The Top 200 Prescribed Drugs

Note: 199 Pravastatin (Pravachol®) has been covered in a previous episode (105)

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200 Ranitidine (Zantac®)

Episode Notes (References Below)

• Brand/Generic:
  • Generic: Ranitidine (Available)
  • Brand: Zantac®
• Mechanism of Action
  • Histamine H2 Antagonsist (H2 Blocker)
  • Inhibits gastric acid secretion by blocking H2-receptors on the gastric parietal cells
• Indication(s)

• Duodenol or gastric ulcer
• GERD (gastroesophogeal reflux disease)
• Erosive esophagitis
• Hypersecretory conditions
• H. Pylori eradication (as part of a multidrug regimen)
• Heart burn and indigestion
• Sour stomach

• Dosage form(s)
  • Capsule
    • 150, 300 mg
  • Premixed infusion solution
    • 50 mg
  • Injection solution
    • 25 mg/mL
  • Oral Syrup
    • 15 mg/mL
  • Tablet
    • 75 [OTC], 150 [OTC], 300 mg
  • Effervescent tablet for solution
    • 25 mg
• Adult Dosing
  • Depends on the indication
  • For most indications (GERD, ulcers, H. pylori, erosive esophagitis maintenance)
    • Usual dose is 150 mg twice daily
  • For erosive esophagitis treatment: 150 mg 4 times/day
  • For OTC use in preventing heartburn:
    • 75 mg 30-60 min before eating or drinking food that may cause heartburn.
    • Max dose: 150 mg in 24 hours
    • Should not self treat for > 14 days
      • See a doctor for long-term treatment
  • For patients with renal impairment: Creatinine clearance (CrCl) < 50 mL/min:
    • Oral 150 mg every 24 hours
    • IV 50 mg every 18-24 hours
    • Adjust the dose carefully if necessary
• Pharmacokinetics
  • ~50% absorption
  • Metabolized in the liver
  • Time to peak: 2-3 hours
  • Excreted in the urine as unchanged drug and the feces as metabolites
• Contraindication(s)
  • Hypersensitivity
• Precaution(s)
  • Long term use may lead to vitamin B12 deficiency
  • Confusion, especially in elderly patients > 50 years of age, although rare, has been documented with the use of ranitidine
    • Fully reversibly, and usually clears within 4 days after discontinuation
  • Relief of symptoms does not eliminate the presence of a gastric tumor or malignangy
  • Adjust dose renal impairment with a CrCl < 50 mL/min
  • Avoid use in patients with a history of actue porphyria
    • Zantac® could exacerbate an attack
• Adverse Drug Reactions
  • Most common
    • Headache
    • GI upest
    • Confusion
    • Dizziness
• MAJOR Drug Interactions
  • Avoid use with either Delavirdine or Erlotinib
  • P-Glycoprotein inhibitors may increase the effects of ranitidine
• Pregnancy Category/Breast feeding
  • Category B
  • Use with caution in breast feeding (does enter breast milk)
• Safety & Efficacy Monitoring Parameters
  • Serum creatinine and renal function
  • Signs and symptoms of peptic ulcer disease
  • Occult blood with GI bleeding
  • Relief of symptoms
• Major Counseling Points
  • If taking ranitidine to prevent heart burn, then you should take the dose 30-60 minutes before eating foods that may lead to heartburn
    • Unless instructed to do so by your doctor, do not exceed 150 mg in a 24 hour period
    • Do not self treat for > 2 weeks
      • If longer treatment is needed, it is recommended to see a doctor to make sure there is no other underlying cause of the symptoms
  • Make sure the patient knows dosing schedule, usually twice daily
  • Common side effects include GI upset, headache, and dizziness
  • Let you doctor or pharmacist know if ranitidine causes any mental confusion
  • As always, report any severe, persistent, or intolerable side effects

References:

1. Ranitidine. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 29]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline
2. Zantac®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17
3. Ranitidine. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2011, cited 2011 Aug 29].  [About 6 p.]. Available from: https://online.epocrates.com/noFrame/
4. Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf

Yeah. So we finished the top 200! I want to thank you all for listening.  And don’t worry. I do have some more pharmacy related podcast in the works that I hope you will be interested in. Be sure to check TheStudentPharmacist.com in the next couple of weeks for more information. Also, I hope you have learned  a little something and have gotten some useful information out of the podcast.  If you have can please share it with others who may be interested AND consider giving a small donation towards this podcast and future podcast like it. There is a donate button now on the studentpharmacist.com.  Every little bit helps. Thanks and see you next time!