 50 mg every 6 to 8 hours is given

Dose in the treatment of Erosive esophagitis:

  • Infants, Children, and Adolescents ≤16 years:

    • Oral: 5 to 10 mg/kg/day divided twice daily is given
    • The maximum dose is 150 mg/dose

  • Adolescents >16 years: Oral

    • Treatment: 150 mg 4 times daily given
    • The maintenance dose is 150 mg twice daily

Dose in the prophylaxis of GI bleed or stress ulcer:

 IV:

  • Intermittent infusion:

    • Infants:

      • 2 to 6 mg/kg/day divided every 8 hours given

    • Children and Adolescents:

      • 3 to 6 mg/kg/day divided every 6 hours given
      • The maximum daily dose is 300 mg/day

    • Continuous infusion:

      • Infants, Children, and Adolescents:

        • Initial: 0.15 to 0.5 mg/kg/dose is given for 1 dose, followed by infusion of 0.08 to 0.2 mg/kg/hour

Dose in the treatment of GERD:

Oral:

  • Infants, Children, and Adolescents ≤16 years:

    • 5 to 10 mg/kg/day divided twice daily is given
    • The maximum daily dose is 300 mg/day

  • Adolescents >16 years:

    • 150 mg twice daily given

Dose in the treatment of Heartburn: OTC labeling:

  • Do not use for more than 2 weeks.

  • Prevention:

    • Children ≥12 years and Adolescents:

      • Oral:
        • 75 to 150 mg is given 30 to 60 minutes before eating food or drinking beverages which cause heartburn
        • The maximum daily dose is 2 doses/day

    • Relief of symptoms:

      • Children ≥12 years and Adolescents:

        • Oral :
          • 75 to 150 mg twice daily given
          • The maximum daily dose is 2 doses/day

      • Patients not able to take oral medication:

        • Infants, Children, and Adolescents <16 years:
          • IV:
            • 2 to 4 mg/kg/day given divided every 6 to 8 hours
            • The maximum dose is 50 mg/dose

        • Adolescents ≥ 16 years:

          • IM, IV:
            • 50 mg every 6 to 8 hours
          • Continuous IV infusion:
            • 25 mg/hour

Dose in the treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison):

  • Adolescents >16 years:

    • Oral:
    • 150 mg twice daily is given
    • adjust dose or frequency as clinically needed
    • doses of up to 6 g/day have been given

    • Continuous IV infusion:

      • Initial:
      • 1 mg/kg/hour.
      • Then measure gastric acid output at 4 hours, if >10 mEq/hour or if the patient is symptomatic, increase the dose in increments of 0.5 mg/kg/hour
      • Doses of up to 2.5 mg/kg/hour (or 220 mg/hour) have been given

Dose in the adjunct therapy of Anaphylaxis:

  • Infants, Children, and Adolescents:
    • IV:
      • 1 mg/kg/dose is given
      • the maximum dose is 50 mg/dose
      • It Should not be used as monotherapy or as first-line therapy.

Ranitidine (Zantac) Pregnancy Risk Factor: B

  • Ranitidine crosses the placenta.
  • Histamine H antagonists were evaluated in the treatment of gastroesophageal acid reflux disease (GERD), as well as for gastric and duodenal vultures during pregnancy.
  • Ranitidine can be used if necessary.
  • For aspiration prophylaxis before cesarean delivery, histamine H antagonists may be used. Breast-feeding considerations

Ranitidine use during breastfeeding:

  • Breast milk contains Ranitidine.
  • Ranitidine's relative infant dose (RID), is between 3.9% and 19.6% when it is calculated from the highest breastmilk concentration. This is compared to an infant therapeutic dosage of 2-10 mg/kg/day.
  • When the RID is greater than 10%, breastfeeding is generally considered unacceptable.
  • The maximum milk concentration is 2.61 mcg/mL. This means that the daily infant dose via breastmilk is 0.39 mg/kg/day.
  • Ranitidine should not be administered to nursing mothers.

Ranitidine (Zantac) dose in Kidney disease:

  • CrCl ≥50 mL/minute:

    • No dosage adjustment required

  • CrCl <50 mL/minute:

    • 150 mg orally given every 24 hours
    • Adjust the dose cautiously if required (frequency of dosing may be increased to every 12 hours or further with caution).
    • OR
    • 50 mg given intravenously every 18 to 24 hours
    • Adjust the dose cautiously if required

  • Hemodialysis:

  • Adjust the dosing schedule so that dose is scheduled to coincide with the end of hemodialysis.

  • Stress ulcer prophylaxis :

    • CrCl <50 mL/minute:

      • Oral, nasogastric (NG) tube:

        • 150 mg 1 to 2 times daily is given

      • IV: Intermittent bolus:

        • 50 mg every 12 to 24 hours is given

Ranitidine dose in Liver disease:

  • There are no dosage adjustments given in the manufacturer’s labeling.
  • Use with caution.

Side effects of Ranitidine:

  • Cardiovascular:

    • Asystole
    • Atrioventricular Block
    • Bradycardia (With Rapid IV Administration)
    • Tachycardia
    • Vasculitis
    • Ventricular Premature Contractions

  • Central Nervous System:

    • Agitation
    • Confusion
    • Dizziness
    • Depression
    • Drowsiness
    • Hallucination
    • Headache
    • Insomnia
    • Involuntary Motor Activity
    • Malaise
    • Vertigo

  • Dermatologic:

    • Alopecia
    • Erythema Multiforme
    • Injection Site Pruritus (Transient)
    • Skin Rash

  • Endocrine & Metabolic:

    • Acute Porphyria
    • Increased Serum Prolactin

  • Gastrointestinal:

    • Abdominal Distress
    • Abdominal Pain
    • Constipation
    • Diarrhea
    • Nausea
    • Necrotizing Enterocolitis (Very Low Weight Neonates; Guillet 2006)
    • Pancreatitis
    • Vomiting

  • Hematologic & Oncologic:

    • Agranulocytosis
    • Aplastic Anemia
    • Granulocytopenia
    • Hemolytic Anemia (Immune; Acquired)
    • Leukopenia
    • Pancytopenia
    • Thrombocytopenia

  • Hepatic:

    • Cholestatic Hepatitis
    • Hepatic Failure
    • Hepatitis
    • Jaundice

  • Hypersensitivity:

    • Anaphylaxis
    • Angioedema
    • Hypersensitivity Reaction (Eg
    • Bronchospasm
    • Eosinophilia
    • Fever)

  • Local:

    • Burning Sensation At Injection Site (Transient)
    • Pain At Injection Site (Transient)

  • Neuromuscular & Skeletal:

    • Arthralgia
    • Myalgia

  • Ophthalmic:

    • Blurred Vision

  • Renal:

    • Acute Interstitial Nephritis
    • Increased Serum Creatinine

  • Respiratory:

    • Pneumonia (Causal Relationship Not Established)

Contraindication to Ranitidine Include:

  • Hypersensitivity to ranitidine, or any component of the formulation
  • OTC labeling: Do not use it if you have trouble swallowing, bloody stools, vomiting, stomach pain, or are allergic to ranitidine.
  • Use it alone or with other acid reducers.
  • If you have kidney disease, do not take 150 mg tablets without consulting a doctor.

Ranitidine (Zantac), has been removed from the market due to carcinogenic impurities found in certain brands!

Warnings and precautions

  • Confusion

    • A ranitidine has been used in rare cases to reverse confusion.
    • This condition is most common in elderly patients or patients who are severely ill, as well as patients suffering from renal or hepatic impairment.

  • Hepatic effects

    • Higher doses (>=100mg) and prolonged IV therapy (>=5 day) have been associated with an increase in ALT levels.
    • Monitor ALT levels daily to ensure that the treatment continues.

  • Vitamin B deficiency:

    • Vitamin B malabsorption can occur if prolonged treatment is continued for more than 2 years.
    • The severity of the deficiency usually depends on the dose and is more severe in women than in those who are younger (30 years).
    • After discontinuation of therapy, the prevalence drops.

  • Gastric cancer:

    • Gastric malignancy can still be present despite symptoms being relieved.

  • Hepatic impairment

    • Patients with hepatic impairment should be cautious (ranitidine is subject to hepatic metabolism).

  • Porphyria

    • Patients with a history or acute porphyria should not use this product. It can cause attacks.

  • Renal impairment

    • Ranitidine is excreted primarily by the renal route
    • Patients with severe renal impairment should adjust their dosage 

Ranitidine: Drug Interaction

Risk Factor C (Monitor therapy)

Cefpodoxime

Histamine H2 Receptor Antagonists may decrease the absorption of Cefpodoxime. Separate oral doses by at least 2 hours.

Cysteamine (Systemic)

Histamine H2 Receptor Antagonists may diminish the therapeutic effect of Cysteamine (Systemic).

Dexmethylphenidate

Histamine H2 Receptor 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.

Doxofylline

RaNITIdine may increase the serum concentration of Doxofylline.

Erdafitinib

May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

Erdafitinib

May increase the serum concentration of OCT2 Substrates.

Fosamprenavir

Histamine H2 Receptor 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.

Indinavir

Histamine H2 Receptor Antagonists may decrease the serum concentration of Indinavir.

Iron Salts

Histamine H2 Receptor Antagonists may decrease the absorption of Iron Salts. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Isomaltoside; Iron Sucrose.

Lumacaftor

May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. Lumacaftor may increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

Methylphenidate

Histamine H2 Receptor 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.

Multivitamins/Minerals (with ADEK, Folate, Iron)

Histamine H2 Receptor Antagonists may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be impaired by H2-antagonists.

Nelfinavir

Histamine H2 Receptor Antagonists may decrease the serum concentration of Nelfinavir. Concentrations of the active M8 metabolite may also be reduced.

P-glycoprotein/ABCB1 Inducers

May decrease the serum concentration of Pglycoprotein/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.).

P-glycoprotein/ABCB1 Inhibitors

May increase the serum concentration of Pglycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of pglycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.).

Prasugrel

RaNITIdine may decrease serum concentrations of the active metabolite(s) of Prasugrel.

Procainamide

RaNITIdine may increase the serum concentration of Procainamide. Ranitidine may also increase the concentration of the active N-acetyl-procainamide (NAPA) metabolite.

Ranolazine

May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

Saquinavir

Histamine H2 Receptor Antagonists may increase the serum concentration of Saquinavir.

Sulfonylureas

RaNITIdine may increase the serum concentration of Sulfonylureas.

Varenicline

Histamine H2 Receptor 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.

Velpatasvir

Histamine H2 Receptor Antagonists may decrease the serum concentration of Velpatasvir.

Warfarin

RaNITIdine may increase the serum concentration of Warfarin.

Risk Factor D (Consider therapy modification)

Acalabrutinib

Histamine H2 Receptor Antagonists may decrease the serum concentration of Acalabrutinib. Management: To minimize the potential for a significant interaction, separate administration of these agents by giving acalabrutinib 2 hours before ingestion of a histamine-2 receptor antagonist.

Atazanavir

Histamine H2 Receptor Antagonists may decrease the serum concentration of Atazanavir. Management: Specific dose limitations and administration guidelines exist; consult full interaction monograph or atazanavir prescribing information.

Bosutinib

Histamine H2 Receptor Antagonists may decrease the serum concentration of Bosutinib. Management: Administer histamine H2 receptor antagonists more than 2 hours before or after bosutinib.

Cefditoren

Histamine H2 Receptor Antagonists may decrease the serum concentration of Cefditoren. Management: Concomitant use of cefditoren with H2-antagonists 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.

Dacomitinib

Histamine H2 Receptor Antagonists may decrease the serum concentration of Dacomitinib. Management: Administer dacomitinib at least 6 hours before or 10 hours after an histamine H2-receptor antagonist (H2RA).

Erlotinib

Histamine H2 Receptor 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.

Gefitinib

Histamine H2 Receptor 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.

Itraconazole

Histamine H2 Receptor Antagonists may increase the serum concentration of Itraconazole. Histamine H2 Receptor Antagonists may decrease the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any histamine H2 receptor antagonists (H2RAs). Exposure to Tolsura brand itraconazole may be increased by H2RAs; consider itraconazole dose reduction.

Ketoconazole (Systemic)

Histamine H2 Receptor 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.

Ledipasvir

Histamine H2 Receptor Antagonists may decrease the serum concentration of Ledipasvir.

Mesalamine

Histamine H2 Receptor 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.

Nilotinib

Histamine H2 Receptor 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.

Pexidartinib

Histamine H2 Receptor Antagonists may decrease the serum concentration of Pexidartinib. Management: Administer pexidartinib 2 hours before or 10 hours after histamine H2 receptor antagonists.

Posaconazole

Histamine H2 Receptor 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.

Rilpivirine

Histamine H2 Receptor Antagonists may decrease the serum concentration of Rilpivirine. Management: Administer histamine H2 receptor antagonists at least 12 hours before or 4 hours after rilpivirine.

Secretin

Histamine H2 Receptor Antagonists may diminish the diagnostic effect of Secretin. Specifically, use of H2-Antagonists may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of histamine H2-antagonists (H2RAs) and secretin. Discontinue H2RAs at least 2 days prior to secretin administration.

Tafenoquine

May increase the serum concentration of OCT2 Substrates. Management: Avoid use of OCT2 substrates with tafenoquine, and if the combination cannot be avoided, monitor closely for evidence of toxicity of the OCT2 substrate and consider a reduced dose of the OCT2 substrate according to that substrate's labeling.

Risk Factor X (Avoid combination)

Cefuroxime

Histamine H2 Receptor Antagonists may decrease the absorption of Cefuroxime. Separate oral doses by at least 2 hours.

Dasatinib

Histamine H2 Receptor 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.

Delavirdine

Histamine H2 Receptor 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.

Neratinib

Histamine H2 Receptor Antagonists may decrease the serum concentration of Neratinib. Specifically, histamine H2 receptor antagonists may reduce neratinib absorption. Management: Administer neratinib at least 2 hours before or 10 hours after administration of a histamine H2 receptor antagonist to minimize the impact of this interaction.

PAZOPanib

Histamine H2 Receptor 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.

Risedronate

Histamine H2 Receptor Antagonists may increase the serum concentration of Risedronate. This applies specifically to delayed-release risedronate.

Monitor:

  • AST and ALT
  • Serum creatinine
  • Occult blood with GI bleeding
  • Signs and 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

How to administer Ranitidine (Zantac)?

  • The injection may be administered Intramuscular or Intravenously:

IM: Injection is given undiluted IV: It Must be diluted; may be given as an intermittent bolus or intermittent IV infusion Intermittent bolus:

  • The manufacturer recommends that a maximum rate of administration of 10 mg/minute (infuse over at least 5 minutes).
  • But, in adults can also be administered at a maximum rate of 25 mg/minute (or over 2 minutes) if required

Intermittent IV infusion:

  • Give over a maximum rate of 2.5 to 3.5 mg/minute (infuse over at least 15 to 20 minutes)

Mechanism of action of Ranitidine (Zantac):

  • It inhibits histamine at the H2-receptors in the gastric parietal cell cells. This reduces gastric acid production, gastric volume and hydrogen ion concentration.
  • It does not affect pepsin secretion, pentagastrin-stimulated intrinsic factor secretion, or serum gastrin.

Absorption: Oral: 50%; IM: Rapid Distribution: V : It Minimally penetrates the blood-brain barrier Infants, Children, and Adolescents: IV, Oral: 1 - 2.3 L/kg Adults: Normal renal function: almost 1.4 L/kg; CrCl 25 - 35 mL/minute: 1.76 L/kg Protein binding: almost 15% Metabolism: Hepatic (minor) to N-oxide, S-oxide, and N-desmethyl metabolites Bioavailability: Oral tablets: almost 50%; IM: 90%-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 - 3 hours; Elderly: 3 to 4 hours IV: Normal renal function: 2 - 2.5 hours; CrCl 25 - 35 mL/minute: 4.8 hours; Elderly: 3.1 hours

Time to peak serum concentration: Oral: 2 - 3 hours; IM: ≤15 minutes

Excretion: From Urine (as unchanged drug): Oral: 30%, IV: 70%; From feces (as metabolites)

International Brands of Ranitidine:

  • Acid Reducer
  • GoodSense Acid Reducer
  • raNITIdine 150 Max Strength
  • raNITIdine Acid Reducer
  • Zantac
  • Zantac 150 Maximum Strength
  • Zantac 75
  • ACT Ranitidine
  • APO-Ranitidine
  • BCI Ranitidine
  • DOM-Ranitidine
  • JAMP-Ranitidine
  • MRanitidine
  • MAR-Ranitidine
  • MED Ranitidine
  • MYL-Ranitidine
  • MYLAN-Ranitidine
  • PHLRanitidine
  • PMS-Ranitidine
  • RAN-Ranitidine
  • Ranitidine-150
  • Ranitidine-300
  • RIVA-Ranitidine
  • SANDOZ Ranitidine
  • TEVA-Ranitidine
  • TRIA-Ranitidine
  • Zantac C
  • Zantac
  • Acicard
  • Acidex
  • Acidine
  • Aciflux
  • Aciloc
  • Acloral
  • Acran
  • Aldin
  • Alquen
  • Anistal
  • Antac
  • Antagonin
  • Antak
  • Apo-Ranitidine
  • Ardoral
  • Arnetin
  • Artonil
  • Atural
  • Ausran
  • Azantac
  • Bindazac
  • Bloxer
  • Consec
  • Contracid
  • Curan
  • Danitin
  • Diciran
  • Eltidine
  • Epiran
  • Ezopta
  • Galidrin
  • Gastrial
  • Gastridin
  • Gastril
  • Gastrone
  • Gastrosedol
  • Gertac
  • Haratac
  • Hazitac
  • Hexal Ranitic
  • Hexer
  • Histac
  • Histak
  • HumaRanidine
  • Hyzan
  • Iqfadina
  • Junizac
  • Locid
  • Lumeran
  • Lydin
  • Nadine
  • Neoceptin-R
  • Nipodur
  • Nitidin
  • Pepiture
  • Peptoran
  • Ponaltin
  • Ptinolin
  • Pylorid
  • RLoc
  • Radinat
  • Ranacid
  • Randin
  • Rani
  • Rani 2
  • Ranial
  • Raniben
  • Raniberl
  • Ranicux
  • Ranidil
  • Ranidin
  • Ranidine
  • Ranigast
  • Ranihasan
  • Ranimex
  • Ranin
  • Ranione
  • Ranipin
  • Raniplex
  • Ranisan
  • Ranisen
  • Ranitab
  • Ranital
  • Ranitic
  • Ranitidin-B
  • Ranitin-150
  • Ranix
  • Ranopine
  • Ranpex
  • Rantac
  • Rantacid
  • Rantag
  • Rantin
  • Ratic
  • Ratinal
  • Raxide
  • Ribotine
  • RND
  • Rolan
  • Sostril
  • Tanidina
  • Taural
  • Tyran
  • Ulcaid
  • Ulceran
  • Ulceranin
  • Ulcex
  • Ulcinorm
  • Ulciran
  • Ulcodin
  • Ulcosan
  • Ulsal
  • Ulticer
  • Ultran
  • Umaren
  • Verlost
  • Vesyca
  • Vizerul
  • Weichilin
  • Weidos
  • Wontac
  • X'Tac
  • Xanidine
  • Xanomel
  • Xantid
  • Xeradin
  • Zantac
  • Zantadin
  • Zantic
  • Zaridex
  • Zendhin
  • Zenti
  • Zerdin
  • Zinetac
  • Zydac
  • Zylium
  • Zynol

Ranitidine Brands in Pakistan:

Ranitidine [Inj 50 Mg]
Anzol Indus Pharma (Pvt) Ltd.

 

Ranitidine [Inj 25 Mg/Ml]
Acigo Harmann Pharmaceutical Laboratories (Pvt) Ltd.
Anatac Treat Pharmaceuticals
Anine Nexus Pharma (Pvt) Ltd
Apsar Star Laboratories (Pvt) Ltd.
Degast Hygeia Pharmaceuticals
H2 Rec Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Lawritidine Lawrence Pharma
Lomadryl Meezab International
Mariadin Elite Pharma
Nitid Danas Pharmaceuticals (Pvt) Ltd
Nulcer Bosch Pharmaceuticals (Pvt) Ltd.
Peptac Mass Pharma (Private) Limited
Peptiject Surge Laboratories (Pvt) Ltd.
Quntique Karachi Pharmaceutical Laboratory
Ra-Not Ipram International
Ranax Standpharm Pakistan (Pvt) Ltd.
Ranexin Akson Pharmaceuticals (Pvt) Ltd.
Ranidin Ferozsons Laboratoies Ltd.
Ranimark Welmark Pharmaceuticals
Ranison Life Line Pharmaceuticals (Pvt.) Ltd.
Ranitide Siza International (Pvt) Ltd.
Ranitidine S. Ejazuddin & Company
Ransly Uni-Tech Pharmaceuticals (Pvt) Ltd
Rantin Macter International (Pvt) Ltd.
Ranulcid Merck Private Ltd.
Ratidine Injection Chas. A. Mendoza
Renatil Goodman Laboratories
Reneph Epharm Laboratories
Rinai Z-Jans Pharmaceutical (Pvt) Ltd.
Shaltac Shifa Laboratories.(Pvt) Ltd.
Ulcemed Mediceena Pharma (Pvt) Ltd.
Ulcerid Medicraft Pharmaceuticals (Pvt) Ltd.
Zanil Bosch Pharmaceuticals (Pvt) Ltd.
Zantac Glaxosmithkline

 

Ranitidine [Susp 75 Mg/5ml]
Chase Shrooq Pharmaceuticals
Danitin Miracle Pharmaceuticals(Pvt) Ltd
Macridine Mac & Rans Pharmaceuticals (Pvt) Ltd
Monocid Webros Pharmaceuticals
Nazet Adamjee Pharmaceuticals (Pvt) Ltd.
Nitidine Bio Labs (Pvt) Ltd.
Octina Neutro Pharma (Pvt) Ltd.
Peptinil Wilsons Pharmaceuticals
Ramed-Ac Raazee Theraputics (Pvt) Ltd.
Raniscot Scotmann Pharmaceuticals
Renatil Susp Neo Medix
Renatil Susp Neo Medix
Stomacid Werrick Pharmaceuticals

 

Ranitidine [Tabs 75 Mg]
Renata Platinum Pharmaceuticals (Pvt.) Ltd.

 

Ranitidine [Tabs 150 Mg]
Acedonil Global Pharmaceuticals
Acidran Valor Pharmaceuticals
Altal Alson Pharmaceuticals
Anzol Indus Pharma (Pvt) Ltd.
Biodine Tabs Alkemy Pharmaceutical Laboratories (Private) Ltd.
Chase Shrooq Pharmaceuticals
Danitn Miracle Pharmaceuticals(Pvt) Ltd
Dart Medicaids Pakistan (Pvt) Ltd.
Degust Hygeia Pharmaceuticals
Dinetac Unexo Labs (Pvt) Ltd.
Dinolive Olive Pharmaceuticals
Duotec Askari Pharmaceuticals.
Fesnidine Alfalah Pharma (Pvt) Ltd.
Fozab Pearl & Pearl
Gertocalm Noble Pharma
Glamet Spencer Pharma
H2 Rec Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Healalser Lisko Pakistan (Pvt) Ltd
Kantac Drug Pharm (Pvt) Ltd.
Lomadryl Meezab International
Mariquine Lisko Pakistan (Pvt) Ltd
Monocid Webros Pharmaceuticals
Nazdac Fynk Pharmaceuticals
Nipodur A.J. & Company.
Nitid Danas Pharmaceuticals (Pvt) Ltd
Nitisaf Saaaf Pharmaceuticals
Noulce Lowitt Pharmaceuticals (Pvt) Ltd
Nulcer Bosch Pharmaceuticals (Pvt) Ltd.
Obatidine Obsons Pharmaceuticals
Peptac Mass Pharma (Private) Limited
Pepticure Nabiqasim Industries (Pvt) Ltd.
Peptinil Wilsons Pharmaceuticals
Purod Caylex Pharmaceuticals (Pvt) Ltd.
Pyrad Genome Pharmaceuticals (Pvt) Ltd
Radicon Medisure Laboratories Pakistan (Pvt.) Ltd.
Ramat Bloom Pharmaceuticals (Pvt) Ltd.
Ramed-Ac Raazee Theraputics (Pvt) Ltd.
Ranax Standpharm Pakistan (Pvt) Ltd.
Ranexin Akson Pharmaceuticals (Pvt) Ltd.
Rani Siam Pharmaceuticals
Ranidin Ferozsons Laboratoies Ltd.
Ranigard Vega Pharmaceuticals Ltd.
Raniloc Orta Labs. (Pvt) Ltd.
Ranipep Davis Pharmaceutical Laboratories
Raniscot Scotmann Pharmaceuticals
Ranison Life Line Pharmaceuticals (Pvt.) Ltd.
Ranizan Medizan Labs (Pvt) Ltd
Rantab Jawa Pharmaceuticals(Pvt) Ltd.
Rantac Sapient Pharma
Rantid Cibex (Private) Limited
Rantin Macter International (Pvt) Ltd.
Ranulcid Merck Private Ltd.
Ratac Paramount Pharmaceuticals
Ratidine Tablet Gray`S Pharmaceuticals
Reliance Mega Pharmaceuticals (Pvt) Ltd
Renacid Drugs Inn Pakistan
Renata Platinum Pharmaceuticals (Pvt.) Ltd.
Renatil Goodman Laboratories
Renera Medera Pharmaceuticals (Pvt) Ltd.
Reniloc Orta Labs. (Pvt) Ltd.
Renoxid Axis Pharmaceuticals
Resotac Rasco Pharma
Rexotide Rex Pharmaceuticals Pakistan
Rinai Z-Jans Pharmaceutical (Pvt) Ltd.
Rio Macquins International
Ritadine Chas. A. Mendoza
Stomacid Werrick Pharmaceuticals
Tagna Panacea Pharmaceuticals
Tatidine Dosaco Laboratories
Tiobine Gray`S Pharmaceuticals
Ulcemed Mediceena Pharma (Pvt) Ltd.
Ulcenor Flow Pharmaceuticals (Pvt) Ltd.
Ulcer Off Unipharma (Pvt) Ltd.
Ulcerid Medicraft Pharmaceuticals (Pvt) Ltd.
Ulsfree Zesion Pharmaceutical (Pvt) Ltd
Xetac Xenon Pharmaceuticals (Pvt) Ltd.
Xetron High - Q International
Zaniate Mediate Pharmaceuticals (Pvt) Ltd
Zantac Glaxosmithkline
Zenit Dr. Raza Pharma (Private) Limited
Zomtic Alliance Pharmaceuticals (Pvt) Ltd.

 

Ranitidine [Tabs 250 Mg]
Ranimax Helicon Pharmaceutek Pakistan (Pvt) Ltd.

 

Ranitidine [Tabs 300 Mg]
Altal Alson Pharmaceuticals
Dart Medicaids Pakistan (Pvt) Ltd.
Dinolive Olive Pharmaceuticals
Duotec Askari Pharmaceuticals.
Geotac Geofman Pharmaceuticals
Nipodur A.J. & Company.
Peptac Mass Pharma (Private) Limited
Peptinil Wilsons Pharmaceuticals
Ranax Standpharm Pakistan (Pvt) Ltd.
Ranipep Davis Pharmaceutical Laboratories
Rantin Macter International (Pvt) Ltd.
Ranulcid Merck Private Ltd.
Reliance Mega Pharmaceuticals (Pvt) Ltd
Stomacid Werrick Pharmaceuticals
Xetron High - Q International
Zantac Glaxosmithkline
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