ranitidine hydrochloride

ranitidine hydrochloride

(ra nye' te deen)

Novo-Ranidine (CAN), Nu-Ranit (CAN), Zantac, Zantac EFFERdose, Zantac GELdose, Zantac 75, Zantac 150

Pregnancy Category B

Drug class

Histamine₂ (H₂) antagonist

Therapeutic actions

Competitively inhibits the action of histamine at the histamine₂ (H₂) receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin, and pentagastrin.

Indications

·        Short-term treatment of active duodenal ulcer

·        Maintenance therapy for duodenal ulcer at reduced dosage

·        Short-term treatment of active, benign gastric ulcer

·        Short-term treatment of GERD

·        Pathologic hypersecretory conditions (eg, Zollinger-Ellison syndrome)

·        Treatment of erosive esophagitis

·        Treatment of heartburn, acid indigestion, sour stomach

Contraindications and cautions

·        Contraindicated with allergy to ranitidine, lactation.

·        Use cautiously with impaired renal or hepatic function, pregnancy.

Available forms

Tablets—75, 150, 300 mg; effervescent tablets and granules—25, 150 mg; syrup—15 mg/mL; injection—1, 25 mg/mL

Dosages

ADULTS

·        Active duodenal ulcer: 150 mg bid PO for 4–8 wk. Alternatively, 300 mg PO once daily hs or 50 mg IM or IV q 6–8 hr or by intermittent IV infusion, diluted to 100 mL and infused over 15–20 min. Do not exceed 400 mg/day.

·        Maintenance therapy, duodenal ulcer: 150 mg PO hs.

·        Active gastric ulcer: 150 mg bid PO or 50 mg IM or IV q 6–8 hr.

·        Pathologic hypersecretory syndrome: 150 mg bid PO. Individualize dose with patient's response. Do not exceed 6 g/day.

·        GERD, esophagitis, benign gastric ulcer: 150 mg bid PO.

·        Treatment of heartburn, acid indigestion: 75 mg PO as needed.

PEDIATRIC PATIENTS

Safety and efficacy not established.

GERIATRIC PATIENTS OR PATIENTS WITH IMPAIRED RENAL FUNCTION

For creatinine clearance < 50 mL/min, accumulation may occur; use lowest dose possible, 150 mg q 24 hr PO or 50 mg IM or IV q 18–24 hr. Dosing may be increased to q 12 hr if patient tolerates it and blood levels are monitored.

Pharmacokinetics

Route	Onset	Peak	Duration
Oral	Varies	1–3 hr	8–12 hr
IM	Rapid	15 min	8–12 hr
IV	Immediate	5–10 min	8–12 hr

Metabolism: Hepatic; T_1/2: 2–3 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

IV facts

Preparation: For IV injection, dilute 50 mg in 0.9% sodium chloride injection, 5% or 10% dextrose injection, lactated Ringer's solution, 5% sodium bicarbonate injection to a volume of 20 mL; solution is stable for 48 hr at room temperature. For intermittent IV, use as follows: Dilute 50 mg in 100 mL of 5% dextrose injection or other compatible solution

Infusion: Inject over 5 min or more; for intermittent infusion, infuse over 15–20 min; continuous infusion, 6.25 mg/hr

Incompatibilities: Do not mix with amphotericin B

Adverse effects

·        CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo

·        CV: Tachycardia, bradycardia, PVCs (rapid IV administration)

·        Dermatologic: Rash, alopecia

·        GI: Constipation, diarrhea, nausea, vomiting, abdominal pain, hepatitis, increased ALT levels

·        GU: Gynecomastia, impotence or decreased libido

·        Hematologic: Leukopenia, granulocytopenia, thrombocytopenia, pancytopenia

·        Local: Pain at IM site, local burning or itching at IV site

·        Other: Arthralgias

Interactions

Drug-drug

·        Increased effects of warfarin, TCAs; monitor patient closely and adjust dosage as needed

Nursing considerations

Assessment

·        History: Allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy

·        Physical: Skin lesions; orientation, affect; pulse, baseline ECG; liver evaluation, abdominal examination, normal output; CBC, LFTs, renal function tests

Interventions

·        Administer oral drug with meals and hs.

·        Decrease doses in renal and liver failure.

·        Provide concurrent antacid therapy to relieve pain.

·        Administer IM dose undiluted, deep into large muscle group.

·        Arrange for regular follow-up, including blood tests, to evaluate effects.

Teaching points

·        Take drug with meals and at bedtime. Therapy may continue for 4–6 weeks or longer.

·        If you also are on an antacid, take it exactly as prescribed, being careful of the times of administration.

·        Have regular medical follow-up care to evaluate your response.

·        You may experience these side effects: Constipation or diarrhea (request aid from your health care provider); nausea, vomiting (take drug with meals); enlargement of breasts, impotence or decreased libido (reversible); headache (adjust lights and temperature and avoid noise).

·        Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, hallucinations, dizziness, severe headache, muscle or joint pain.

Adverse effects in Italic are most common; those in Bold are life-threatening.