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ranitidine hydrochloride (ra nye' te deen) Alti-Ranitidine (CAN), Novo-Ranidine (CAN), Nu-Ranit (CAN), Zantac, Zantac EFFERdose, Zantac GELdose, Zantac 75 Pregnancy Category B Drug class Histamine2 (H2) antagonist Therapeutic actions Competitively inhibits the action of histamine at the histamine2 (H2) receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin, and pentagastrin. Indications Short-term treatment of active duodenal ulcer Maintenance therapy for duodenal ulcer at reduced dosage Short-term treatment of active, benign gastric ulcer Short-term treatment of GERD Pathologic hypersecretory conditions (eg, Zollinger-Ellison syndrome) Treatment of erosive esophagitis Treatment of heartburn, acid indigestion, sour stomach Contraindications and cautions Contraindicated with allergy to ranitidine, lactation. Use cautiously with impaired renal or hepatic function, pregnancy. Pharmacokinetics Route Oral IM IV Onset Varies Rapid Immediate Peak 1–3 hr 15 min 5–10 min Duration 8–12 hr 8–12 hr 8–12 hr Metabolism: Hepatic; T1/2: 2–3 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Incompatibilities: Do not mix with amphotericin B Adverse effects CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo CV: Tachycardia, bradycardia, PVCs (rapid IV administration) Dermatologic: Rash, alopecia GI: Constipation, diarrhea, nausea, vomiting, abdominal pain, hepatitis, increased ALT levels GU: Gynecomastia, impotence or decreased libido Hematologic: Leukopenia, granulocytopenia, thrombocytopenia, pancytopenia Local: Pain at IM site, local burning or itching at IV site Other: Arthralgias Interactions Drug-drug Increased effects of warfarin, TCAs; monitor patient closely and adjust dosage as needed Nursing considerations Assessment History: Allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy Physical: Skin lesions; orientation, affect; pulse, baseline ECG; liver evaluation, abdominal examination, normal output; CBC, liver and renal function tests Interventions Administer oral drug with meals and hs. Decrease doses in renal and liver failure. Provide concurrent antacid therapy to relieve pain. Administer IM dose undiluted, deep into large muscle group. Arrange for regular follow-up, including blood tests, to evaluate effects. Teaching points Take drug with meals and at bedtime. Therapy may continue for 4–6 wk or longer. If you also are on an antacid, take it exactly as prescribed, being careful of the times of administration. Have regular medical follow-up care to evaluate your response. You may experience these side effects: Constipation or diarrhea (request aid from your health care provider); nausea, vomiting (take drug with meals); enlargement of breasts, impotence or decreased libido (reversible); headache (adjust lights and temperature and avoid noise). Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, hallucinations, dizziness, severe headache, muscle or joint pain. Adverse effects in Italic are most common; those in Bold are life-threatening.