Gastric acid hypersecretion, duodenal ulcers and GERD and esophagitis are gastric acid related conditions. These are often treated with a common class of medications known as histamine H2 antagonist, among other treatment options. The medication works by reducing the secretion of gastric acid and when used with other medications, has been known to be effective in managing the conditions. Following subsections offer a detailed look at the drug, including possible side effects of ranitidine. This is intended to help users identify the possible undesired outcomes and prevent or manage the effects.

Overview of ranitidine

Pursuant to a US FDA in April 2020, ranitidine is not available in the US. This applies to all forms of the medication. The contents of this article are therefore not suitable for readers in the US, and is appropriate only for readers in nations where the medication is not banned.

Ranitidine is presently available in different formulations, such as tablets, effervescent formulations, and injections. Due to the reported effectiveness of the drug in handling gastric acid related conditions, it has been a popular choice for managing GERD, apart from other similar conditions.  It may be taken either alone, or along with other antacids, as part of short-term treatment options. Individuals with Zollinger-Ellison syndrome, have also been recommended the medication due to the increased gastric acid secretion. Other conditions that are managed with ranitidine include systemic mastocytosis, apart management dosages for gastric ulcers.

Mechanism of action of the H2 blocker ranitidine

The outcomes of the H2 blocker are attributed to the mechanism of action, which results in the reduction of gastric acid secretion. Histamine is released after a meal, as a result of the stimulation by gastrin hormone. This histamine ends up binding to the histamine H2 receptors, and consequent to this, gastric acid is released.  The medication works by binding reversibly to the H2 receptors, and this binding action prevents the histamine from binding to the H2 receptors, when it is released by the gastrin hormone. This brings about a reduction in the secretion of gastric acid, thereby helping to offer relief from gastric acid related conditions. The onset of action after the medication has been administered could take around one hour, and this could last for as long as ten hours depending on the dosage and the form of medication. This delivers symptomatic relief that is effective and long enough for patients suffering from conditions mentioned above.

Ideal dosage when on H2 blockers

Ranitidine is one of the different H2 blockers; and while ranitidine in different forms has been banned, other H2 blockers are approved and available. It is important to follow dosage instructions diligently. The schedule of intake and dosage of these medications are of great significance, as a significant percentage of undesirable effects are attributed to wrong dosage and schedule. This is especially true in the case of medications like H2 blockers that were also purchased as OTC products. The urge to find better results or the need for longer effects, have often prompted individuals to end up taking stronger than required dosages. It is therefore necessary to follow instructions to avoid possible side effects of ranitidine.

Available strengths

Ranitidine is available in the following strengths – injection solutions are typically 25 mg/mL, syrups are usually 15 mg/mL and tablets are available in strengths of 75 mg, 150 mg and 300 mg. When administered to adults for treating gastroesophageal reflux conditions, the ideal dosage is 150 mg once in twelve hours, while the injections are administered in 50 mg strengths once every eight hours. For hypersecretory conditions, the dosage is the same as the above condition. For gastric ulcers that are benign, tablets in strengths of 150 mg are administered once in six hours, while injections in strengths of 50 mg are given once in 6 hours. The maintenance dosage is different, with tablets given in the same strength, but once in twelve hours. These are intended for reference only and the actual dosage will depend on various factors, as determined by the specialist.

When administered as an injection or in a healthcare setting, the chances of incorrect dosage or schedule are minimal. However, when the medication is taken as a tablet, the chances of making mistakes are higher. Typically, tablets are recommended to be taken once a day, and the ideal time is before going to bed. However, in the event of the medication being prescribed to be taken twice daily, there is usually a gap of around 12 hours, with the first does in the morning and the second in the evening.

Precautions for certain categories of individuals

The drug is to be avoided by certain categories of individuals due to the distinct mechanism of action and the properties that may have an impact. For instance, elderly patients are advised to stay off the presently available H2 blockers as the likelihood of confusion increases manifold. In the event that it is to be taken, patients are to ensure that utmost care is followed; including monitoring of behavior or outcome. Individuals with kidney ailments or any liver condition are also to seek medical advice before taking H2 blockers. This is because of the possible effects on the vital organs due to the mechanism of action of the medication. Women with suckling infants are also to avoid the drug as it is known to pass into breast milk.

Commonly reported side effects of ranitidine

All drugs, including prescription and OTC formulations may trigger undesirable effects among individuals. The nature and intensity of effects may differ from person to person, with some experiencing mild effects, while others may experience stronger effects. All users may not necessarily experience side effects, with some reportedly free from all unwanted outcomes; benefitting fully from the desired outcomes of the medication. The mild or moderate effects are known to resolve naturally and may not require any kind of treatment. However, these effects are likely to be more commonly or frequently experienced.

The serious effects may require some kind of treatment, or may sometimes warrant discontinuation of the medication. This depends on the intensity and the duration. These effects, are relatively rare in occurrence and are known to affect only a small percentage of users. Undesirable effects of medications are managed symptomatically, or the medication is discontinued, or the individual copes with the effect, till it resolves naturally. All drugs undergo rigorous and documented testing before approval, and this includes human trials to determine the effects. It is therefore relatively safe to take medications, despite the known side effects. Here is a compilation of documented effects of H2 blockers. This is not an exhaustive list of effects, and it is a compilation of effects reported across different H2 blockers. Therefore, it is wrong to assume that users may be exposed to all these effects from single brand of medications belonging to H2 blockers category.

Documented effects

Individuals on ranitidine and other H2 blockers may experience headaches frequently, while some may end up with pain in the abdomen. The patient may exhibit agitated behavior, and may often appear to be confused. This is one of the reasons for elderly patients being dissuaded from using the medication. There is a possibility of hair loss, and this some patients may find it difficult to cope with this issue.  Other effects include constipation, diarrhea and possible vomiting sensations. Dizzy feelings are also relatively common among users of H2 blockers; similarly, users are known to react with hypersensitivity.

The mechanism of action of the drug may also cause anemia in patients. The medication is also known to trigger necrotizing inflammation in new-born babies and the fetus. This may occur in the small intestines and the colon; and this is another reason for the warning for pregnant women against use of the drug. Women planning a pregnancy are also to exercise utmost caution, and medical advice is mandatory prior to use.

Effects considered as rare and a cause for concern

Effects that are a cause for concern include possible pancreatitis, and a reduction in blood cells, platelets and white blood cells. Individuals may end up with acquired immune hemolytic anemia apart from possible pain in the muscles or the joints.  The possibility of an impact on the central nervous system also exists and this includes slurring of speech and possible hallucinations.

Drug interactions of the H2 blocker

Similar to undesirable outcomes of medications, all drugs come with the possibility of drug interactions, when taken along with other drugs. This is attributed to the conflicting mechanisms of action or the properties of medications. This is not restricted to prescription drugs, but may also be experienced with other OTC formulations, supplements, nutraceuticals, herbal remedies, alternative medicines and certain food products. There are different outcomes from drug interactions; for instance, there could be an increase in the potency of one medication, more than the desired outcome.

There could also be a reduction in the efficacy of the medication when taken with some other product or drug. Finally, there is the possibility of aggravation of side effects of the medication when taken with other products. Here is a small list of medications that could trigger interactions when taken with H2 blockers. This is intended to serve as a reference of possible interactions and is not to be considered as an exhaustive list of interactions. Medicines and herbal products such as atazanavir, itraconazole, mesalamine, ponatib, blessed thistle, devil’s claw, etravirine, miglitol, propantheline and triazolam are known to interact with ranitidine.

Actions to mitigate the interactions

Depending on the type of interaction and the intensity, doctors may recommend discontinuation of either of the two drugs, after determining the importance of each. In the event that both are of equal importance, the schedule may be altered and the dosage may also be modified to minimize the effects. H2 blockers can impact the efficacy of pain medications, and the effectiveness of blood thinners, it is therefore necessary to intimate the treating specialist about use of medications for existing conditions.

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