Some oral ranitidine products (tablets and liquids) have been recalled by the manufacturers. This recall warning was a purely as a precaution, because of possible contamination of
ranitidine with an impurity called NDMA which is classified as a probable human carcinogen
based on results from laboratory tests and is a known environmental contaminant found in
water and foods. Although this contaminant may cause harm in large amounts, the levels found in ranitidine barely exceed amounts you might expect to find in common foods.
Following this product recall, there resulted in a shortage of oral ranitidine products.
ADVICE TO PATIENTS ON RANITIDINE:
All patients should be reviewed as repeat prescriptions are requested and if ongoing treatment is required, be switched to clinical alternatives.
YOUR GP HAS AN ACTION PLAN
1. Arrange a medication review with patients (or their parent/guardian) upon request of a
repeat prescription for ranitidine; patients with remaining supplies of ranitidine can
continue to take their medicine.
2. Assess the clinical need for long-term acid suppression therapy, and withdraw treatment
if possible. See ‘How to stop an H2-antagonist’ for advice on withdrawing treatment
without causing rebound hyperacidity.
3. For patients in whom continued treatment is required:
a) For indications which can be treated with a PPI (see NCL guidance), switch to a PPI
at the recommended dose (omeprazole is the preferred choice for most patients).
Note: PPIs have a different risk profile to ranitidine therefore ensure the benefits
of treatment outweigh the risk of long-term use.
b) For indications where PPIs are inappropriate, maintain ranitidine or switch to an
alternative H2-antagonist at an equivalent dose (see
c) Table 1 and Table 2), if stock is available.
4. Consult specialist clinicians when ranitidine cannot be substituted with a PPI or
alternative H2-antagonist and/or is used for a specialist indication not listed in the NCL
guidance and H2-antagonists are not available.
The recommendations above have been developed in conjunction with NCL Gastroenterologists.