Making the most of OTC meds – ranitidine (Zantac)

If you’ve ever seen a patient bleed out from an ulcer, you’ll recognize ranitidine as a potentially life-saving drug. The same could be said of other acid-reducing over-the-counter medications, including Tagamet, Axid, Pepcid, Prilosec, and Prevacid – all if which began as prescription-only medications.

I choose ranitidine because it is inexpensive, safe, and readily available. Most of what follows is also true of the other H2-blockers, Pepcid, Axid, and Tagamet, though Tagamet tends to have more drug interactions as well as CNS (mental) side-effects.

Most people consider these meds good for simple heartburn, which they are, but that is only the tip of the iceberg. 

More importantly, they can:

  • prevent (or treat) a bleeding ulcer
  • prevent (or treat) cough due to reflux, as well as reduce reflux leading to asthma or pneumonia
  • allow patients requiring anti-inflammatory drugs to tolerate their medicine
  • reduce or eliminate significant chest pain or stomach pain related to various acid conditions
  • treat hives either alone or in combination with simple antihistamines or steroids
  • decrease post-gastroenteritis abdominal distress that may lead to weight loss or dehydration
  • decrease erosive esophagitis that may cause scarring or Barrett’s esophagus, which may lead to cancer

Over-the-counter ranitidine is marketed in 75-mg and 150-mg doses, whereas prescription ranitidine comes in 150-mg and 300-mg tablets.  It’s all the same medicine, though the dose varies according to condition.  For example, 75 mg is usually sufficient for symptoms of occasional heartburn due to dietary indiscretions, which brings up a good point: for the heartburn-prone patient, an ounce of prevention is worth a pound of cure.  Avoid tobacco and alcohol use as well as tomatoes, orange juice and other citrus fruits, onions, spicy foods, fatty foods, chocolate, caffeine – all the yummy stuff. Avoid lying down after eating, lose weight, wear looser clothing, don’t eat late at night, avoid stress, avoid large meals. Whenever possible, avoid aspirin and related medicines.

For a patient with more significant or persistent symptoms, 150 mg once or twice daily usually suffices, though twice this amount is often recommended for stomach ulcers or erosions of the esophagus (300 mg twice daily). 

(I have never prescribed as much as 6 grams daily, though this amount has been used to treat Zollinger Ellison syndrome.)

When heartburn, regurgitation, abdominal pain, or chest pain are expected as a result of consuming irritating foods or certain medications, ranitidine should be taken 30-60 minutes ahead of time.

Before the days of the proton pump inhibitors (Prilosec, Prevacid, Nexium, Aciphex, Protonix, and Dexilant) the H2-blockers (Zantac, Tagamet, Pepcid, and Axid) were the standard of care for all acid-related conditions – and they really worked quite well. Nowadays Americans want the big guns even for smaller problems, but this would be unwise at TEOTWAWKI. In fact, I’d say all these acid-reducing medicines are best reserved for serious problems.

For example, bleeding ulcers are potentially lethal, either via hemorrhaging or stomach/duodenal perforation leading to sepsis.  Ranitidine works by lowering the amount of acid that may be eroding a blood vessel or burning a hole through the stomach wall.

Another big concern at the end of life as we know it will be pain treatment. Few citizens will have unlimited access to narcotics, but at least for now, we have relatively unlimited access to OTC ibuprofen, aspirin, and naproxen, all excellent drugs for both pain and inflammation, and all of which I’d recommend for stockpiling.  Unfortunately, a fair number of people experience stomach discomfort, pain, or even vomiting when taking these anti-inflammatory medications. However, taking ranitidine (75 to 600 mg) before taking an anti-inflammatory drug may allow an otherwise intolerant patient to tolerate aspirin, ibuprofen, or naproxen (all of which should be taken with food whenever possible).

Lately I’ve seen a number of patients who have experienced difficulty recovering from what seems to be a regular stomach flu. Though initial symptoms resolve in a few days, some experience on-going food intolerance, stomach pain, and lack of appetite for weeks afterward, which may lead to weight loss and/or dehydration.  Although excess stomach acid is not the primary problem, reducing the amount of stomach acid by taking ranitidine may hasten recovery (dose: 75 to 300 mg twice daily for several days to a few weeks).

Although urticaria (hives) is not a life-threatening condition, the itch can be miserable.  Usually they are treated with antihistamines typically prescribed for colds or allergies: Benadryl, Zyrtec, Claritin, and Allegra. However, ranitidine offers another option, either used alone or in conjunction with the above antihistamines.

Side-effects of ranitidine are uncommon, though I have seen some patients experience drowsiness, diarrhea, and constipation.

Drug interactions with ranitidine are likewise uncommon, especially with those likely to be available at TEOTWAWKI. (Ranitidine may reduce the absorption of iron salts, itraconazole, and ketoconazole.)   

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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2 Responses to Making the most of OTC meds – ranitidine (Zantac)

  1. Zantac says:

    Zantac is as equally effective as Tagamet, another anti-acid medication in the same class as Zantac. Zantac is not as potent as Prilosec or Prevacid, both very srong stomach acid inhibitors. For those with occasional bothersome mild heartburn, Zantac is a good place to start in terms of treatment. It is relatively cheap, and it is effective in controlling mild cases of heartburn. However, in more persistent and serious cases, one may consider taking the more potent (and more costly) Prilosec or Prevacid. The latter two medications generally work in cases where Zantac and Tagamet will not.

    [All true, but one note of caution: the reason the OTC formulations of Prilosec and Prevacid have a 2-week warning on them is in case something more serious is going on, such as a stomach ulcer or even stomach cancer. So as long as there’s docs around, if you need these meds more than occasionally, check with your physician. And if you’re taking them and they don’t work, the problem may be with the gall bladder, pancreas, intestines, kidneys, or other. – Doc Cindy]

  2. stevesmitty79 says:

    Years ago, my doctor prescribed Ranitidine to help distinguish stomach acid upset from cardiac symptoms. I didn’t use it much and accumulated quite a collection. Recently when my Lisinopril was upped due to a pharmacy mistake, I broke out in hives numerous times. Eventually, a review of my meds narrowed down the problem. At the ER, I was given Prednisone tablets and some other injected med I do not recall. I believe it was a steroid. Anyway, Ranitidine and Claritin was prescribed during allergy season during these hive episodes. They have since gone away when my Lisinopril was reduced to the proper level. I was switched to a larger pill and didn’t realize I was to quarter it. I’m glad I didn’t throw away all that Ranitidine. I didn’t realize until it was prescribed for hives and allergies just how versatile it was.

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