ranitidine hydrochloride

(ra nye' te deen)

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

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 gastroesophageal reflux disease (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—150 mg; capsules—150,
300 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; T1/2: 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 exam, normal output; CBC, liver and renal function tests

Interventions
• Administer oral drug with meals and at bedtime.
• 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 wk 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.
• These side effects may occur: 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.