Ranitidine is a representative of Ukrainian antiulcer drugs of the second generation. It belongs to H2-histamine receptor antagonists, and helps patients in the fight against peptic ulcers and gastroesophageal reflux disease, in which the production of hydrochloric acid in the stomach increases. The drug has an antisecretory effect.
The drug enters the parietal cells and interacts with the cell membranes of the gastric mucosa through competitive inhibition of histamine-sensitive receptors. As a result, basal and stimulated secretion of hydrochloric acid decreases. There is a decrease in the volume of gastric juice, which is produced during food loads and the action of hormones: gastrin, histamine and pentagastrin on the gastric walls. The drug increases the pH value of the contents in the stomach and reduces the activity of an enzyme called pepsin.
Why is Ranitidine better than analogues?
The medical product is superior to analogue drugs because it is different:
- affordable price,
- ease of use, as it is taken once or twice a day,
- the duration and speed of onset of the therapeutic effect - the effect of the medicine occurs fifteen minutes after administration and lasts twelve hours,
- no toxic effects on the liver,
- possibility of long-term use, as it is prescribed by doctors for the treatment and prevention of relapses of diseases from two to eight weeks, depending on the patient’s diagnosis,
- the practicality of storage at a temperature that does not exceed + 25 degrees, therefore it is used as an “emergency” medicine during trips and business trips.
New opportunities in pain and replacement therapy for chronic pancreatitis.
Elena Aleksandrovna Poluektova , doctor, candidate of medical sciences:
– We are returning to gastroenterology, and the message will be given by Doctor of Medical Sciences, Professor Oleg Samuilovich Shifrin “New opportunities in pain and replacement therapy for chronic pancreatitis.”
Oleg Samuilovich Shifrin , professor, doctor of medical sciences:
– Dear colleagues, the working group of the Russian Gastroenterological Association has developed recommendations for the management of patients with chronic pancreatitis. Please note that very important fundamental principles that a doctor should take into account in the management of this type of patient are indicated in red. This is the determination of the cause of pain, abdominal pain in chronic pancreatitis and its treatment. The second important area is the treatment of exocrine pancreatic insufficiency. These are the questions that form the basis of my message.
So, at the onset of chronic pancreatitis, abdominal pain occupies a very important place, this is a cardinal sign. It occurs much more often than manifestations of exocrine insufficiency, symptoms of pancreatogenic diabetes, jaundice, etc. In almost 90% of patients with various forms of pancreatitis, regardless of etiology, pain occupies a central leading place at the onset of the disease. At an advanced stage of the disease, exocrine insufficiency may come to the fore, and this is important to take into account.
Clinical example. A 54-year-old man came to our clinic with a complaint of severe abdominal pain in the upper abdomen of a semi-girdling nature, most often occurring about 30-40 minutes after eating, severe painful bloating and diarrhea (unformed stool about 2 -3 times a day). It should be noted that the patient abused alcohol for 2-3 decades, drank about 2-3 bottles of strong alcoholic drinks a week, and smoked a lot. Smoker's index 240 points. We will dwell a little later on the interaction of these two extremely important pancreatotoxic factors: alcohol and smoking.
So, urine tests revealed that the patient had a 2-3-fold level of hyperamylasuria. Therapy with drotaverine, secretion blockers, and festal was ineffective.
What questions should you ask when undertaking to treat this patient? First, the diagnosis should be clarified: is it pancreatitis? It is no secret that pancreatitis, unfortunately, is very often both underdiagnosed and overdiagnosed. Next, when confirming the diagnosis, the question must be asked: what kind of pancreatitis is this? It is very important to determine the etiology and morphological form of the disease. It is necessary to identify and highlight the main clinical syndromes of the disease. And finally, if there is abdominal pain, and our patient has severe abdominal pain, its nature should be determined. This is fundamentally important in the future when prescribing optimal therapy.
It should be said that according to the Heidelberg classification, the so-called M-ANNHEIM classification, German colleagues identify the polyetiological cause of the development of pancreatitis. That is, various factors are combined in different proportions, and very rarely we are faced with a monoetiological form of the disease.
In our patient, two pancreatotoxic factors are clearly identified (even when questioning him): alcohol abuse and smoking. When interacting, these factors mutually reinforce each other, causing rapid development and progression of the disease.
Objectively, pain in the projection of the pancreas and bloating were noted. Otherwise, no significant changes were found. The analyzes showed a twofold increase in urine amylase levels. Please note that, despite obvious manifestations of exocrine insufficiency, fecal elastase is within normal limits.
Computed tomography shows the heterogeneous structure of the pancreas, but no pronounced local changes such as pseudocysts were identified.
Speaking about the causes of pain in a patient, we should highlight the pain associated with the actual inflammation of the pancreatic tissue, no matter whether exudation processes predominate, when inflammatory edema compresses the nerve ganglia, or when alterative processes predominate in the inflammatory substrate, when biologically active substances act on the membrane of the nerve ganglia and destroy it. In these cases, inflammation itself plays a leading role in the genesis of pain. This is type A pain, which we will discuss a little later.
In the case of complications of the actual inflammation of the pancreatic tissue with the development of pseudocysts, in which aggressive pancreatic juice affects the exposed nerve endings, with compression of the bile ducts or duodenum enlarged due to inflammation by the head of the pancreas, or due to compression of the Wirsung duct by areas of fibrosis, pain occurs B -type.
What is their difference? Type A pain, that is, pain caused by inflammation of the pancreatic tissue itself, is distinguished by a relatively short duration, usually somewhere less than two weeks, with long light intervals of several months. And the effect comes from conservative therapy, no matter whether it is the prescription of several paracetamol tablets or hospitalization of the patient in the intensive care unit with a set of measures to treat severe exacerbation of pancreatitis. But healing and improvement in this case are brought about by conservative tactics, that is, such patients are under the care of gastroenterologists and therapists.
B-type pain. Clinically, it is distinguished by a long period of exacerbation, usually at least two months, short clear intervals and the effect occurs either from surgical or endoscopic treatment methods.
Another mechanism of abdominal pain in chronic pancreatitis. Already at the relatively early stages of the disease, the production of bicarbonate solution by the pancreas (the pancreas, let me remind you, weighs only 60-80 grams) decreases. A healthy pancreas produces one and a half to two liters of bicarbonate solution per day. Due to a decrease in the production of bicarbonate solution, acidification of the initial parts of the duodenum occurs, due to acidification of the environment in the intestine, enzymes are inactivated, and manifestations of exocrine insufficiency occur. And all this is accompanied by severe motor impairment and the development of flatulence, which sometimes patients cannot distinguish from a feeling of abdominal pain. Let me remind you that our patient has severe flatulence, which sharply reduces his quality of life.
So, what are the main directions of pain treatment, conservative directions? I emphasize that this is a treatment for type A pain. Quitting smoking and drinking alcohol for any form of pancreatitis, not necessarily for toxic forms, both for biliary and hereditary; for any pancreatitis, additional pancreatotoxic factors should be abandoned and removed. The first step is to prescribe mild analgesics, then “light” opioids such as tramadol may be prescribed, but this rarely happens, and even less often, in exceptional cases with pancreatitis, unlike pancreatic cancer, classical narcotic drugs are prescribed. This is a last resort; each time this approach requires a very careful discussion and assessment of the full depth of the situation in relation to a particular patient. Tricyclic antidepressants - the so-called drug denervation of the pancreas - are an effective method of treating type A abdominal pain.
Please note that secretion inhibitors, which we very often use in the treatment of abdominal pain in chronic pancreatitis, as well as sandostatin, do not show their effectiveness in the treatment of painful pancreatitis in controlled studies. Obviously, this is due to the fact that the study group includes patients with both A-pain and B-pain, that is, there is a mixture of different types of pain. And accordingly, when processing statistical data, it is not possible to obtain reliable results. Although all of us clinicians know very well that we begin to treat abdominal pain, first of all, with a combination of enzyme preparations and secretion inhibitors.
So, let's focus on enzyme preparations. Classic studies from the end of the last century showed that traditional pancreatin tablets are more effective in the treatment of A-type abdominal pain in chronic pancreatitis, and they also significantly reduce pressure in the pancreatic ducts. At the same time, encapsulated, microgranulated pancreatin preparations do not significantly reduce the level of A-type abdominal pain and do not significantly reduce elevated pressure in the pancreas ductal system.
Due to lack of time, I will not dwell on the pathogenesis of the action of tablet and microgranular drugs. But the point is that tablet drugs use the releasing system, a feedback mechanism, to a greater extent, because pancreatin, which is contained in tablets, proteases begin to act earlier in the initial parts of the duodenum, where, in fact, the feedback mechanism is carried out , where the releasing system operates.
Let's return to our patient. Chronic pancreatitis in the acute stage, caused by toxic factors (alcohol and smoking), first stage according to the Cambridge classification. Small intestinal microbial overgrowth syndrome. Exogenous-constitutional obesity of the first degree, this is also often found with pancreatitis. One should not necessarily think that all these patients must necessarily be extremely emaciated.
What are the directions of treatment tactics? We convinced the patient, including his relatives, that he completely needed to give up alcohol and smoking. The patient received sufficient detoxification therapy. We prescribed him the drug Mezim 20,000, two tablets 3 times a day until his condition improved, then we slightly reduced this dosage, and omeprazole. I will add that, taking into account the microbial overgrowth syndrome, a short course of seven-day treatment with rifaximin, an antibacterial drug, was also prescribed.
In our clinic, a study was conducted to compare the analgesic effect of classic pancreatin mezim 10,000 tablets and encapsulated pancreatin in the form of microspheres containing the same amount of lipase - 10,000 in one capsule. It was noted that Mezim 10,000 more often effectively reduced the level of pain and even stopped it completely, Mezim 10,000 less often caused the development of constipation, and Mezim 10,000 quite effectively reduced the level of flatulence, which often bothers our patients. Thus, Mezim 10000 and Mezim 20000, which reappeared on the market about a year ago, can effectively relieve type A abdominal pain, and they provide its effective leveling in case of moderate exocrine insufficiency. In addition, it should be noted that against the background of tablet preparations of pancreatin in the form of Mezim 10000 and Mezim 20000, such a complication of enzymatic therapy as constipation occurs less frequently.
Let us return once again to the main directions of treatment of chronic pancreatitis. In addition to eliminating toxic factors, we must prescribe enzyme preparations in an adequate dose, this is when treating abdominal pain, primarily with tablet preparations. If abdominal pain is combined with a severe degree of exocrine insufficiency, already encapsulated drugs are added.
I want to say that now a new pancreatin drug is appearing on our market - pancreatin microtablets enclosed in capsules - pangrol drug. It will be represented by 10,000 pancreatin capsules in terms of lipase content and, accordingly, pangrol 25,000 units, which contain 2.5 times more lipase. We will look at this drug in more detail a little later.
In addition, proton pump blockers are required. It should be borne in mind here that in the presence of, say, biliary pancreatitis, octreotide, which causes thickening of bile, should be used with caution, but nevertheless it has a good antisecretory effect in terms of the pancreas itself.
When treating spastic disorders (they most often occur with pancreatitis), it is certainly necessary to use antispasmodics, drug denervation of the pancreas, and prescribe tricyclic antidepressants. And mandatory treatment of trophological deficiency, microbial overgrowth syndrome, which is very often combined with chronic pancreatitis, and, finally, antioxidant therapy.
What is the advantage of the drug Mezim 20000? It contains a more effective enzymatic complex compared to Mezim 10000, which allows us to reduce the number of tablets that we prescribe to the patient, and this is very important, since in this case the patient’s desire to follow the doctor’s instructions increases. Patients do not like to take a large number of pills, patient compliance and their mood for treatment increases.
The drug Pangrol is, as I already said, capsules filled with mini-tablets. Each mini-tablet contains 500 units of lipase. Two forms of release are capsules of 10,000 units and capsules of 25,000 units. It is very important that the minitablets are coated not only with an enteric coating that is resistant to acidic gastric juice, but also with a functional membrane. This functional membrane, made on the basis of methacrylic acid derivatives, allows the drug to be released evenly in the small intestine. That is, you see, a comparison was made of how enzymes, in particular lipase, are released from mini-tablets and from mini-microspheres. It turned out that enzymes are released more evenly from minitablets, which is very important in relation to the treatment of exocrine pancreatic insufficiency.
In addition, mini-tablets ensure uniform mixing with food, and optimal activation of enzymes occurs in different parts of the small intestine.
It turned out that pangrol significantly reduces steatorrhea already on the 5th day of treatment, and in patients with severe exocrine pancreatic insufficiency.
It is very important that during therapy, in most patients, by the sixth month of treatment, body weight is normalized and serum albumin levels are normalized.
And I wanted to conclude my speech by saying that, despite the fact that new modern drugs have appeared in the treatment of chronic pancreatitis, in particular enzymatic drugs, the work of a gastroenterologist, the work of a therapist has not become less difficult. But the fact that new effective drugs have appeared makes it possible to make it more effective, that is, to help more of our patients.
For what diseases is the drug used?
Doctors prescribe ranitidine tablets for the treatment of exacerbations to patients who suffer from:
- functional dyspepsia,
- chronic gastritis with increased acid-forming function of the stomach, peptic ulcer of the stomach and duodenum, which:
- not caused by the bacterium Helicobacter pylori,
- occurs as a result of stress and taking NSAID medications,
- erosive and reflux esophagitis,
- Zollinger-Ellison syndrome,
- ulcers that occur after operations and are complicated by bleeding.
The medicine is used to prevent the reflux of gastric juice into the respiratory tract when using anesthesia during operations.
Ranitidine or De-Nol – which is better?
De-Nol is an imported analogue without side effects, sold freely from pharmacies based on bismuth salt. The medication combines several actions:
- protects the gastric mucosa;
- antiulcer;
- bactericidal against the causative agent of gastritis and peptic ulcer Helicobacter pylori;
- anti-inflammatory;
- astringent.
The analogue is applied over a course of 4–8 weeks. Combination with proton pump inhibitors (Omeprazole, Rabeprazole, Esomeprazole) and Ranitidine is possible.
Which is better depends on the indications and the severity of the condition. The analogue is safer and more effective.
Ranitidine is an antiulcer drug sold without a doctor's prescription. However, for timely treatment of gastritis and ulcers, it is advisable to visit a gastroenterologist, make an accurate diagnosis and undergo comprehensive treatment. One of the measures is taking Ranitidine or analogues.
Contraindications for use
Ranitidine for stomach relief is not prescribed for:
- increased individual sensitivity to the active substance and excipients of the drug,
- malignant neoplasms of the stomach,
- liver cirrhosis and liver failure,
- severe renal failure.
The drug is not used during pregnancy, since the drug penetrates the placenta barrier, and the risk of affecting the fetus cannot be ruled out. Doctors do not use the medicine in the treatment of women who are breastfeeding, because the instructions say that the medicine is absorbed into breast milk. The drug is not used to treat children under twelve years of age.
How to choose the right analogue?
Many patients try to select analogues of drugs prescribed by gastroenterologists. If they differ only in price and the active ingredients are similar, consulting a doctor is not necessary. If there is a difference in the active component, the effect on the body, or the risk of side effects, laboratory and instrumental testing is first carried out. Blood, urine, feces, and gastrointestinal morphology are examined.
If you change the drug without the recommendation of a gastroenterologist, negative reactions may occur not only for the gastrointestinal tract, but also for any part of the body.
For example, if a patient evaluates which is better, Ranitidine or Omeprazole, consultation with a doctor is required. The drugs contain different active ingredients that can cause negative effects. Many medications provoke neurological disorders, dysfunction of the gastrointestinal tract, genitourinary, and biliary systems. It will be necessary to additionally eliminate the negative disorders that have arisen.
If the substitute is chosen correctly, gastrointestinal function is normalized when using the first dose. The secretion of hydrochloric acid is reduced, the development of erosion and ulcers on the surface of the mucous membrane is prevented. Patients stop experiencing heartburn, which causes damage to the esophagus and stomach. Patients with peptic ulcer disease may experience remission, especially with the combined use of several prescribed drugs.
Side effects
The drug is well tolerated, but rarely causes:
- immune hemolytic and aplastic anemia, decreased levels of leukocytes in the blood and agranulocytosis, thrombocytopenia and pancytopenia,
- severe allergies, which are accompanied by angioedema and anaphylactic shock, urticaria and multimorphic exudative erythema, fever and fever, Lyell's syndrome, itching and rash, dry skin and hyperemia,
- dysfunctions of the nervous system and psyche in elderly patients, which are manifested by increased fatigue, confusion and dizziness, drowsiness and insomnia, anxiety and depression, hallucinations and tinnitus, headache and disorientation, visual impairment,
- disorders in the functioning of the cardiac and vascular systems, which are complicated by hypotension, bradycardia and tachycardia, asystole and arrhythmia, extrasystole and atrioventricular block and vasculitis,
- vomiting and nausea, diarrhea and bloating, decreased appetite and a feeling of dry mouth, attacks of acute pancreatitis,
- arthralgia and myalgia,
- dysfunction of the kidneys, which lead to acute interstitial nephritis,
- increased prolactin in the blood and gynecomastia, amenorrhea, decreased potency in men.
Popular questions about Ranitidine
What is Ranitidine for?
The drug is used in the combined treatment of exacerbations: peptic ulcers of the stomach and duodenum, dyspepsia and chronic gastritis, which increases the production of hydrochloric acid in gastric juice.
How to take Ranitidine?
Adults and schoolchildren from the age of twelve drink orally - one tablet twice a day: in the morning and before bed, regardless of the meal, two tablets once before falling asleep. The course of therapy is two to three weeks. The medication is swallowed and washed down with 1/2 glass of water.
When is it better to take Ranitidine: before or after meals?
Eating does not affect the pharmacological properties of the drug.
Where can you buy Ranitidine?
The medicine Ranitidine is sold in pharmacies of the retail pharmaceutical network 9-1-1, or you can book the medication on the website - Pharmacy 9-1-1 and purchase it at a pharmacy convenient to your location.
Answers on questions
- Can Ranitidine be used during pregnancy or not?
The medicine is not recommended for use during this period. If treatment is necessary, it is important to contact a gynecologist or therapist to select an effective, safe analogue.
- Is ranitidine an antibiotic or not?
No, the medicine belongs to the group of drugs for the treatment of stomach diseases (ulcers, gastritis), suppresses the secretion of hydrochloric acid.
- Does ranitidine help with heartburn or not?
Yes, the drug affects the cause of the symptom – increased production of hydrochloric acid. However, it is not advisable to use pills constantly and haphazardly to get rid of heartburn.
- Which is better - Kvamatel or Ranitidine?
These are two identical drugs based on different active substances - famotidine and ranitidine. They differ in manufacturer, price and quality. Kvamatel is an imported analogue, more expensive than domestic medicine. When using a substitute, side effects occur less frequently and are better tolerated.
Note!
The description of the drug Ranitidine on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.
