Dosing & Uses
Dosage Forms & Strengths
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
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
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
- 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
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
Active Duodenal/Gastric Ulcer
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
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
1 month - 16 years
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
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
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Necrotizing enterocolitis in fetus or newborn
Acquired immune hemolytic anemia (rare)
Hypersensitivity to ranitidine or components of the formulation
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
Pregnancy & Lactation
Pregnancy category: B
Lactation: Drug crosses into breast milk; discontinue drug, use caution
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.
Mechanism of Action
H2-receptor antagonist; blocks H2 receptors of gastric parietal cells, leading to inhibition of gastric secretions
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)
Protein bound: 10-19%
Vd: 1.4 L/kg (normal renal function)
Metabolized in liver
Metabolites: Ranitidine N-oxide, desmethylranitidine, ranitidine S-oxide (inactive)
Enzymes inhibited: Unlike cimetidine, ranitidine does not inhibit microsomal enzymes
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)
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
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
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
Store at 4-30°C (39-86°F)
Protect from light and excessive heat
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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.
|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.|
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