Ranitidine alternative drugs are in demand. UK markets have been wiped out from ranitidine, a popular medication used mainly in the management of indigestion / acid reflux. In the US and UK, ranitidine was subject to a number of recalls at the end of 2019 and the beginning of 2020 due to possible contamination with N-Nitrosodimethylamine (NDMA), a probable human carcinogen (a chemical that possibly causes cancer). The topic of ranitidine and cancer risk with updates on all ranitidine recalls was previously discussed in the post: Ranitidine recalls – updates & patients information. Ranitidine alternative drugs will be discussed in this post, in brief, the following will be reviewed:
- Ranitidine: drug classification and licensed use
- Drugs alternative to ranitidine: pharmacological and legal classification
- Ranitidine alternative drugs: over the counter (OTC) options
- Ranitidine alternative drugs: prescription-only medication (POM) options
Ranitidine drug classification
Ranitidine belongs to a group of medicines called H2-receptor antagonists, commonly known as H2-blockers. Although as complicated as it may sound, the meaning behind this definition is straight forward:
- H2 – a type of receptor located in the stomach lining.
- Receptor – a molecule which has a role of ‘a port’ to which other molecules, including drugs, can bind.
- An antagonist is a chemical or drug which binds to a receptor and stops some biological action from happening. In relation to this post, the secretion of stomach acid is reduced when ranitidine binds to an H2 receptor.
Ranitidine alternative drugs: classification
Over the counter (OTC) or prescription-only medications (POMs) which can be used as an alternative to ranitidine belong to one of the following groups:
- (other) H2-receptor antagonists (same drug class as ranitidine)
- Proton pump inhibitors (PPIs) for example omeprazole or esomeprazole
From a legal perspective, drugs alternative to ranitidine are available as products licensed according to one of three categories:
- Over the counter options also known as Genera Sale List (GSL) items. GSL products can be sold in any retail outlets such as supermarkets, shops, etc.
- Pharmacy-only medicines (P) are only available from pharmacies or online pharmacies that operate under the supervision of a pharmacist.
- Prescription-only medicines (POMs) available only on prescription, written by a doctor or any other qualified prescriber.
Gastro-oesophageal reflux disease (GORD) explained (video)
To understand even more the treatment used in the management of GORD< i strongly recommend to watch the video below.
Ranitidine alternative drugs: over the counter products
Over the counter H2-receptor antagonist
In the UK, ranitidine it the only H2-receptor antagonist available over the counter. Over the counter ranitidine is available in different brands with Zantac being most popular. Most large pharmacy chains (Lloyds, Boots) and supermarkets (Tesco, Asda) sell their version of ranitidine. All ranitidine products available for the public to buy contains 75mg of ranitidine per tablet.
Over the counter Proton Pump Inhibitors as an alternative to ranitidine
There is a number of PPIs available to buy without a prescription from the pharmacy (P) or simply off the shelf in supermarkets or other retail outlets (GSL).
PPIs are more effective in reducing acid production than H2-receptor antagonists such as ranitidine; however, they are associated with the possibility of more common side effects and a number of possible interactions with other medicines. If in doubt, read product information leaflet or speak to the pharmacist before using a PPI.
Over the counter PPIs: cautions in use
All over the counter PPIs have similar license and recommendation on the duration of treatment:
- All PPIs available without prescription are licensed for adults aged 18 years and over.
- Over the counter PPIs ad are generally used in short term management of heartburn / acid reflux.
- If symptoms do not resolve within 14 days of the treatment with over the counter PPIs, patients are advised to speak to their GP.
- For all PPIs, some patients may need to take the medication for 2-3 days before improvement in symptoms is seen; however, some may experience relief from symptoms on day 1. Nevertheless, over the counter PPIs are not advertised as products for the immediate release of heartburn symptoms.
PPIs common side effects
Common side effects associated with the use of PPIs:
- Upset stomach: diarrhoea, constipation, flatulence (wind)
- Vomiting (being sick) or nausea (feeling sick)
- Formation of benign polyps in the stomach
Over the counter PPIs: Interactions with other drugs
Please refer to the product information leaflet or speak to the pharmacist if you take any other medication.
Omeprazole as an alternative to ranitidine
1. Omeprazole 10mg gastro-resistant tablets
Availability: Pharmacy only medication
Dose: The recommended dose is 20mg daily (Two 10mg tablets) for up to 14 days.
Omeprazole is available as pharmacy only medication in the form of 10mg gastro-resistant tablets. Large pharmacy chains mainly sell omeprazole 10mg under their brand name, for example, Boots Acid Reflux 10 mg Gastro-Resistant Tablets (Boots Pharmacy) and Lloyds Pharmacy Heartburn Relief 10mg Tablets.
2. Pyrocalm Control (Omeprazole)
Availability: GSL medication – any retail outlet or website, supermarkets, and pharmacies.
Dose: 1 tablet taken once daily for a recommended maximum of 14 days.
Available as GSL product, each Pyrocalm Control tablet contains 20mg of omeprazole. Pyrocalm Control was launched in 2019, and it is still a relatively new product. Not all pharmacies or supermarkets stock it; however, it can easily be bought online. Pyrocalm Control comes in two box sizes with 7 or 14 tablets.
Esomeprazole products alternative to ranitidine
The main active ingredient of the next two products is esomeprazole. Like omeprazole, esomeprazole is a proton pump inhibitor. Similarly, patients may need to take esomeprazole to 2-3 consecutive days to control their symptoms, although a single dose of esomeprazole may provide relief from symptoms of acid reflux. If no improvement in symptoms is seen within two weeks despite the treatment with esomeprazole, patients need to speak to their GP.
3. Nexium Control (Esomeprazole)
Availability: GSL – any retail outlet or website, supermarkets, and pharmacies.
Dose: the recommended dose is one capsule/tablet per day
Nexium Control contains 20mg of esomeprazole as an active ingredient. A single dose of Nexium Control can settle the symptoms of heartburn for up to 24 hours. Read Nexium Control review to learn more about this medication, including common side effects, drug interactions, and information about the effectiveness as compared to omeprazole drug.
Nexium Control is widely available, most supermarkets and pharmacies stock this product. It can also be bought online from different websites, including Amazon.co.uk (link below).
Nexium Control comes in the form of capsules and tablets, available in two different pack sizes of 7 and 14 tablets. Nexium Control capsules are advertised as Nexium Control Mini-Capsules due to a much smaller size than tablets. Produces of Nexium Control capsules inform that capsules are 53% smaller than the tablet (based on the volume of the capsule vs. the tablet).
4. Guardium Acid Reflux Control (Esomeprazole)
Availability: GSL – any retail outlets or websites, supermarkets, and pharmacies.
Dose: the recommended dose is one tablet per day (20mg of esomeprazole daily) for up to two weeks.
Guardium Acid Reflux Control also contains esomeprazole as an active ingredient. It is the latest addition of esomeprazole containing products available without a prescription in the UK. Guardium Acid Reflux Control can be purchased online. It is a GSL product, and therefore within the next few months, one would expect it to be available in supermarkets and pharmacies. Guardium Acid Reflux Control is promoted as product ‘from the makers of Gaviscon’, a popular brand of a wide range of antacid medications used in the symptomatic management of heartburn.
Guardium Acid Reflux Control comes in a pack size of 7 and 14 tablets.
5. Pantoloc Control (Pantoprazole)
Availability: Pharmacy only medication
Dose: One tablet per day (20mg of pantoprazole daily)
The last on the list of ranitidine alternative drugs is Pantoloc. This product contains 20mg of pantoprazole per tablet, another drug classified as PPI. Not all pharmacies stock Pantoloc. A quick search online revealed that limited websites stock Pantoloc. Pantoloc Control is sold in two box sizes of 7 and 14 tablets.
Antacids less effective in the management of acid reflux. Antacids do not stop the production of gastric acid but neutralise it in the stomach. Antacids can provide fast and short-term relief from heartburn symptoms.
Antacid can be purchased from supermarkets, pharmacies, and retail outlets. There is a number of antacid products available on the market. Antacid can be bought as chewable tablets, a liquid formulation or sachets.
Popular brands of antacid products include:
- Gaviscon range of antacid products
- Rennie range of heartburn and indigestion chewable tablets
- Tums chewable tablets
- Peptac liquid
Shop on Amazon.co.uk now:
OTHER POPULAR HEARTBURN AND INDIGESTION ANTACIDS
Ranitidine alternative drugs: prescription-only medicines
Prescribed H2-receptor antagonists
There are few options when it comes to H2-receptor antagonists available on prescription including:
All of the above drugs are not commonly prescribed. At the point of writing of this post, all above H2-receptor antagonists are out of stock, most likely due to increased demand caused by supply problems with ranitidine. To give you a rough idea, in the last 12 months, over 6.1 mln ranitidine prescriptions were issued. During the same period (OpenPrescribing.net, 2019):
- Famotidine was prescribed 13,716
- Nizatidine was prescribed 17,866
- Cimetidine was prescribed 43,206
Cimetidine is not commonly prescribed as it affects how other medications are absorbed (how much drug gets into the body), their metabolism (how much medication is changed into the active form in the body), and elimination (how much drug leaves the body). With a number of potential interactions with other drugs, cimetidine became an obsolete choice in the management of gastro-oesophageal reflux disease (GORD).
Prescribed omeprazole is available in different formulations, including:
- Omeprazole gastro-resistant tablets
- Omeprazole gastro-resistant capsules
- Omeprazole dispersible tablets
- Omeprazole liquid
Tablet and capsule forms of omeprazole exist in the following strengths: 10mg, 20mg, and 40mg.
Omeprazole liquid is classified as a special product in the UK. It is made on an individual basis for each patient, usually children, but also patients with swallowing difficulties. To learn more about omeprazole liquid, please read my separate post on this product. Omeprazole became the first choice when PPIs are considered in the treatment due to low cost and effectiveness.
Lansoprazole is the second most prescribed PPI in the UK. Lansoprazole is available in the form of 15mg and 30mg capsules and orodispersible tablets. When prescribed, orodispersible formulations (brand name: Zoton FasTab) are commonly used in patients with swallowing difficulties or in children. Orodispersible tablets dissolve in the mouth when placed on the tongue.
Esomeprazole comes in forms of capsules and tablets, available as 20mg and 40mg preparations. Esomeprazole can be prescribed as a generic medication or as Nexium. The latter is not commonly prescribed due to the price difference between generic versions of esomeprazole and Nexium.
Pantoprazole on prescription comes only in the form of tablets. 20mg and 40mg of pantoprazole drug are available. Pantoprazole is not commonly prescribed in the NHS.
Similarly to pantoprazole, rabeprazole is not commonly prescribed in the UK. Rabeprazole comes in form 10mg and 20mg gastro-resistant tablets.
Which PPI is the best?
There is no evidence to suggest one PPI is better than another. However, when PPIs are prescribed for treatment of GORD, for example, patients may be switched between PPIs if one fails to produce a satisfactory response (NICE, 2017). Omeprazole and lansoprazole are the most prescribed PPIs in the UK.
Ranitidine alternative drugs: Conclusion
When it comes to short-term management of heartburn / acid reflux, patients have a good choice of drugs, which are available without a prescription. Five different proton pump inhibitors are available over the counter from a pharmacy, with three being licensed as general sale items, which can be purchased from any retail outlet.
Patients who have been experiencing symptoms of heartburn for longer than two weeks (despite PPI treatment) should speak to their GP. Additional symptoms highlighted by manufacturers of PPIs needed a referral include:
- as weight loss (for no reason)
- repeated episodes of sickness
- difficulties in swallowing
- blood present in the vomit or faeces
- repeated episodes of indigestion
- presence of new or recently changed in symptoms in patients who are 55 and over
- presence of pain or lump in the stomach
- Ranitidine recalls – updates & patients information
- Omeprazole Alternative Drugs BEST for Acid Reflux
- Omeprazole liquid
- Nexium Control review
- Ranitidine vs Omeprazole: which drug is better?
NICE (2017). Dyspepsia – proven GORD. Available at: https://cks.nice.org.uk/dyspepsia-proven-gord Accessed on 06/02/2020
OpenPrescribing.net (2019), EBM DataLab, University of Oxford, 2017. Prescribing information for H2-receptors anatagonist. Available at: https://openprescribing.net/chemical/ Accessed on 06/02/2020