WITHDRAWAL OF RANITIDINE
In April 2020, the
Food and Drug Administration (FDA)requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. This recommendation was made because unacceptable levels of NDMA, a probable carcinogen (cancer-causing chemical), were found in some ranitidine products. If you’re prescribed ranitidine, talk with your doctor about safe alternative options before stopping the drug. If you’re taking OTC ranitidine, stop taking the drug and talk with your healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, dispose of them according to the product’s instructions or by following the FDA’s guidance.
Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.
GERD (gastroesophageal reflux disease) is a chronic form of heartburn. It occurs when stomach acids leak back up into the esophagus. Over time, this causes potentially damaging inflammation or swelling.
While many people occasionally deal with the pain and irritation associated with heartburn, you might have GERD if these symptoms occur more than twice a week on a regular basis. The consequences of this digestive disease can be serious because it can damage the esophagus over time.
In most cases, GERD can be diagnosed and managed by your primary care doctor. When it is severe or unresponsive to first-line medication, you may need referral to a gastroenterologist, which is a type of doctor who specializes in digestive diseases. Treatment focuses on a combination of lifestyle changes and medications. Antacids are usually the first line of defense because they’re readily available over the counter. They may also be more affordable than prescription medications. Let your doctor know if you are experiencing heartburn symptoms on a regular basis.
Antacids are quick-relief methods that work by directly counteracting the acidity inside your stomach. The presence of these acids is natural in the stomach because they work to help digest food. The stomach is the only part of your digestive tract that is designed to withstand the low pH. When the stomach contents back up into the esophagus, it causes heartburn because your esophagus is not built to withstand acidity, especially over a prolonged period of time. Antacids help neutralize these acids, so the esophageal lining is less exposed to gastric acids.
Most antacids contain one or more of the following ingredients:
- aluminum hydroxide
- calcium carbonate
- magnesium trisilicate
Liquid versions tend to work faster. More convenient options, such as tablets and gum, are also available.
Traditional antacids are convenient to buy because they’re available over the counter. Some of the most popular brand names include:
Antacids are meant to be taken for quick relief when you experience symptoms of GERD, but they do not prevent these symptoms. There are other medications, such as H2 blockers or PPIs (proton pump inhibitors), that can be used for prevention.
Long-term use of antacids can cause side effects in some users. You might experience:
Antacids are not recommended for people with kidney disease or high blood calcium levels. They may also interact with medications, such as thyroid hormones.
Another concern is the fact that antacids only neutralize acid and don’t treat the inflammation caused by GERD. When the esophagus is left inflamed over time, it can erode the lining or, rarely, develop into cancer. This is why it’s important to not self-treat GERD with over-the-counter medications. While a doctor might give the go-ahead to use antacids, this type of medication is only a temporary solution to a long-term problem.
In some cases, acid-blocking medications are needed to treat GERD. Your doctor might recommend preventive medications called H-2-receptor antagonists (H2RAs). These work by reducing the amount of acid the stomach produces. According to the Mayo Clinic, H2RAs can work for up to 12 hours at a time. Unlike over-the-counter antacids, these medicines are maintenance medications and meant to be taken regularly to help prevent symptoms of GERD in the first place. These medications work by decreasing the actual production of gastric acids made by your stomach, not just neutralize them.
Common over-the-counter H2RAs include:
- Axid AR
- Pepcid AC
- Tagamet HB
If you still experience frequent heartburn, your doctor might recommend proton pump inhibitors (PPIs) instead. These work similarly to H2RAs, but they’re stronger and work for up to 24 hours. PPIs are also ideal for patients with significant esophageal damage. Prevacid and Prilosec are among the best-known over-the-counter brands. Ask your doctor before use, especially if you are at risk for osteoporosis. PPIs may increase the risk of bone fractures.
Prescription versions of both classes of medications are available for more severe cases of GERD. The Mayo Clinic recommends calling your doctor if regular medications don’t improve your symptoms within three weeks. You may need to see a gastroenterologist for better management or further investigation of your disease.
While antacids can help alleviate heartburn symptoms, it’s usually only meant to be used on an as-needed (and not daily) basis. You’re more likely to take a combination of antacids and other medications to not only treat heartburn symptoms, but to prevent them in the first place. You may also need medication for esophageal damage.
It’s also important to consider how lifestyle changes can help complement antacid treatment. Weight loss, eating smaller meals, and avoiding trigger foods can all help. Be sure to stay in touch with your doctor if symptoms don’t improve — otherwise, you may risk damaging your esophagus.