Substitutes for ranitidine
November 28, 2019 12:35 AM   Subscribe

Most ranitidine is in recall or has been removed from shelves due to recent discovery of possible carcinogenic contaminants. I've been on it for a couple of years (per my doctor's orders) to control GERD. YANMD, I am not you and my mileage may vary but have you also been on it long term and what did your doctor switch you to? I'm not taking it as much as I once used to and my GERD is better but I'd like to know what generally is being recommended that people take instead.
posted by Rufous-headed Towhee heehee to Health & Fitness (18 answers total) 8 users marked this as a favorite
Proton pump inhibitors like Nexium, Somac, Losec etc are what is commonly prescribed these days. I had to switch myself.
posted by smoke at 12:41 AM on November 28, 2019

It's still available by prescription, in larger (double) than the usual OTC dose. I'm not sure if one can cut the tablets in half and get the same effect, but I've just been using my prescription more now.
posted by amtho at 4:51 AM on November 28, 2019

Unfortunately there are plenty of things to worry about with PPI meds too, and they’re scarier to me than the distant cancer risk of the contaminant in ranitidine. Look it up. I would not be taking Prilosec/nexium on a regular basis myself. And I used to. Indeed those concerns led me to using ranitidine. If you need them you need them, but usually for a defined and time-limited course.

OP, I am in the same boat. An occasional Zantac was my go to when GERD got bad. I’m back to using regular Tums antacids and watching my diet more closely at the moment.

Here’s a useful link about balancing the risks and benefits of PPI drugs. (NIH link)

The major concern, especially for women, is long term increased risk of osteoporosis.
posted by spitbull at 4:51 AM on November 28, 2019 [2 favorites]

I just talked to a pharmacist about this yesterday. He said that so far most docs have been switching people to famotidine (AKA Pepcid), which is in the same class as ranitidine.
posted by ActionPopulated at 5:04 AM on November 28, 2019 [5 favorites]

Check with your doctor. PPIs are common enough now that it’s a little surprising that a doctor would have put you on an H2 antagonist instead, so I wonder if there was a specific reason your doctor didn’t. Were you taking it every day, or only as needed? In my experience doctors are uncomfortable recommending either class of drug be taken every day because of the potential for side effects, but they also don’t want you to be miserable.

My own doctor was a little horrified to learn I was taking famotidine (Pepcid) every day and moved me to omeprazole – at least five years ago. He was the same doctor who’d put me on famotidine in the first place a few years before that. Before making the switch he made sure I didn’t have other prescriptions that had bad interactions with omeprazole, and I feel like there was also some follow up to check on potential side effects. Both omeprazole (Prilosec) and esomeprazole (Nexium) seem equally effective to me, and more effective than famotidine ever was.
posted by fedward at 5:15 AM on November 28, 2019

I don't believe either H2 antagonists or PPIs are meant to be taken long term although I know many people that are in fact doing that.

People with chronic GERD should be trying to stay in Phase 1: Behavorial Modifications with Antacids and only using medications during say periods of high stress.

The best treatment I've found for periods of high reflux is Gaviscon Advance which bafflingly is only sold in Europe. It is not a medication. It does not enter the bloodstream. It is primarily sodium alginate which foams up in your stomach and forms a protective barrier to prevent acid from coming up.
posted by vacapinta at 5:27 AM on November 28, 2019 [7 favorites]

Agreed talk to your doctor. I’m on Prilosec (which is available otc but I’m on Rx 40mg because it’s WAY cheaper as an Rx. I pay $4/90pills.)

Yes, PPIs have their issues. But any less than 40mg for me and I literally can’t swallow or eat. Regardless, many OTCs can be given to you as an Rx for much cheaper if you have insurance.

Peptobismal can work well. You can take quite a bit of it and it comes in liquid, chewable, or swallowable tablets (my preferred.) Tums barely does anything for me but make things taste like metal.
posted by Crystalinne at 7:25 AM on November 28, 2019

My daughter's gastroenterologist switched her to nizatidine (Axid) when the news about the contaminants in Zantac came out. She's only been on meds for GERD since September and we have a follow-up soon.
posted by danielleh at 7:49 AM on November 28, 2019

I found my reflux was sometimes dramatically worse after consuming simple carbs. Since going off ranitidine, I've made a real effort to reduce my intake, and it's helped a lot. Now when I cave it's a crapshoot, sometimes okay and sometimes a bit miserable. Last night I made myself some lemon/ginger tea (gotta be Yogi... no others are gingery enough!) and it helped quite a bit. Counterintuitively, a very weak solution of apple cider vinegar in water also helps. Good luck.
posted by kate4914 at 8:29 AM on November 28, 2019 [1 favorite]

I just switched to the generic version of another product on the advice of my pharmacist cousin. My local pharmacy pulled all the Zantac and generic equivalents from their shelves.
posted by terrapin at 10:39 AM on November 28, 2019

After dietary adjustments started working (it took many months on a very restricted diet because my reflux/GERD was severe) I switched from a daily PPI to famotidine (Pepcid is an example of brand name variety). No one should be on a long term PPI for longer than necessary because they’ve been linked to sudden kidney failure. H2 blockers like ranitidine and famotidine aren't linked to this side effect.

I also second vacapinta’s recommendation of Gaviscon, but it must be the tablet type found in Canada (or Europe? Sounds the same). You want the ingredients to say “313 mg Alginic Acid (derived from brown seaweed), 63 mg Magnesium Carbonate/tablet” or similar. I take two before bed and it helps a lot. The liquid type in Canada, and the American versions, are not the same.
posted by hurdy gurdy girl at 10:46 AM on November 28, 2019

The best treatment I've found for periods of high reflux is Gaviscon Advance which bafflingly is only sold in Europe. It is not a medication. It does not enter the bloodstream. It is primarily sodium alginate which foams up in your stomach and forms a protective barrier to prevent acid from coming up.

I came in to suggest this. PPIs didn't work for me, but a few weeks of using this after buying it on amazon from the UK seemed to kill my reflux entirely.
posted by PhoBWanKenobi at 6:44 PM on November 28, 2019 [2 favorites]

Famotidine (Pepcid) is in the same class as ranitidine. It's very safe and equally effective.

Famotidine and ranitidine are "H2 blockers" (antagonists of the type 2 histamine receptor). They're roughly half as potent at reducing stomach acid production as proton pump inhibitors (PPIs) such as omeprazole.
posted by neuron at 8:52 PM on November 28, 2019

I switched to famotidine (generic Pepcid) also. Seems to work about the same as ranitidine, or perhaps even a bit better.

Re: the Gaviscon Advance, you can order the UK version from Amazon here or here (or other places).

I don't know where in the world you are, but in the U.S. you can also just pick up Gaviscon Advance in any drugstore. It does have less of the sodium alginate by weight than the UK/Canada versions but based on my experiments making my own imitation Gaviscon recipes, that is far less important than people make it out to be. (For one thing, sodium alginate is super water-attracting/hydrophilic, so you can easily double the weight just by putting it in a humid environment for a while. Or dry it out really good & now the weight is cut in half or less.)

Point is, you can try local Gaviscon Advance for a low price from your own local drugstore, and if it works it works. If it doesn't, try getting ahold of the (far more expensive) UK/Canada versions from Amazon or elsewhere.

Another option, especially if you've tried Gaviscon Advance and it works for you but seems mighty expensive, is to buy the raw ingredients and make your own. It's actually very, very easy to do.

--> Make your own Gaviscon Advance at a fraction of the price ingredients list, sources, and recipe here.
posted by flug at 10:04 PM on November 28, 2019 [1 favorite]

Omeprazol. I’ve been taking it for years. Having heard of the problems with it I spoke to my doctor. She said my low dose makes it an extremely low risk for me, and it works perfectly for my GERD (I’m a male).
posted by lhauser at 10:38 PM on November 28, 2019

When I talked to a gastrointestinal doctor about this, he said that the standard that he and the other people in his office are doing is switching people to famotidine. I don't know if they're doing it for extremely long term like they did with ranitidine, I'll find out when I next see him.
posted by Hactar at 1:18 AM on November 29, 2019

All good information, thanks folks. I was on the ranitidine twice a day every day (as recc'd by my dr.) but my gerd has gotten quite a bit better so I don't think I'll have trouble taking famotidine on a not-daily basis and of course I'll check in with my Dr., thanks for the info on the gaviscon too, I will look into that.
posted by Rufous-headed Towhee heehee at 4:12 AM on November 29, 2019

Jumping on the finding better results with Pepcid/moeprazole bandwagon, my mail-order pharmacy sends a 30 day supply for $2, YMMV. It does interact with a number of medications so be sure to consult your Dr.'s office.
posted by nenequesadilla at 7:21 PM on November 29, 2019

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