Ranitidine

May be taken with or without food.

Patient with chronic lung disease or diabetes. Immunocompromised or severely ill patient. Patients taking NSAIDs (especially in those with a history of peptic ulcer). Avoid use in patients with history of acute porphyria. Smokers. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation. Monitoring Parameters Rule out malignancy prior to initiation of therapy in patients with gastric ulcers and patients of middle age and over with new or recently changed dyspeptic symptoms. Measure intragastric pH and try to maintain pH >4 when used to prevent stress-related gastrointestinal bleeding. Monitor AST, ALT, serum creatinine; occult blood with gastrointestinal bleeding; gastric acid secretion (when used for Zollinger-Ellison syndrome); signs or symptoms of CNS changes (confusion, depression, hallucinations) and gastrointestinal disturbance.

Significant: Elevated ALT levels (particularly with high doses or prolonged IV use), may reduce the absorption of vitamin B₁₂ (prolonged use), may increase the risk of developing community-acquired pneumonia. Rarely, reversible mental confusion, bradycardia associated with rapid administration of inj (particularly in patients with predisposing factors to cardiac rhythm disturbances), may precipitate acute porphyric attacks. Blood and lymphatic system disorders: Rarely, leucopenia, thrombocytopenia, granulocytopenia, agranulocytosis, pancytopenia (sometimes with marrow hypoplasia or aplasia), aplastic anaemia, acquired immune haemolytic anaemia. Cardiac disorders: Rarely, atrioventricular block, tachycardia, premature ventricular beats. Ear and labyrinth disorders: Rarely, vertigo. Eye disorders: Rarely, reversible blurred vision. Gastrointestinal disorders: Abdominal pain or discomfort, constipation, diarrhoea, nausea, vomiting. Rarely, acute pancreatitis. General disorders and administration site conditions: Transient pain (IM), local burning or itching (IV) at the site of inj. Rarely, malaise. Hepatobiliary disorders: Rarely, hepatitis (with or without jaundice), hepatic failure. Immune system disorders: Rarely, hypersensitivity reactions including urticaria, angioneurotic oedema, fever, bronchospasm, hypotension, and chest pain; very rarely, anaphylactic shock. Investigations: Rarely, transient and reversible LFT changes, elevated plasma creatinine. Musculoskeletal and connective tissue disorders: Rarely, arthralgia, myalgia. Nervous system disorders: Rarely, headache (sometimes severe), dizziness, reversible involuntary movement disorders. Psychiatric disorders: Rarely, agitation, depression, hallucinations, insomnia, somnolence. Renal and urinary disorders: Rarely, acute interstitial nephritis. Reproductive system and breast disorders: Rarely, reversible impotence, breast symptoms and breast conditions (e.g. gynaecomastia and galactorrhoea). Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Rarely, rash, erythema multiforme, alopecia. Vascular disorders: Rarely, vasculitis.

Altered prothrombin time with coumarin anticoagulants (e.g. warfarin). High doses of ranitidine may reduce excretion and increase the plasma levels of procainamide and active N-acetylprocainamide metabolite. May increase the absorption of midazolam, triazolam, and glipizide. May reduce the absorption of atazanavir, delavirdine, ketoconazole, and gefitinib. Decreases the exposure of erlotinib. Reduced absorption with high-dose (2 g) sucralfate.

Antacids, Antireflux Agents & Antiulcerants

A02BA02 - ranitidine ; Belongs to the class of H2-receptor antagonists. Used in the treatment of peptic ulcer and gastro-oesophageal reflux disease (GERD).