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.
Acid reflux, also known as heartburn, is the hallmark symptom of gastroesophageal reflux disease (GERD). GERD is a condition in which the muscle at the end of the esophagus is too loose or doesn’t close properly, allowing acid (and food particles) from the stomach to rise back up into the esophagus.
More than 60 million Americans experience acid reflux at least once a month.
As well as cause the common burning sensation of heartburn, the acid from reflux can also damage the esophagus. A sore throat is one symptom of GERD that may be caused by this damage.
Acid reflux is the backward flow of stomach contents, including stomach acid, into the esophagus. Acid reflux is caused in part by a weakening of the lower esophageal sphincter (LES), a ring-shaped band of muscle located at the bottom of your esophagus.
The LES is a valve that opens to allow food and drink down to your stomach for digestion and closes to keep matter from reversing its flow back up. A weak LES isn’t always able to close tightly. This allows stomach acids to creep back up your esophagus, ultimately damaging your throat and causing the familiar burning sensation.
To manage a sore throat that accompanies acid reflux, it’s more effective to treat the underlying cause: GERD. Both over-the-counter (OTC) and prescription medications work by eliminating, reducing, or neutralizing stomach acids. The neutralizing process reduces heartburn and sore throat.
Changes to your eating habits may help relieve a sore throat caused by acid reflux. Experiment with different textures when eating to find items that soothe your throat. People who have trouble swallowing may find that eating sticky foods or drinking liquids is more difficult and painful than soft foods or solids cut into small pieces.
Find out the foods and drinks that trigger heartburn. Because everyone’s triggers are different, you can try keeping a journal to record what you eat and drink and when you feel symptoms. This may help you narrow down the causes. Once you know what your triggers are, you can start changing your diet.
Eat small and frequent meals and avoid acidic, spicy, or overly fatty foods. These items are more likely to induce symptoms such as heartburn and sore throat.
You should also avoid drinks that can trigger your heartburn and irritate your esophageal lining. These vary from person to person, but often include:
- caffeinated drinks (coffee, tea, soft drinks, hot chocolate)
- alcoholic beverages
- citrus and tomato juices
- carbonated sodas or water
Try not to lie down within a few hours of eating to prevent GERD symptoms. Talk to your doctor before using herbal supplements or other medications to soothe a sore throat. Although the pain is uncomfortable, it’s important to treat your symptoms safely.
You may want to consider medications if your acid reflux isn’t helped by changing your eating habits. GERD medicines that help reduce or neutralize stomach acids include antacids, H2 receptor blockers, and proton pump inhibitors (PPIs).
Antacids are OTC medications. They work to neutralize stomach acid and relieve symptoms of GERD with salts and hydroxide or bicarbonate ions. Ingredients you should look for include:
- calcium carbonate (found in Tums and Rolaids)
- sodium bicarbonate (baking soda, found in Alka-Seltzer)
- magnesium hydroxide (found in Maalox)
- aluminum hydroxide formulas (usually used in combination with magnesium hydroxide)
H2 blocker medications work by stopping cells in your stomach from producing so much acid. There are both OTC and prescription H2 blockers available. Some of the OTC options include:
- cimetidine (Tagamet or Tagamet HB)
- famotidine (Pepcid AC or Pepcid Oral Tabs)
- nizatidine (Axid AR)
PPI medications are the strongest drugs for reducing stomach acid production. In most cases, your doctor will need to prescribe them (one exception is Prilosec OTC, which is a weaker version of Prilosec). PPI drugs for GERD include:
- omeprazole (Prilosec)
- lansoprazole (Prevacid)
- rabeprazole (Aciphex)
- pantoprazole (Protonix)
- esomeprazole (Nexium)
Whether you use medications or lifestyle strategies (or both), it’s important to manage your GERD symptoms. Chronic, unmanaged acid reflux can contribute to throat soreness and can lead to complications. Possible complications of acid reflux on the throat include:
- Esophagitis: Irritation of the tissues lining the throat is due to the potent nature of stomach and esophageal acids.
- Continuous cough: Some people with GERD feel the need to clear their throats frequently, creating soreness and hoarseness.
- Dysphagia: This is difficulty swallowing when scar tissue forms in the esophageal lining from GERD. Narrowing of the esophagus (benign esophageal stricture) can also lead to throat pain and dysphagia.
In addition to sore throat, chronic and severe acid reflux that goes unmanaged can lead to a rare but serious condition called Barrett’s esophagus. This occurs when the lining of your esophagus changes its composition to resemble the lining of your intestines.
Anywhere from 1.6 to 6.8 percent of adults in the United States develop Barrett’s esophagus. People with Barrett’s esophagus have a slightly increased risk of developing esophageal cancer.
Symptoms of Barrett’s esophagus may include:
- heartburn (burning in the chest, sore throat)
- upper upper abdominal pain
- chest pain
You’re not alone if you’re suffering from the symptoms of GERD. Talk to your doctor if you think your sore throat is due to acid reflux. Managing acid reflux with medications and with lifestyle strategies can reduce your symptoms and help prevent any future complications.