Treatment of coronavirus. Famotidine against COVID-19: new hope. The most complete review

Ranitidine stomach tablets

Ranitidine is a histamine H2 receptor blocker. Reduces basal and stimulated secretion of hydrochloric acid caused by irritation of baroreceptors, food load, the action of hormones and biogenic stimulants (gastrin, histamine, pentagastrin). Ranitidine reduces the volume of gastric juice and the content of hydrochloric acid in it, increases the pH of the stomach contents, which leads to a decrease in pepsin activity. After oral administration in therapeutic doses, it does not affect prolactin levels. Inhibits microsomal enzymes.

Famotidine to fight Covid: with increasing impatience

If the pathophysiological picture of COVID-19 is indeed partly due to dysfunctional degranulation of mast cells, then existing drugs on the market used in the treatment of diseases associated with mast cells will help contain this process. Among these potentially useful drugs are: mast cell stabilizers, other histamine antagonists (for example, blockers of histamine H1 and H4 receptors), leukotriene and leukotriene receptor antagonists, anti-inflammatory drugs (for example, developed against inflammatory bowel disease), inhibitors of mast cell activation.

If the above finds clinical evidence, a completely working scheme for the treatment and prevention of covid emerges, simultaneously involving direct antiviral inhibitors of SARS-CoV-2 like remdesivir.

A plateau of famotidine concentrations sufficient to successfully antagonize the H2 receptor (and its inverse agonism) is easily achieved by taking very inexpensive oral tablets at a safe dose. Yes, in the ongoing clinical trial NCT04370262, famotidine is administered intravenously at a dose that is more than 20 times the half-maximal inhibition concentration (IC50) required to antagonize the histamine H2 receptor. However, this is clearly too much.

To maintain the proper level of famotidine in the body, it is enough to take it at a dose of 40–60 mg every 8 hours. Since famotidine is excreted primarily by the kidneys, higher doses require adequate functional status.

Mechanism of action of the drug

The mechanism of action of the drug lies in pharmacokinetics, which shows the entire spectrum of action of the drug. After taking the drug orally, it is rapidly absorbed from the human digestive system. Eating does not affect the absorption of the drug; scientific research has shown that protein binding accounts for approximately fifteen percent of the total absorption. The drug actively penetrates into breast milk, the placental barrier and cerebrospinal fluid. Inhibitory secretion is long-lasting and can reach 8-12 hours. Most of the active substance after use becomes a biaccumulated substance, and a small systemic metabolism is observed.

The concentration of Ranitidine in blood plasma reaches its maximum value approximately one to three hours after application.

This drug is slightly metabolized to form ranitidine N-oxide, and active secretion mainly occurs in the renal ducts. The drug is eliminated naturally through human urine in an unchanged form. The half-life of Ranitidine is 2-4 hours after the start of oral administration. If the patient has any problems with organ dysfunction, the elimination of the drug may be significantly delayed compared to the half-life in a healthy person.

Bismuth preparations

De-Nol

Medicines based on bismuth have a coating effect on the inner lining of the stomach, protecting it from the action of gastric juice.

In addition, bismuth preparations suppress the growth and reproduction of Helicobacter. Doctors prescribe the following drugs:

Vikalin
De-nol
Bismuth nitrate

Ranitidine bismuth citrate is a complex preparation of bismuth with an H2-histamine receptor blocker. All these medications are taken 1–1.5 hours after meals. Bismuth preparations color feces black. This is not a contraindication for further treatment with bismuth.

Ranitidine: indications for use

Adults:

Duodenal ulcers and benign gastric ulcers, including those associated with taking non-steroidal anti-inflammatory drugs (NSAIDs).
Prevention of duodenal ulcers caused by NSAIDs (including aspirin), especially in patients with a history of peptic ulcers.
Treatment of duodenal ulcer associated with Helicobacter pylori infection. Postoperative ulcers.
Reflux esophagitis, including for long-term use. Relief of symptoms of gastroesophageal reflux disease. Zollinger-Ellison syndrome.
Chronic episodic dyspepsia, characterized by epigastric or substernal pain that is associated with food intake or disrupts sleep, but does not relate to the above conditions.
Prevention of gastrointestinal bleeding from stress ulcers in seriously ill patients.
Prevention of recurrent bleeding in patients with bleeding peptic ulcers. Before anesthesia in patients at high risk of aspiration of acidic gastric contents (Mendelssohn syndrome), especially in women in labor.

Children over 12 years old:

Short-term treatment of peptic ulcers.
Treatment of gastroesophageal reflux, including reflux esophagitis and relief of symptoms of gastroesophageal reflux disease.

Use for diseases of the esophagus

In diseases of the esophagus, in most cases, damage to its walls occurs with gastric acid due to insufficiency of the sphincter, which ensures compression of the lumen that closes the entrance to the stomach. Frequent releases of acidic contents damage the mucous membrane of the esophagus and purulent foci, as a result of inflammation, and ulcers form on its walls.

Such diseases include reflux esophagitis. Its symptoms include frequent and prolonged pain, heartburn, bad breath and belching. The disease is accompanied by neuroses and sleep disturbances. Taking Ranitidine relieves burning and pain, restores the mucous membrane by regulating the secretion of gastric juice and stimulating the work of the sphincter.

The drug is taken in the same dosage as for gastritis and ulcers - 300 mg; for severe pain, you can double the daily dose - 600 mg, in this case the medicine is taken 4 times.

Treatment of other diseases

Ranitidine is produced by different pharmaceutical companies

The drug can be used for erosive and ulcerative lesions of the intestines, benign neoplasms accompanied by heartburn. Tumors can affect the excess of the hormone gastrin in the body, which stimulates the production of gastric juice.

This can cause intestinal ulcers called Zollinger-Ellison syndrome. The drug restores the mucous membrane and slows down ulcerative manifestations. The drug is prescribed for this disease in a daily dosage of 450 mg, the dose is divided into three times.

Ranitidine: what is it prescribed for?

By its nature, the drug is an antihistamine, but its real scope of action is somewhat different from simply suppressing the manifestations of allergies. The active substance - ranitidine hydrochloride - inhibits H2 receptors located in the gastric mucosa, and also reduces the production of hydrochloric acid and affects acidity, reducing its level. Thus, the pharmacology of “Ranitidine” is an antiulcer agent that allows you to relieve acute symptoms of any lesions of the gastric mucosa: both gastroduodenitis and ulcers.

The dosage of the active substance per 1 tablet is 150 and 300 mg.

After taking 150 mg (single dose), the effect persists for 12 hours, the maximum concentration is observed 3 hours after administration, while food consumption does not affect these indicators. Ranitidine (as a substance) is active in breast milk and may also affect prolactin levels (temporarily) if administered intravenously. The duration of elimination depends on renal function.

Famotinide against Covid: cheap but not available

Regardless of the lack of reliable evidence of the anti-Covid activity of famotidine, its obvious deficiency is observed. So, at the beginning of May 2022, the United States was faced with an insufficient supply of famotidine - as soon as it became known that it could seem to help in countering Covid. The acute shortage of this cheap drug continues to this day.

In the wake of encouraging news that famotidine is useful for Covid, it literally completely disappeared from Russian pharmacies. This is evidenced both by numerous user messages on online discussion platforms and by the results of searching for famotidine tablets through pharmacy aggregators.

What are Ranitidine tablets taken for?

The antisecretory effect of Ranitidine creates favorable conditions for the healing of gastric and duodenal ulcers. Ranitidine increases protective factors in the tissues of the gastroduodenal zone: enhances reparative processes, improves microcirculation, and increases the secretion of mucous substances.

peptic ulcer of the stomach and duodenum in the acute stage;
prevention of exacerbations of peptic ulcer disease;
symptomatic ulcers (rapidly developing ulcers of the stomach and duodenum due to stress on the body, taking medications or diseases of other internal organs);
erosive esophagitis (inflammation of the esophagus with disruption of the integrity of its mucous membrane) and reflux esophagitis (inflammation of the esophagus caused by the reflux of gastric contents into the esophagus);
Zollinger-Ellison syndrome (a combination of a stomach ulcer and a benign pancreatic tumor);
prevention of lesions of the upper gastrointestinal tract and in the postoperative period;
prevention of aspiration of gastric juice (entry of gastric juice into the respiratory tract) in patients undergoing surgery under anesthesia.

Use of famotidine for the treatment of acute ulcer bleeding

Currently, H2 blockers are the most common medications used in the treatment of peptic ulcers. This is primarily due to their pronounced antisecretory properties, but in addition, H2 blockers suppress basal and stimulated production of pepsin, increase the production of gastric mucus, increase the synthesis of prostaglandins in the gastric mucosa, increase the secretion of bicarbonates, improve microcirculation, normalize the motor function of the stomach and duodenum intestines. A positive effect of drugs from this group on the normalization of ultrastructural parameters of the gastric epithelium was also discovered.

The first histamine H2 receptor blockers were synthesized in 1972, but had a large number of side effects, in particular, a toxic effect on the bone marrow. Cimetidine, the first drug to enter widespread clinical practice, also has serious side effects: it blocks peripheral receptors of male sex hormones, can cause an increase in testosterone in the blood, have a hepatotoxic effect (decreased blood flow in the liver, increased transaminase levels), blocking the cytochrome P system –450, increased creatinine levels in the blood, damage to the central nervous system, hematological changes, cardiotoxic effects, immunosuppressive effects.

At the same time, intravenous administration of 300–400 mg of cimetidine to patients with duodenal ulcers causes a gradual increase in pH in the body of the stomach over 20–30 minutes to a hypoacid or anacid state (pH>6.0). Intragastric pH-metry was used in the study by S. Duma in a comparative study of the effectiveness of cimetidine and ranitidine in 100 cardiac surgical patients for the prevention of stress ulcers. In this study, the use of intravenous injections of cimetidine at a dose of 400 mg 3 times a day provided a higher level of intragastric pH when recorded over 8 hours than intravenous administration of 150 mg of ranitidine 2 times a day (p = 0.0001).

Famotidine

belongs to the 3rd generation of histamine H2 receptor blockers.
H2 blockers can be used in patients with renal failure (at lower doses depending on the degree of reduction in creatinine clearance). It is known that famotidine is superior in activity to ranitidine, roxatidine and cimetidine
. A 5 mg dose of famotidine is equivalent to 300 mg of cimetidine. The effect of cimetidine, ranitidine and famotidine occurs at approximately the same time after administration, however, the duration of action of famotidine is much longer - 2 times compared to cimetidine. After intravenous administration of 20 mg of famotidine, the half-life of the drug is 3.8 hours. The widespread use of famotidine in modern clinical practice is due to the fact that this drug has a very small number of side effects. Famotidine has no hepatotoxic effect, does not block the cytochrome P-450 system, does not increase plasma creatinine levels, does not penetrate the blood-brain barrier and does not cause neuropsychiatric disorders. When taking 40 mg of famotidine daily for 4 weeks, there is no change in the levels of prolactin, testosterone, follicle-stimulating and luteinizing hormones. After oral administration of 40 mg of famotidine or intravenous administration of 20 mg of the drug, there is no change in blood pressure, heart rate or ECG pattern. Taking famotidine at a dose of 40 mg twice a day does not disrupt the gastric emptying process and does not affect pancreatic function. According to HG Dammann, based on data on the use of famotidine at a dose of 40 mg/day in 10,814 patients in Germany, bloating occurs in only 1.17% of cases, constipation in 0.20%, diarrhea in 0.31%, skin reactions - 1.12%.

In urgent situations, such as ulcer bleeding, intravenous H2 blockers are widely used. Studies that were performed using intravenous injections of famotidine also showed the high effectiveness of this drug. In the LS Welage study, famotidine 20 mg twice daily was significantly more effective than cimetidine 300 mg four times daily administered intravenously in 42 intensive care unit patients (p<0.001). In the work of A. Al-Quorain et al. has been shown to be more effective than ranitidine when administered intravenously to patients in critical condition

. When famotidine 20 mg was administered every 12 hours, the pH level of gastric juice was significantly higher (p<0.05) than when ranitidine was administered 50 mg every 8 hours.

When 20 mg of famotidine was administered intravenously to healthy subjects, the onset of action of the drug was observed on average after 36.3 ± 11.9 minutes if the injection was carried out at 14.00, and after 53.6 ± 22.3 minutes when administered at 20.00. The duration of action of the drug was 6.0±1.1 hours and 11.4±1.6 hours, respectively. Data from HS Merki et al., which were obtained in a double-blind study with intravenous drip administration of famotidine at a dose of 3.2 or 4 mg/hour, show the high effectiveness of this drug both between meals and at altitude digestion.

In the work of GM Fullarton et al. the high effectiveness of intravenous infusion of 10 mg famotidine for ulcer bleeding has been convincingly demonstrated

. The average intragastric pH was 7.1 units in the group receiving famotidine. pH in the placebo group – 1.6 units. The period of time when the pH value exceeded 6 units was 87% against the background of famotidine administration and 13% against the background of placebo. The high activity of famotidine was also shown in the work of VR Espita et al. The pH exceeded 6 units per day. for 94.8% of the time when famotidine was administered at a dose of 40 mg/day, and 97.2% when administered 20 mg/day. It was found that jet intravenous administration of famotidine at a dose of 10 mg in patients with hyperacidity reduces the production of hydrochloric acid in the stomach by 73.8%, and at a dose of 20 mg - by 77.2%. The effect of the drug lasted for 12 hours.

At the Clinic of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology named after. V.Kh. Vasilenko, we conducted a study of the intravenous form of famotidine (Kvamatel)

in 42 patients with duodenal ulcer (29 men, 13 women; average age – 39.29±1.99 years, from 15 to 66). The effectiveness of suppressing intragastric acidity was assessed using the Gastroscan-5 acidogastrometer (Istok-Sistema, Russia). After recording the basal pH and submaximal stimulation of gastric secretion, patients were slowly injected intravenously with the contents of 1 bottle (0.02 g) of the drug "Kvamatel" (active substance - famotidine, "Gedeon Richter", Hungary).

The time of onset of the pH response in the antrum of the stomach was 47.35±4.59 minutes (from 6 to 117), in the body of the stomach - 44.95±4.27 minutes (from 11 to 117). The time of onset of action of Kvamatel in the antrum and body of the stomach was longer than the corresponding indicator for the antacid drug. Kvamatel was superior to pirenzepine in the rate of onset of effect in the body of the stomach.

When using famotidine to stop bleeding from the upper gastrointestinal tract, it is important to note that there is significant heterogeneity in the distribution of patients according to the time of onset of the pH response, especially in terms of the time of onset of the response in the body of the stomach (Fig. 1). The onset of the antisecretory effect varies greatly from 16 minutes to almost one and a half hours (81 minutes). Thus, simultaneously with the administration of antisecretory drugs, the patient must immediately begin aspiration of gastric contents and administer liquid antacids.

Rice. 1. Distribution of patients with peptic ulcer disease according to the time of onset of the pH response

Famotidine increased the pH in the antrum of the stomach to neutral values: 7.05±0.34 units (from 1.97 to 9.40), as well as in the body of the stomach - 7.14±0.29 (from 2 .05 to 9.40). In all patients with peptic ulcer, the effect of Kvamatel persisted for more than 3 hours (until the maximum duration of short-term intragastric pH-metry expired) (Fig. 2).

Rice. 2. Dynamics of pH in a patient with peptic ulcer under basal conditions, after submaximal stimulation and after intravenous administration of 20 mg Kvamatel

In clinical practice, for bleeding, H2 blockers are administered intravenously or bolus 20–40 mg every 3–6 hours, or a continuous infusion of the drug is carried out (preferably under the control of intragastric pH). Since the onset of action of the drug, its severity and duration vary significantly in different patients, the second method is certainly preferable.

In addition to H2 blockers, for gastrointestinal bleeding, infusion forms of proton pump inhibitors that have recently appeared on the pharmaceutical market are used, most often omeprazole. At the same time, there are concepts that suppressing gastric secretion alone is not enough to stop bleeding, and especially to prevent relapses. Thus, the Daneshmend study compared the effectiveness of intravenous omeprazole and placebo in 1147 patients with acute bleeding from the upper gastrointestinal tract. Antisecretory therapy significantly reduced the severity of endoscopic signs of bleeding, but the frequency of recurrent bleeding, surgical interventions and mortality were the same in both groups.

As already indicated based on our own data, along with the administration of an H2 blocker, a patient with ulcer bleeding should be given antacid drugs orally or administered through a tube during the first 1–1.5 hours in large doses.

Synthetic analogues of somatostatin reduce pressure in the portal vein, blood flow in the arteries of the abdominal cavity, as well as gastric secretion of hydrochloric acid and pepsin. In this regard, drugs of this group are often used for the treatment of acute ulcer bleeding, but a large study (more than 600 patients) showed that they do not significantly reduce the frequency of re-bleeding, the percentage of surgical interventions and mortality (Somerville K et al., 1985) .

Antifibrinolytic agents (tranexamic acid) are widely used, but to date there has been no evidence of their effectiveness.

In clinical practice, one should not forget about such simple measures as gastric lavage with cold solutions.

If conservative treatment of a patient with bleeding from the upper gastrointestinal tract is ineffective or insufficiently effective, endoscopic methods

(laser, thermo- or electrocoagulation, injections of adrenaline and sclerosants). The effectiveness of various endoscopic methods is approximately the same, and the choice mainly depends on the experience of the surgeon and the available capabilities.

A more complex technique is intra-arterial administration of vasopressin or embolization of a bleeding artery. This method is used mainly for hidden bleeding, when the source of blood loss is detected using angiography, most often with primary vascular pathology.

Finally, the last step in the fight against bleeding is to perform abdominal surgery

. Although it should be recognized that due to significant progress in the field of pharmacotherapy of bleeding, as well as endoscopic treatment methods over the past 20 years, there has been a significant decrease in the frequency of such operations throughout the world.

Contraindications and side effects

Hypersensitivity to ranitidine or other components of the drug. Pregnancy, lactation. Children's age up to 14 years. Side effects of ranitidine:

From the nervous system and sensory organs: headache, feeling of fatigue, dizziness, drowsiness, insomnia, vertigo, anxiety, depression; rarely - confusion, hallucinations (especially in elderly and weakened patients), reversible blurred vision, impaired accommodation of the eye.
From the cardiovascular system and blood (hematopoiesis, hemostasis): arrhythmia, tachycardia, bradycardia, AV block, decreased blood pressure; reversible leukopenia, thrombocytopenia, granulocytopenia; rarely - agranulocytosis, pancytopenia, sometimes with bone marrow hypoplasia, aplastic anemia; sometimes - immune hemolytic anemia.
From the gastrointestinal tract: nausea, vomiting, constipation, diarrhea, abdominal discomfort, pain; rarely - pancreatitis. Sometimes - hepatocellular, cholestatic or mixed hepatitis with/without jaundice (in such cases, ranitidine should be stopped immediately). These effects are usually reversible, but in rare cases they can be fatal. Rare cases of liver failure have also been reported. In healthy volunteers, AST concentrations were increased by at least 2-fold relative to pre-treatment levels in 6 of 12 people receiving 100 mg 4 times IV for 7 days and in 4 of 24 people receiving 50 mg 4 times IV for 5 days.
From the musculoskeletal system: rarely - arthralgia, myalgia.
Allergic reactions: skin rash, bronchospasm, fever, eosinophilia; rarely - erythema multiforme, anaphylactic shock, angioedema.

Side effect

The drug may have side effects due to its improper use, dosage violations and non-compliance with instructions. Side effects:

Poor appetite
Nausea
Vomit
Constipation
Rarely tinnitus
Increased blood pressure
Dry mouth
Headache
Fatigue
Violation of potency
Muscle pain
Quincke's edema
Bronchial spasm
Interaction
Reduces the effect of Ketonazole
Inhibits metabolism: Aminophenazone, Thiophylline, Lidocaine, Diazepam, Metronidazole

Compatible with:

Sodium chloride
Dextrose
Sodium bicarbonate

Directions for use and doses

Prescribe to adults and children over 12 years of age. Take orally, without chewing, with a small amount of water, regardless of meals. Peptic ulcer of the stomach and duodenum, not associated with Helicobacter pylori (in the acute phase). Prescribe 150 mg (1 tablet) 2 times a day in the morning and evening or 300 mg (2 tablets) 1 time a day at night for 4 weeks. For ulcers that have not healed, continue treatment for the next 4 weeks.

Prevention of peptic ulcers of the stomach and duodenum associated with the use of non-steroidal anti-inflammatory drugs. Prescribe 150 mg (1 tablet) 2 times a day in the morning and evening for the period of NSAID therapy.
Functional dyspepsia. Prescribe 150 mg (1 tablet) 2 times a day in the morning and evening for 2-3 weeks.
Chronic gastritis with increased acid-forming function of the stomach in the acute stage. Prescribe 150 mg (1 tablet) 2 times a day in the morning and evening for 2-4 weeks.
Gastroesophageal reflux disease. To relieve symptoms, prescribe 150 mg (1 tablet) 2 times a day in the morning and evening for 2 weeks; If necessary, continue the course of treatment.

For repeated treatment and in case of exacerbation of gastroesophageal reflux disease, prescribe 150 mg (1 tablet) 2 times a day in the morning and evening or 300 mg (2 tablets) 1 time per day at night for 8 weeks; if necessary, continue the course of treatment for up to 12 weeks. Patients with severe renal failure (creatinine clearance <50 ml/min). The daily dose of the drug for this category of patients is 1 tablet (150 mg ranitidine).

Famotidine for coronavirus: first doubts

The October preprint spoke out strongly against prescribing famotidine to Covid patients. A retrospective study found that the addition of famotidine (started within 24 hours of hospital admission) to standard therapy in patients hospitalized with COVID-19 demonstrated neither additional risk nor additional benefit in terms of 30-day mortality. However, among those who did not take famotidine at home but received it in hospital, the risk of death increased by 77%.

The above turned out to be true regardless of adverse reactions and possible confounding factors in the context of Covid, such as old age, obesity, smoking status, risk comorbidity, severe COVID-19, use of toxic hydroxychloroquine, etc.

The analysis included data from 1156 patients, of whom 35.5% (n=410) received famotidine.

The authors of the study, however, highlight a number of shortcomings and flaws in their work, which do not allow a general conclusion about famotidine to be made. First, an observational design cannot detect cause-and-effect relationships and may be biased. Second, no serum biomarker or viral load analysis was performed to evaluate the anti-inflammatory and antiviral properties of famotidine. Finally, over 95% of the cohort patients received low or moderate doses of famotidine, meaning there is no way to determine whether high-dose famotidine is beneficial.

Analogs of Ranitidine in tablets

The drugs listed below are analogues of the drug Ranitidine. Analogues mean drugs that have the same international nonproprietary name or ATC code. To replace the drug prescribed to you with an analogue, be sure to consult your doctor!

Gastrosidin
. Indications: Peptic ulcer of the stomach and duodenum, including prevention of relapses; symptomatic (stress, medication, etc.). Ulcer; functional dispersion; erosive reflux esophagitis, prevention of bleeding from the upper gastrointestinal tract, Zollinger-Ellison syndrome.
Kvamatel
. Indications: Gastric and duodenal ulcers. Gastroesophageal reflux disease and other conditions accompanied by hypersecretion (for example, Zollinger-Ellison syndrome). Prevention of recurrence of stomach and duodenal ulcers. Prevention of the development of symptoms and erosions or ulcerations associated with gastroesophageal reflux disease.
Neutraken
. Indications: Treatment of gastric and duodenal ulcers in the presence of gastroesophageal reflux disease and in the absence of H. pylori: non-ulcerative dyspepsia, chronic gastroduodenitis in the acute stage. Prevention of relapse of gastric ulcer.

Precautions and contraindications

The drug requires careful use in hepatosis, cirrhosis and other liver diseases, inflammation of the gallbladder, renal failure, nephritis. These pathologies increase the risk of side effects. Famotidine contraindications include:

individual intolerance to any of its components;
oncological diseases of the gastrointestinal tract;
pregnancy at all stages;
lactation period.

In pediatrics, the medication is used with caution, in doses strictly determined by the doctor, with constant monitoring of the well-being of children.

Famotidine slows down the breakdown of indirect anticoagulants, antidepressants, caffeine, drugs based on lidocaine, theophylline, metronidazole, phenytoin, buformin. This must be taken into account during simultaneous courses of treatment.

Ranitidine analogue without side effects

Ecofuril.
This is a capsule medicine with powerful antibacterial properties against intestinal infections. Main active ingredient: Nifuroxazide international name: Ecofuril, compatibility with alcohol: no, during pregnancy: after doctor's prescription.
Smecta®.
This is a product with an adsorbent effect. The key active component of Smecta is dioctahedral smectite, active ingredient: Dioctahedral smectite, international name: Smecta, compatibility with alcohol: no, during pregnancy: after prescription
Creon.
Multienzyme drug to improve digestion processes. Created on the basis of regular pancreatin, active ingredient: Pancreatin, international name: Kreon, compatibility with alcohol: no, during pregnancy: after prescription
Mezim.
Disturbances in the functioning of the well-functioning digestive mechanism require special attention. They can be not only a consequence, active substance: Pancreatin, international name: Mezym Forte, compatibility with alcohol: no, during pregnancy: after a doctor’s prescription
Hermital.
A frequent consequence of a number of diseases is digestive dysfunction, active ingredient: Pancreatin, international name: Ermytal

Analogue of Ranitidine in Russia

Nolpaza
. An analogue of Ranitidine in tablets is the drug Nolpaza from the group of proton pump inhibitors. The main substance is pantoprazole, which reduces the production of hydrochloric acid. The disadvantage of the analogue is its high cost. Nolpaza® is a selective proton pump inhibitor, a drug that reduces the amount of acid in your stomach. Nolpaza® is used to treat diseases associated with high acidity of the stomach and duodenum.
Rabeprazole
. An analogue of Ranitidine is Rabeprazole, produced in tablets by various manufacturers and dispensed from pharmacies with a doctor's prescription or freely, depending on the dosage. Peptic ulcer of the stomach and duodenum in the acute stage, gastroesophageal reflux disease; conditions characterized by pathological hypersecretion, incl. Zollinger-Ellison syndrome.
Omeprazole
. Preparations for the treatment of diseases associated with acidity disorders. Antiulcer drugs and drugs for the treatment of gastroesophageal reflux (GORD). Proton pump inhibitors. Omeprazole.

Ranitidine or Omez: which is better?

To understand whether to choose Ranitidine or Omez, you should compare these drugs. Both products have almost identical indications. Medicines are used for gastrointestinal diseases, to reduce the acidity of stomach juice. Thanks to this, the work of the digestive system is stimulated. The drugs have antiulcer properties. But what is the difference between Ranitidine and Omez, gastroenterologists know.

Medicines differ in their mechanism of action. Thus, Omez suppresses the function of the proton pump, and Ranitidine is considered a histamine antagonist. This means that the tablets have a similar effect, but their modes of influence are different. The drugs have different basic compositions. Omez contains omeprazole, and the second drug is Ranitidine. The latter is produced in Russia, Serbia and India, while Omez is produced in India. Both medications have similar contraindications and side effects. The products are available in the form of tablets and medicinal solution.

Regarding the dosage regimen, Omez is taken twice a day, 20 mg. The daily dose of Ranitidine is 300 mg, divided into 2 doses.

When thinking about whether Ranitidine or Omeprazole is better, you need to consider the prices of the drugs. The cost of Omez is about 100 to 300 rubles. The price of Ranitidine is cheaper - about 100 rubles. Gastroenterologists recommend choosing Omez. The drug is a more modern, effective remedy. Omeprazole can be taken by elderly patients. Also, the medicine is relatively safe and can be taken for a long time.

Composition, dosage forms of the drug

The active substance of the drug is famotidine. The compound reduces the secretion of hydrochloric acid and increases the mucus content in gastric juice. The drug has two pharmaceutical forms:

Tablets for oral use: in dosages of 20 and 40 mg, coated with soluble film. Auxiliary components: talc, starch, silicon dioxide, magnesium stearate. Sold in packs of 10–50 pcs.
Lyophilized powder for the preparation of injection solutions: white or yellowish free-flowing substrate in ampoules. Available complete with solvent. Cardboard packages of the drug contain 5 ampoules, each containing 20 mg of Famotidine and excipients: mannitol, aspartic acid.

Ranitidine or Omeprazole: which is better?

Since when prescribing a drug it is necessary to take into account the form of the disease, the doctor must choose one or another medication taking into account the severity of the existing symptoms. Since medications have a similar effect on the organs of the digestive system, their side effects are approximately the same. Omez has fewer contraindications; it can be taken by children over one year of age and by pregnant women from the second trimester. Omez has fewer contraindications; it can be taken by children over one year of age and by pregnant women from the second trimester. Ranitidine should not be prescribed to children under 12 years of age or to pregnant women. There are also differences in the cost of drugs: Omez is more expensive.

Both medications are effective in treating gastrointestinal diseases. Most often, these drugs are used to treat gastric or duodenal ulcers. Both drugs quickly exhibit therapeutic effects in the body. Each of these medications can reduce the stomach's production of hydrochloric acid. Therefore, with the use of these drugs, the pathology can be completely cured.

The differences between these drugs lie in the effect they have on stomach acidity. The end result of both medications is a decrease in gastric acidity. But at the same time, Ranitidine inhibits histamine receptors, and Omez acts on enzymes that deliver protons to the area of hydrochloric acid formation. Taking these differences into account, the gastroenterologist prescribes the medicine. The differences lie in the active ingredients of the drugs and in their concentration.

Comparison of addiction between Ranitidine and Famotidine

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So, the totality of the values of such parameters as “syndrome o” for Ranitidine is less than the similar values for Famotidine. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible.

Ranitidine or Famotidine: which is better?

Although famotidine and ranitidine are different molecules, their basic effects on the body are almost the same. They reduce the production of acids by the cells that line the stomach by influencing certain receptors found on the surface of these cells. Both drugs are suitable for treating stomach ulcers, gastroesophageal acid reflux, and other conditions that cause overproduction of stomach acids, but the amount needed to produce a therapeutic effect and the way they are absorbed into the body differ. Famotidine and ranitidine are part of a group of drugs called histamine H2 blockers.

Famotidine and ranitidine block H2 receptors, preventing them from recognizing histamine. In this regard, drugs in this group got their name - H2-histamine receptor blockers.

The other two main drugs in this group, as of 2011, are cimetidine and nizatidine. All of these drugs act on a specific molecule called the H2 receptor, which appears on the surface of some cells. In the stomach, cells with H2 receptors on their surface are called parietal cells, and when they receive the appropriate signal, they release acids into the stomach. Histamine acts as a signaling molecule in this case.

Antacids for gastritis

Phosphalugel - used in the treatment of acute and chronic gastritis.

These drugs must meet the following criteria: neutralize hydrochloric acid, effectively remove toxins, reduce irritation of the stomach walls, and produce an analgesic effect.

Absorbed antacids - Rennie, Bourget's mixture - enter into a chemical reaction with gastric juice.

After the effect of the drug ends, hydrochloric acid begins to be produced in greater quantities than before taking the antacid. Therefore, these drugs are not used in the treatment of gastritis.

In acute and chronic cases, non-absorbable antacids are indicated. The choice of these drugs is wide - Almagel, Maalox, Phosphalugel, Taltsid, Vikalin.

Why has Ranitidine disappeared from pharmacies?

Ranitidine is the international nonproprietary name. Like, for example, acetylsalicylic acid. And there are many more trade names of drugs that contain this acetylsalicylic acid. In the territory of the former Soviet Union, ranitidine is represented by about 50 trade names. So why is there no ranitidine on the market? Now let's look at the composition. Raw materials are produced for the production of the drug. The raw materials are produced by some huge factory. And then a certain plant, which is located in India, produced raw materials for the production of ranitidine, and it was bought by a bunch of different companies. And in this raw material a component was found that is a carcinogen, i.e. causes cancer. And, accordingly, all these ranitidine preparations, with different trade names, made from this raw material, are theoretically dangerous.

Nobody says that if you take a ranitidine tablet tomorrow, something will happen to you.

But since the drug is very common, self-respecting companies, having discovered that the permissible concentration of carcinogens in their medicine exceeds the permissible concentration, withdraw the drug from sale. There are variants of ranitidine that do not contain this raw material, and they can be used. There are those that are not allowed.

But by and large, no one wants to take the risk, and more and more doctors are stopping prescribing ranitidine. What should patients do? To date, ranitidine and its group of drugs are not considered the most effective drugs for combating high stomach acidity. There are more effective drugs called proton pump inhibitors.