Ranitidine - instructions for use, dose, side effects, contraindications

The blocker of histamine H2-receptors. Suppresses the basal and stimulated by histamine, gastrin and acetylcholine (to a lesser extent) the secretion of hydrochloric acid. It increases the pH of gastric contents and reduces the activity of pepsin. DurationThe action of ranitidine with a single admission - 12 hours.

Pharmacokinetics:

After oral administration ranitidine quickly absorbed from the digestive tract. Food intake and antacids slightly affect the degree of absorption. Biodinostupnost - about 50% because of the effect of "first passage" through the liver. The maximum concentration in the plasma is achieved after 2 hours after a single oral intake.After intramuscular injection quickly and almost completely absorbed from the injection site. Maximum concentration achieved in 15 minutes.

Binding to proteins - 15%. Scope distribution - 1.4 l / kg. Ranitidine excreted in breast milk.

Half-life is 2-3 hours. About 30% of the dose is excreted unchanged in the urine. The rate of excretion is reduced if the liver or kidney function is impaired.

Indications:Stomach ulcer and duodenal ulcerin the phase of exacerbation; prevention of exacerbations of peptic ulcer; symptomatic ulcers; erosive and reflux esophagitis; Zollinger-Ellis syndromeshe is; prevention of "stressful" gastrointestinal ulcers, postoperativeulcers, relapses of bleeding from the upper gastrointestinal tract; prevention of aspiration of gastric juice during surgery under anesthesia.

ICD-10

II.D37-D48.D44 Neoplasm of uncertain or unknown character of endocrine glands

X.J60-J70.J69.0 Pneumonitis caused by food and vomit

X.J95-J99.J95.4 Mendelssohn syndrome

XI.K20-K31.K20 Esophagitis

XI.K20-K31.K21 Gastroesophageal reflux

XI.K20-K31.K25 Stomach ulcer

XI.K20-K31.K26 Duodenal ulcer

XI.K20-K31.K27 Peptic ulcer of unspecified site

XI.K20-K31.K30 Dyspepsia

XI.K20-K31.K31.8 Other specified diseases of the stomach and duodenum

XI.K90-K93.K92.2 Gastrointestinal bleeding, unspecified

XV.O60-O75.O74.0 Aspiration pneumonitis due to anesthesia during the process of labor and delivery

XVII.Q80-Q89.Q82.2 Mastocytosis

XVIII.R10-R19.R12 Heartburn

XIX.T36-T50.T39 Poisoning by non-opioid analgesic, antipyretic and antirheumatic agents

Contraindications:

Pregnancy, lactation (breastfeeding), hypersensitivity to ranitidine.

Carefully:

Cirrhosis of the liver with portosystemic encephalopathy in history, renal and / or hepatic insufficiency, acute porphyria (including in the anamnesis), malignant neoplasms of the stomach, children's age (up to 12 years).

Pregnancy and lactation:

Recommendations for FDA - Category B. Ranitidine passes through the placenta. The use in pregnancy is possible only if the expected effect of therapy exceeds the potential risk for the fetus (adequate and strictly controlled studies of safety of use in pregnant women have not been conducted).

Penetrates into breast milk, there is a possibility of suppressing the production of hydrochloric acid in the stomach, suppressing the metabolism of other medicines and exciting the central nervous system of the baby.Stop breastfeeding if necessary with ranitidine.

Dosing and Administration:

Inside for treatment adults and children over 14 years of age apply in a daily dose of 300-450 mg, if necessary, the daily dose is increased to 600-900 mg; the frequency of reception is 2-3 times a day. For the prevention of exacerbations of diseases apply to 150 mg per day before bedtime. The duration of treatment is determined by indications for use. Patients with renal insufficiency with a creatinine level of more than 3.3 mg / 100 ml - 75 mg twice a day.

Intramuscularly or intravenously - 50-100 mg every 6-8 hours.

Side effects:

From the side of cardio-vascular system: in isolated cases (with intravenous administration) - atrioventricular blockade.

From the side digestive system: diarrhea, constipation; hepatitis.

From the side of the central nervous system: headache, dizziness, fatigue, blurred vision; in isolated cases (in seriously ill patients) - confusion, hallucinations.

From the side hematopoiesis system: thrombocytopenia; with prolonged use in high doses - leukopenia.

From the side metabolism: a slight increase in serum creatinine at the beginning of treatment.

From the side endocrine system: with prolonged use in high doses may increase the prolactin content, gynecomastia, amenorrhea, impotence, decreased libido.

From the side musculoskeletal system: arthralgia, myalgia.

Allergic reactions: skin rash, hives, angioedema, anaphylactic shock, bronchospasm, arterial hypotension.

Other: recurrent parotitis; loss of hair, vasculitis. With prolonged use, development of B12-deficit anemia.

Overdose:

Symptoms: convulsions, bradycardia, ventricular arrhythmias.

Treatment: induction of vomiting or gastric lavage, symptomatic therapy. With convulsions - diazepam intravenously, with bradycardia - atropine, with ventricular arrhythmias - lidocaine.

Interaction:

Aluminum phosphate. On the background of aluminum phosphate, the absorption of ranitidine is reduced.

Acenocoumarol. When combined application ranitidine can both enhance and weaken the action of acenocoumarol.

Acetylsalicylic acid + Chlorfenamine + Phenylephrine. With simultaneous use with acetylsalicylic acid (in combination acetylsalicylic acid + chlorphenamine + phenylephrine) ranitidine increases its toxicity.

Bisacodyl. Ranitidine may cause too rapid dissolution of the enteric-soluble coat of bisacodyl and irritation of the mucosa of the stomach or duodenum; when combined appointment, the interval between admission should be at least 1 hour.

Warfarin. Ranitidine changes prothrombin time: it can lengthen or shorten; when co-administered, control of hemocoagulation parameters is necessary.

Gliklazid + Metformin. Ranitidine, secreted in tubules, competes for tubular transport systems and, with prolonged combination therapy, can increase the maximum concentration of metformin (in combination gliclazide + metformin) by 60%.

Diazepam. Against the background of ranitidine, biotransformation slows down and the effect of diazepam may increase.

Dirithromycin. Against a background of ranitidine, the absorption of dirithromycin increases.

Ibandronic acid. Ranitidine (with intravenous administration) increases the bioavailability of ibandronic acid by 20%.

Itraconazole, ketoconazole. It is a weak acid and against the background of ranitidine, alkalinizing the contents of the stomach,absorbed with less speed and completeness; at joint appointment it is necessary 2 hours (and more) of an interval between reception.

Metformin. Ranitidine slows down excretion, increases (more than half) the maximum concentration (secreted by the renal tubules and competes for tubular transport systems), enhances the effect.

Metformin + Saxaglyptine. Ranitidine is excreted by the kidneys by tubular secretion and can theoretically interact with metformin (in combination metformin + saxagliptin), competing for common transport systems of renal tubules. It is recommended to carefully monitor patients and, if necessary, adjust the dose of the combination metformin + saxagliptin and / or ranitidine in the case of their simultaneous application.

Metformin + Sitagliptin. Careful observation of the patient and dose adjustment of the combination are recommended. metformin + sitagliptin and / or ranitidine.

Metformin + [Sibutramine + Microcrystalline Cellulose]. Ranitidine, secreted in the renal tubules, competes with metformin (in the combination metformin + [sibutramine + MCC]) for the tubular transport systems and, when combined, can lead to an increase in the maximum concentration of metformin.

Midodrin. Ranitidine can slow down (mutually) excretion, competing for a common transport system in the renal tubules.

Morphine. Ranitidine can alter enterohepatic circulation; with the simultaneous appointment should be carefully monitored.

Naproxen. Against the background of ranitidine, alkalizing the contents of the stomach, reduced absorption of naproxen; simultaneous use is not recommended.

Procainamide. On the background of ranitidine, a decrease in excretion (competition for excretory systems of the renal tubules) and an increase in the concentration of procainamide in the blood are possible.

Propranolol. Against the background of ranitidine slows biotransformation of propranolol.

Rilpivirin. It is assumed that rilpivirine should be used with caution when administered concomitantly with ranitidine, as this can lead to a significant decrease in rilpivirin level in the blood plasma due to an increase in the pH level in the stomach. Ranitidine should be taken at least 12 hours before or 4 hours after rilpivirin.

Sucralfate. On the background of sucralfate, the absorption of ranitidine may decrease; with a combined appointment, the interval between admission should be at least 2 hours.

Theophylline. Against the background of ranitidine, biotransformation of theophylline is inhibited.

Phenytoin. Against the background of ranitidine, the biotransformation of phenytoin slows down.

Cyclosporine. On the background of ranitidine, the risk of renal dysfunction increases.

Ciprofloxacin. On the background of ranitidine, the absorption of ciprofloxacin decreases (should be taken 2 hours before or 4 hours after ranitidine).

Special instructions:

Before the start of treatment, the presence of malignant neoplasm in the stomach and duodenum (can mask the symptoms of stomach cancer) should be excluded. The risk of cardiotoxic effects is increased in patients with heart disease, with rapid intravenous administration and use in high doses. It is undesirable to abolish abruptly ranitidine because of the danger of aggravation of the condition. With long-term treatment of weakened patients under stress, bacterial lesions of the stomach are possible with the subsequent spread of infection.

May increase the activity of glutamyltranspeptidase.In the treatment of ranitidine, a false positive reaction is possible when carrying out a sample for protein in the urine.

During the treatment period, patients should be cautious when engaging in potentially hazardous activities.

Instructions

Ranitidine (Ranitidinum)