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How to wean off ranitidine?

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Posted on Tue, 22 Jul 2014
Question: I am a 53 year old male, diagnosed with Celiac 20 months ago. 2 years ago I was prescribed 300mg ranitidine for ongoing nausea. After my celiac diagnosis, my primary care physician said keep taking it. After some duodenal ulcers were found 14 months ago during my endoscopy/colonoscopy, my GI doctor said keep taking it. But I continue having occssional nighttime diarrhea and fairly frequent nausea. My GI doctor has retired and I'm at least 8-10 weeks away from a new appointment. I have read fairly recently that low stomach acid can be a cause of nausea and diarrhea. And my frequent indigestion after meals led me to a number of anecdotal reports by people who said their low stomach acid was contributing.

I do not want to be on ranitidine for life, but I can't get a doctor to help me understand why I should stay on it. I'd like to wean myself off ranitidine to investigate if low stomach acid is indeed causing me distress. I'm afraid to go to sleep at night because of the occassions where I wake up at 2 am with nausea, cramping, cold sweats, and diarrhea. I am terrific at avoiding gluten, soy, and dairy, and I eat smaller meals and never eat past 3 pm.

Can you advise anything I might consider or that I have not considered?
doctor
Answered by Dr. Prasad (6 hours later)
Brief Answer:
Plan fresh treatment with help of new GI doctor...

Detailed Answer:
Hi,

I empathize with your condition. However I do not feel those occasional abdominal pain with nausea and loose stool is entirely due to low acid / achlorhydria. In fact most cases where an individual is woken up from good sleep by abdominal pain is usually due to peptic ulcers, gall stones or emergency intestinal pathologies. Since duodenal ulcers are documented, the cramps, nausea and diarrhea are most likely due recurring ulcer.

I truly understand you take ranitidine everyday. However I would start acid lowering drugs after excluding H.pylori infection. Was a test to rule out H.pylori infection done?
The current stats reveal that more than 70% cases of duodenal ulcers are caused by H.pylori infection and ungoverned NSAID pain killer use. Every day ranitidine doesn't do any treat this infection.

Therefore in the current context, I suggest you to continue ranitidine 300mg until you see a new GI doctor. Discuss about the role of H.pylori. Plan test to detect this infection if the doctor agrees with my opinion. We can treat this infection fairly effectively with the current available drugs and that should solve your problem.
You should avoid taking painkillers unnecessarily. A low spice food and good sleep is also advocated.

Hope this helped. Let me know if you need clarifications.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prasad (42 minutes later)
What good might the ranitidine be doing for me? Do people use it for life? Is low stomach acid not a problem?
doctor
Answered by Dr. Prasad (1 hour later)
Brief Answer:
I prefer to stop it...

Detailed Answer:
Hi,

I was able to interview a couple of patients who had been taking acid lowering drugs for very long time at my clinic. I manage them in association with gastroenterologist. They did not complaint of serious abdominal cramps and diarrhea which was due to hypochlorhydria.

That doesn't mean all the anedotal reports that you heard are wrong. Yes hypochlorhydria/achlorhydria is a risk associated with long term use especially when the drug in question is a proton pump inhibitor. Therefore I do advocate ranitidine withdrawal. The new doctor can consider this option after analyzing the current ulcer status. Since ulcers do heal over a period of time, I trust a repeat endoscopy will reveal no more ulcers, which should encourage your new GI doctor to withdraw ranitidine.

As far as answering your questions:
1. Ranitidine does play a role in controlling acid secretions which gives time for ulcer to heal. Therefore unless this ulcer was bleeding and recurring, I feel it is wise to stop the drug after few weeks. More encouragement should be given to lifestyle and diet changes. With those changes and by avoiding undue medication duodenal ulcers can be managed effectively. You should further discuss about the long term pros and cons of using acid lowering drugs with the new GI.
2. Yes, I have seen people use it for long time; but from my experience it is usually with patients who are on chemotherapy and chronic pain management drugs.
3. Low acid is a problem; but it would be difficult to prove whether your current pain is due to hypochlorhydria or ulcer pain. 24 gastric pH monitoring may be an option to confirm it.

Hope this helps. Let me know if you need clarifications.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prasad (8 hours later)
My thanks!
doctor
Answered by Dr. Prasad (3 hours later)
Brief Answer:
Welcome!

Detailed Answer:
My pleasure....

Please close the discussion of all your questions are answered.

Good luck!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Prasad

General & Family Physician

Practicing since :2005

Answered : 3598 Questions

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How to wean off ranitidine?

Brief Answer: Plan fresh treatment with help of new GI doctor... Detailed Answer: Hi, I empathize with your condition. However I do not feel those occasional abdominal pain with nausea and loose stool is entirely due to low acid / achlorhydria. In fact most cases where an individual is woken up from good sleep by abdominal pain is usually due to peptic ulcers, gall stones or emergency intestinal pathologies. Since duodenal ulcers are documented, the cramps, nausea and diarrhea are most likely due recurring ulcer. I truly understand you take ranitidine everyday. However I would start acid lowering drugs after excluding H.pylori infection. Was a test to rule out H.pylori infection done? The current stats reveal that more than 70% cases of duodenal ulcers are caused by H.pylori infection and ungoverned NSAID pain killer use. Every day ranitidine doesn't do any treat this infection. Therefore in the current context, I suggest you to continue ranitidine 300mg until you see a new GI doctor. Discuss about the role of H.pylori. Plan test to detect this infection if the doctor agrees with my opinion. We can treat this infection fairly effectively with the current available drugs and that should solve your problem. You should avoid taking painkillers unnecessarily. A low spice food and good sleep is also advocated. Hope this helped. Let me know if you need clarifications. Regards