ranitidine (Rx)

Brand and Other Names:Zantac, Zantac 150 Maximum Strength, more...Zantac 75
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection solution

  • 25mg/mL

syrup

  • 15mg/mL

tablet

  • 75mg
  • 150mg
  • 300mg

capsule

  • 150mg
  • 300mg
more...

Gastroesophageal Reflux Disease

150 mg PO q12hr or 50 mg IM/IV q6-8hr

Gastric Ulcer, Benign

Treatment: 150 mg PO q12hr or 300 mg PO at bedtime

Maintenance of healing: 150 mg PO at bedtime

Erosive Esophagitis

Treatment: 150 mg PO q6hr or 50 mg IM/IV q6-8hr intermitent bolus or infusion; alternatively, 6.25 mg/hr IV by continuous infusion

Maintenance of healing: 150 mg PO q12hr

Hypersecretory Conditions

150 mg PO q12hr; up to 6 g/day used

Parenteral: 50 mg (2 mL) IM or intermitent IV bolus or infusion q6-8hr; not to exceed 400 mg/day; alternatively, 6.25 mg/hr continuous infusion

Dosing considerations

  • More frequent doses may be necessary; individualize dosage, and continue as long as indicated; dosages up to 6 g/day have been used for severe disease
  • Zollinger-Ellison syndrome: Start IV infusion at 1 mg/kg/hr, then adjust upward in 0.5 mg/kg/hr increments according to gastric acid output (not to exceed 2.5 mg/kg/hr or 220 mg/hr)  

Stress Ulcer Prophylaxis (Off-label)

150 mg PO or NG q12hr

50 mg (2 mL) IM or intermitent IV bolus or infusion q6-8hr; not to exceed 400 mg/day; alternatively, 6.25 mg/hr continuous infusion

Dosing Modifications

Renal impairment (CrCl <50 mL/min): 50 mg IV/IM q18-24hr or 150 mg PO once daily

Hepatic impairment: Dosage adjustment not necessary

Dosage Forms & Strengths

injection solution

  • 25mg/mL

syrup

  • 15mg/mL

tablet/capsule

  • 75mg
  • 150mg
  • 300mg

capsule

  • 150mg
  • 300mg
more...

Active Duodenal/Gastric Ulcer

Treatment: 4-8 mg/kg PO q12hr; not to exceed 300 mg/day  

Maintenance: 2-4 mg/kg PO once daily; not to exceed 150 mg/day

Parenteral: 2-4 mg/kg/day IV divided q6-8hr; not to exceed 50 mg/dose or 200 mg/day

Gastroesophageal Reflux Disease

1 month - 16 years

5-10 mg/kg/day PO divided q12hr; not to exceed 300 mg/day 

Parenteral (Off-label): 2-4 mg/kg/day IV divided q6-8hr; not to exceed 50 mg/dose or 200 mg/day; alternatively, infusion at 1mg/kg/dose once followed by continuous infusion of 0.08-0.17 mg/kg/hr or 2-4 mg/kg/day

Erosive Esophagitis

1 month - 16 years

5-10 mg/kg/day PO divided q12hr; not to exceed 300 mg/day  

Parenteral (Off-label): 2-4 mg/kg/day IV divided q6-8hr; not to exceed 200 mg/day; alternatively, 1mg/kg/dose once followed by continuous infusion of 0.08-0.17 mg/kg/hr or 2-4 mg/kg/day

Neonates (Off-label)

Term Neonates (<29 days)

  • 2-4 mg/kg/day PO divided q8-12hr or 2 mg/kg/day IV divided q8hr  
  • Prophylaxis against dexamethasone associated ulceration: 0.031-1.25 mg/kg/hr during dexamethasone therapy to maintain gastric pH >4
  • Prophylaxis against stress ulceration: 2 mg/kg q12hr or 1.5 mg/kg IV q8hr; alternativley, 2 mg/kg over 10 min, followed by continuous infusion of 0.083 mg/kg/hr
Next:

Interactions

Interaction Checker

and ranitidine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            1-10%

            Headache (3%)

            <1%

            Abdominal pain

            Agitation

            Alopecia

            Confusion

            Constipation

            Diarrhea

            Dizziness

            Hypersensitivity reaction

            Nausea

            Vomiting

            Frequency Not Defined

            Anemia

            Necrotizing enterocolitis in fetus or newborn

            Pancreatitis (rare)

            Thrombocytopenia (rare)

            Pancytopenia (rare)

            Agranulocytosis (rare)

            Acquired immune hemolytic anemia (rare)

            Arthralgia (rare)

            Myalgia (rare)

            Previous
            Next:

            Warnings

            Contraindications

            Hypersensitivity to ranitidine or components of the formulation

            Cautions

            If gastroesophageal reflux disease does not respond adequately in 6-8 weeks, do not increase dosage; prescribe proton pump inhibitor instead

            Prolonged treatment may lead to B12 malabsorption and subsequent vitamin B12 deficiency; degree of deficiency is dose-related and association stronger in females and younger in age (<30 years)

            Use caution in renal impairment; adjust dosage

            Use caution in hepatic impairment

            Elevation of ALT levels reported with higher doses (≥100 mg) or prolonged IV therapy (≥5 days); monitor for ALT levels for the remainder of treatment

            Avoid in patients with acute porphyria; may precipitate attack

            Symptom relieve does not rule out presence of gastric malignancy

            Reversible comfusional state reported with use (linked to age >50 years and renal or hepatic impairment); clears within 3-4 days after discontinuation

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Drug crosses into breast milk; discontinue drug, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next:

            Pharmacology

            Mechanism of Action

            H2-receptor antagonist; blocks H2 receptors of gastric parietal cells, leading to inhibition of gastric secretions

            Absorption

            Bioavailability: 50% (PO); 90-100% (IM)

            Onset: 1 hr (IV/PO)

            Duration: 4-5 hr (IV/IM); 4-6 hr (PO)

            Peak serum time: 15 min (IM); 2-3 hr (PO)

            Distribution

            Protein bound: 10-19%

            Vd: 1.4 L/kg (normal renal function)

            Metabolism

            Metabolized in liver

            Metabolites: Ranitidine N-oxide, desmethylranitidine, ranitidine S-oxide (inactive)

            Enzymes inhibited: Unlike cimetidine, ranitidine does not inhibit microsomal enzymes

            Elimination

            Half-life: 2.5-3 hr (PO; increases to 4.8 hr with CrCl 25-35 mL/min); 2-2.5 hr (IV)

            Dialyzable: Yes (HD, PD)

            Renal clearance: 25 L/hr

            Total body clearance: 1.29-1.44 L/hr/kg

            Excretion: Urine (30% PO; 70% IV)

            Previous
            Next:

            Administration

            IV Compatibilities

            Solution: Compatible with most common solvents

            Additive (partial list): Ampicillin(?), ciprofloxacin, dexamethasone, dobutamine, dopamine, epinephrine, erythromycin, floxacillin, fluconazole with ondansetron, furosemide, gentamicin, heparin, lidocaine, midazolam, norepinephrine (incompatible at 2 g), penicillin G potassium/sodium, potassium chloride, protamine sulfate, sodium nitroprusside, vancomycin

            Syringe (partial list): Atropine, dexamethasone, dimenhydrinate, diphenhydramine, dobutamine, dopamine, fentanyl, glycopyrrolate, heparin, hydromorphone, metoclopramide, morphine hydrochloride/sulfate, prochlorperazine, promethazine

            Y-site (partial list): Acyclovir, allopurinol, ceftazidime, ciprofloxacin, diltiazem, dobutamine, dopamine, epinephrine, esmolol, fentanyl, furosemide, heparin, linezolid, lorazepam, midazolam, morphine sulfate, nitroglycerin, norepinephrine, ondansetron, propofol, vecuronium, warfarin, zidovudine

            IV Incompatibilities

            Solution: D5W in LR(?)

            Additive: Amphotericin B, atracurium, cefamandole, cefazolin, cefoxitin, ceftazidime, cefuroxime, clindamycin(?), ethacrynate, insulin(?), phytonadione

            Syringe: Chlorpromazine(?), diazepam(?), hydroxyzine, lorazepam(?), methotrimeprazine, midazolam, papaveretum, pentobarbital, phenobarbital

            Y-site: Amphotericin B cholesteryl sulfate, hetastarch, insulin

            IV Administration

            Direct injection: 50 mg diluted to ≥20 mL with compatible IV infusion fluid and given over ≥5 minutes (4 mL/min)

            Intermittent infusion: 50 mg added to ≥100 mL of compatible IV solution and infused over 15-20 minutes

            Continuous infusion: 150 mg diluted in 250 mL of IV fluid and infused at 6.25 mg/hr for 24 hours

            IM Administration

            Administer undiluted

            Storage

            Store at 4-30°C (39-86°F)

            Protect from light and excessive heat

            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous