Ranitidine withdrawn

I have been taking ranitidine (300 mg per day) since being diagnosed with AF. This has been withdrawn because an ingredient may be carcinogenic. My GP thinks it may never be available again (although , apparently, you can buy some low strength ranitidine in pharmacies). It seems that the only alternative is a PPI such as omeprazole. I am reluctant to take this because it has been associated with a risk for dementia. I am wondering whether it’s worth not taking *any* medication for heartburn to see how this works out. I haven’t had much by way of reflux or heartburn recently. I could try gaviscon, but I have not found this very effective in the past. Any thoughts?

[Pita]

Hi Sam, I would try Gaviscon Advance, not the normal Gaviscon. I take it 3 times a day even if I don't feel my reflux. PPI's I have been taken them for well over 10 years, and I do suffer with painful and stiff joints now, which is part and parcel of these damn PPI's. I used to be an a large dose of PPI's and am now down to 20mg a day from 80mg. Pam

[Hidden in reply to Pita]

Thanks. I’ll get some today. I’ll have to be even more careful about not eating too late as well.

[Pita in reply to Hidden]

Hi Sam, I never eat no later than 6pm, and my last hot drink (tea) is at 8-30pm, drinking water is ok. Like Jean said place wood blocks at least 6inchs tall under the head of the bed this may help with night time reflux. I never eat any spicy foods as this causes bad reflux. Pam

[jeanjeannie50]

Hi Sam, yes try not taking any medication for heartburn (it has horrible side effects).

Cut out all fat and vinegar from your diet, bear in mind these are hidden in a lot of other foods such as coleslaw and baked beans. Make sure you eat almonds, red apples and when the soreness strikes a banana. If you're taking magnesium this could be causing the soreness, so try a magnesium spray or put it in your bathwater. Also put some blocks of wood under the top of your bed to raise it. I cured myself this way.

Jean

[Hidden in reply to jeanjeannie50]

Thanks. I haven’t had much by way of symptoms recently, but I don’t like the idea of just suddenly stopping a medication which seemed to work. I’ll try elevating the head of the bed. I don’t usually have vinegar, nor baked beans (except recently during lockdown).

[CDreamer]

Hi Sam - I used to be very against any PPI’s however, I think a lot more is now known about the huge damage that acid reflux causes to oesophagus and lungs so I think it worth considering, depending upon how frequent and how symptomatic the reflux is.

So far, I have got away with only Gaviscon Advanced but a cough is sometimes symptomatic of acid reflux and it is possible to aspirate stomach acid into the lungs, causing damage, without having usual reflux symptoms - I am now learning. That has stopped me in my tracks and made me reconsider because I am on a med that is known to cause acid reflux and no matter what I do diet wise, it’s starting to get worse.

I think knowing what is causing the acid reflux in the first place is maybe the key - could it be diet - eating a carb heavy diet certainly made things a whole lot worse for me so I stopped cereal, bread, cake and biscuits and dairy and it improved. Could it be hiatus hernia? Or SIBO - (could you have a breath test?).

It is so difficult knowing if the medications are worse than the disease isn’t it?

My own conclusions - I would try the diet and eating plans first, use Gaviscon Advanced when needed but if it is more than occasional and explicable reflux then ask for some investigations to try to get to the cause.

As a last resort - consider PPI’s because the damage that acid reflux can do shouldn’t be underestimated.

[Hidden in reply to CDreamer]

I was diagnosed with reflux long before PAF, but it has always been intermittent- long periods with nothing at all, then reflux. I had very few problems since I took ranitidine. I used to take omeprazole and it was effective, but I don’t like taking it long term. I’m hoping that as my alcohol consumption is very low ( actually it’s been zero since the start of lockdown) I will be able to get away with using Gaviscon. If ranitidine is

cleared, I would probably using it again, even if I have to buy it. Thanks for the reply.

[BobD Volunteer]

My personal view is that these drugs need to be avoided at all costs and attempts made to change life style/diet etc rather than drugs although Gaviscon very occasionally is fine. I became "dependent" on ppis many years ago till I discovered how they actually made things worse if taken for any length of time.

[Hidden in reply to BobD]

I agree, but if the reflux is bad enough you will need to take something. I’m going to try to get by with Gaviscon and careful eating, but who knows if that will work.

[R1100S1 in reply to BobD]

Apart from the AF I have half pancreas, duodenum, gallbladder and bile duct removed. So was on ranatadine now changed to lanzoprazole due to its withdrawal.

Bit worrying as was on the ranatadine for nearly 30 years before I had Whipple procedure last November

[Tapanac in reply to R1100S1]

My friend had the same as you and the whipple procedure, but her consultant has put her on lansoprazole and she is fine and has been on it for approx 7+ years.

[Hidden]

Ime in process of stopping taking ranitadine after it was recently taken of the market,at the moment I only take 1 150 mg tablet with my evening meal and feel ok I take more gaviscon to counter act any possible acid,I hope to be ranitadine free soon

[Buffafly]

I didn’t know that, my pharmacist just sent me an ‘owing’ note as he didn’t have any in stock, no mention of withdrawal. This is going to be a problem for me 😦

[Hidden in reply to Buffafly]

As stated above, my GP says she thinks that the NHS will not reinstate Ranitidine which just leaves PPIs or things like Gaviscon.

[momist in reply to Hidden]

Eek! I've been on 150mg Ranitidine twice a day since I discovered that Lansoprozole gives me bad diarrhoea after a week or two. I thought it was bad food causing it, but starving myself didn't do any good! I've just ordered my repeat prescription today, let's see if it gets filled?

[Hidden in reply to momist]

It seems to have been reinstated!

[Mrsvemb]

I was prescribed ranitidine about 8 weeks ago following an endoscopy which revealed drug related erosive gastritis and a gastric ulcer, caused by Rivaroxaban.

I cannot tolerate omeprazole or lansoprazole so don’t have a lot of choice. Apparently, the erosive gastritis will lead to stomach cancer if left untreated. The risk involved in taking ranitidine is lower.

I collected a prescription for ranitidine yesterday so it is still available in UK

[momist in reply to Mrsvemb]

I'm hoping so - I've just ordered mine!

[Ppiman]

I've had several discussions of the potential side effects of PPI drugs with my excellent GP who feels that they are safe and -more importantly - far safer than the diseases they prevent such as Barrett's oesophagus. I've taken lansoprazole for many years now and, despite trying hard to stop taking it (for the reasons you have described), I have had to return to it. I tried ranitidine but it just didn't stop the acid and nausea.

Ranitidine is a much less effective drug than a PPI and works through a different mechanism; however, if it was sufficiently effective for you, then, with luck, your reflux disease is mild enough for you to manage with antacids such as Rennies or Milk of Magnesia? You could supplement these with the older drug, cimetidine, which is well tried and safe enough. There are also gel type treatments such as Gaviscon, which many find helpful but which, sadly, don't work for me at all for some reason. Cimetidine isn't much less effective than ranitidine and was, in its day, the gold standard.

Steve

[Rhiannonimity1 in reply to Ppiman]

Where I am (north west) , cemitidine is not available. The pharmacists haven’t had any for months. Can you get it ? Thanks

[Ppiman in reply to Rhiannonimity1]

I haven't tried. It's odd that some drugs aren't available now.

Steve

[Hidden in reply to Ppiman]

Thanks for this info. Gaviscon doesn’t usuaally work for me. I’ll speak to the GP about cimetidine.

[Ppiman in reply to Hidden]

I see there is some shortage around. I don't know why. Have you asked your local pharmacist what the reason is?

I would also ask your GP to confirm that he or she really does think that a PPI is the best route for you since it is likely to be for the long term (I would ask about this, too, because these drugs were, initially, only approved for short term use. I've always thought this odd since they cannot cure the cause of the reflux, only the symptoms caused by strong stomach acid leaking into the unprotected oesophagus).

Mention your fears and worries and be guided by their very long experience with these drugs. They've been around a very long time now. In the end, I was convinced I had no realistic choice. I was told that those people that can manage without them are either lucky in that they have a less difficult form of acid reflux, or are putting themselves at risk of oesophageal erosion and worse.

Steve

[Rhiannonimity1]

Hello. I was given omeprazole 3 years ago and took 20mg a day until recently. Tbh I never felt I needed it every day, just occasionally - I also used ranitidine before a heavier meal (or meal in a restaurant) and I felt it protected me. Like you I was worried about side effects and went back to the GP. I now take omeprazole if I have a meal that upsets my stomach to an extent where nothing else will work - so I take as a PIP not regularly. On a normal evening I eat early, avoid my triggers and then if I feel I need it, take tsp of bicarbonate of soda in water before bed - or I take gaviscon. I realised I had a problem with dairy about 3 months ago and started taking lactase tablets before a meal. My heartburn has significantly improved.

Just a note about bicarb- if you get very windy with your reflux, bicarb will make you belch which could release more acid into your oesophagus. So watch for that. In the main bicarb is an old fashioned remedy, but I found it very helpful and a good replacement for ranitidine.

[Palpman]

Omeprazole is to be taken under supervision by patients with LQTS due to the possible occurrence of TdP.

[Bowcat]

They have reinstated ranitidine as I have been taken it for the past 4 years and they have bought out a new batch. I have gord and have tried all the other options but nothing seems to work on me. Have tried without but I couldn't manage so GP gave me a new batch of Ranitidine. So it is still available.

[Hidden in reply to Bowcat]

That’s interesting. Am going to ring pharmacy.

[Flystar]

I have been put on instead of ranitidine is Pantoprazole 40mg and so far it is helping

[Mish-da]

Hi Sam I was in a similar situation to you. They suggested PPI but they irritated my stomach in the last so prescribed me Cimetidine 400mg as an alternative which is similar to Ranitidine. Been on it since Xmas... no problems at all.

[Bmwpaul1971]

I was on ranitidine as a pip but escalated to lansoprazole as it stopped working. Am on 1 a day currently but used to be on 2 a day, but am going to cut it down very gradually. I take 7 a week in total so am going to take 6 a week then 5 etc etc.

[Foulplay]

I had taken ranitidine for years but also had to stop because it is withdrawn. It is not a PPI. Famotidine which is the ingredient in Pepcid is similar and doesn’t have the problems caused by PPI’s. It is about impossible to find because everyone switched when they pulled the ranitidine. They also have been using it experimentally in high doses through an IV in covid -19 patients because they think it may stop the replication of the virus. So of course everyone ran out and bought the over the counter stuff which isn’t the same . I have an esophagus problem with the heart stuff and it is important to take acid reflux medicine if your doctor recommends it. The acid can errode your esophagus and also causes me severe chest and back pain which then I wonder is it my heart or acid reflux. I also sleep raised up Like Jean suggested which helps some and follow a pretty bland diet but still get the acid reflux.

[Esteeve]

Try apple cider vinegar, please don’t use things like gaviscon, rennie or any of that stuff. Just a gentle suggestion look at low carb diets ( look for “the fat emperor” his pod casts have been life changing for me. From 24 hrs after minimising cabs from my diet I went from between 8-12 rennie a day to none. 6 months in and still not taken one, they are so bad for you. Start to see what information is out there now. The whole understanding around Disease and food implications has rapidly changed in the last couple of years. Many doctors are still unaware of the latest research. They also have to follow guidelines from their respective health organisations, so may privately not agree with the advice they have to give.

Some of the latest research is indicating that all heart disease is is a form of diabetes, or prediabetes (which at current estimates over 60% of adult Americans have) and can have for years before developing full blown condition) Diabetes type 2 now can be reversed within a month.

iTry no to be passive with your health. There is plenty of information now available. I have astonished my Dr now on a quarter of previous medication.

Look I’m not a doctor but I will say this “ if you always do what you’ve always done, you’ll always get what you always got!”

[Tapanac]

My husband has been on lansoprazole, omniprazole, pantoprazole for at least 40+ years and is fine. He only changes from one to another simply as a change. I also have been on lansoprazole since about 2000 and touch wood fine. I do stop occasionally, but if the indigestion and reflux starts again, I then go back on it.

[planetiowa]

I have vagal AFIB which is very sensitive to acid reflux. I was taking omeprazole (a PPI) for several months with very good results but switched to an H2 blocker (ranitidine such as Zantac) because of potential side effects I was warned about with PPIs. Once ranitidine was taken off the shelf I switched to another type of H2 blocker (famotidine - such as Pepcid) which seemed to work just as well for me. One note with famotidine though is that there were recent observations that people taking this recover from COVED-19 faster so it may be more difficult to find as people have been rushing out to buy it.

[Hidden]

It could be your diet. I used to have heartburn. Since going GF and Dairy Free it no longer ever bothers me.

My father was addicted to antacids. The Gastro we took him to see said that the biggest problem he saw in older people was too little stomach acid resulting in an imbalance of the PH in the gut. As a result food just sits there and does not digest properly causing the reflux. He took him off of all antacids and put him on HCL instead. The difference was amazing and we were able to remove the wedge from under his mattress. The antacid just was a bandaid on the symptoms, but the HCL fixed the problem.

[Madscientist16]

Ranitidine is in the family of H2 blockers to reduce stomach acid. Other medications in the H2 blocker family include famotidine (Pepcid) and cimetidine (Tagamet). Why don't you try one of those.