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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.
Do you ever feel a fiery, tingling sensation at the back of your mouth after eating a heavy meal or spicy foods? What you’re feeling is stomach acid or bile flowing back up into your esophagus. This is often accompanied by heartburn, which is characterized by a burning or tightening sensation in the chest behind the breastbone.
According to the American College of Gastroenterology, more than 60 million Americans experience acid reflux at least once per month, and more than 15 million Americans may experience it every day. Though it can occur in anyone, including infants and children, acid reflux is most common in pregnant women, people who are obese, and older adults.
While it’s normal to experience acid reflux occasionally, those who experience it more than twice per week may have a more serious problem known as gastroesophageal reflux disease (GERD). GERD is a chronic form of acid reflux that can irritate the lining of your esophagus, causing it to become inflamed. This inflammation may lead to esophagitis, which is a condition that may make it difficult or painful to swallow. Constant esophageal irritation may also result in bleeding, narrowing of the esophagus, or a precancerous condition called Barrett’s esophagus.
The symptoms of acid reflux in teenagers and adults can include:
- a burning sensation in the chest that gets worse when bending over or lying down and usually occurs after a meal
- frequent burping
- abdominal discomfort
- a bitter taste in the mouth
- a dry cough
The symptoms of acid reflux in infants and young children can include:
- wet burps
- frequent spitting up or vomiting, especially after meals
- wheezing or choking due to acid backup into windpipe and lungs
- spitting up after age 1, which is the age at which spitting up should stop
- irritability or crying after meals
- refusing to eat or only eating small amounts of food
- difficulty gaining weight
Acid reflux is the result of a problem that occurs during the digestive process. When you swallow, the lower esophageal sphincter (LES) normally relaxes to let food and liquid travel from your esophagus to your stomach. The LES is a circular band of muscles located between your esophagus and stomach. After food and liquid enter the stomach, the LES tightens and closes the opening. If these muscles relax irregularly or weaken over time, stomach acid can back up into your esophagus. This causes acid reflux and heartburn. It’s considered erosive if an upper endoscopy shows breaks in the esophageal lining. It’s considered nonerosive if the lining looks normal.
Though it can occur in anyone, including infants and children, acid reflux is most common in pregnant women, people who are obese, and older adults.
You may need an upper endoscopy so that your doctor can make sure there are no serious underlying reasons for your symptoms.
You may need this procedure if you have:
- difficulty or pain with swallowing
- GI bleeding
- anemia, or a low blood count
- weight loss
- repeated vomiting
If you’re a man who’s older than 50 years old and you have nighttime reflux, are overweight, or you smoke, you may also need an upper endoscopy to determine the cause of your symptoms.
The type of treatment for acid reflux that your doctor will suggest depends on your symptoms and your health history. Common treatments include:
- histamine-2 receptor blockers to reduce stomach acid production, such as famotidine (Pepcid)
- proton pump inhibitors to reduce stomach acid production, such as esomeprazole (Nexium) and omeprazole (Prilosec)
- medications to strengthen the LES, such as baclofen (Kemstro)
- surgeries to reinforce and strengthen the LES
Making some simple lifestyle changes can also help treat acid reflux. These include:
- raising the head of the bed or using a wedge pillow
- avoiding lying down for two hours after meals
- avoiding eating for two hours before bed
- avoiding wearing tight clothing
- limiting your consumption of alcohol
- quitting smoking
- losing weight if you’re overweight
You should also avoid avoid foods and beverages that trigger acid reflux, including:
- citrus fruits
- fatty and fried foods
- carbonated beverages
- tomato-based foods and sauces
When your baby is experiencing acid reflux, the doctor may suggest:
- burping your baby a few times during a feeding
- giving smaller, more frequent meals
- keeping your baby upright for at least 30 minutes after eating
- adding up to 1 tablespoon of rice cereal to 2 ounces of infant milk (if using a bottle) to thicken the milk
- changing your diet if you’re breast-feeding
- changing the type of formula if the suggestions above haven’t been helpful
Untreated acid reflux or GERD can lead to complications over time. Call your doctor right away if you or your child experiences any of the following symptoms:
- persistent difficulty swallowing or choking, which can indicate severe damage to the esophagus
- trouble breathing, which can indicate a serious heart or lung problem
- bloody or black, tarry stools, which can indicate bleeding in the esophagus or stomach
- persistent abdominal pain, which can indicate bleeding or an ulcer in the stomach or intestines
- sudden and uncontrollable weight loss, which can indicate a nutritional deficiency
- weakness, dizziness, and confusion, which can indicate shock
Chest pain is a common symptom of GERD, but it may require medical attention as it can indicate the onset of a heart attack. People sometimes confuse the sensation of heartburn with a heart attack.
Symptoms more suggestive of heartburn may include:
- burning that starts in the upper abdomen and moves into the upper chest
- burning that occurs after eating and that gets worse when lying down or bending over
- burning that can be relieved by antacids
- a sour taste in the mouth, especially when lying down
- slight regurgitation that backs up into the throat
People over age 50 are at an increased risk for heart attacks and other heart problems. The risk is also higher among those with high blood pressure, high cholesterol, and diabetes. Obesity and smoking are additional risk factors.
Call 911 immediately if you believe you or someone you know is experiencing a heart attack or another life-threatening medical condition.