1.3.1 H2-receptor antagonists

ChoiceDrugDosage
1st choiceRanitidine tablets 150mg, 300mg; effervescent tablets 150mg, 300mg; oral solution 75mg/5mlDoses:
· gastric or duodenal ulcer, chronic episodic dyspepsia, NSAID-associated ulcer: 150mg twice daily or 300mg at night
· in duodenal ulcer, 300mg can be given twice daily for 4 weeks to achieve a higher healing rate
· prophylaxis of NSAID-associated ulcer, 300mg twice daily [unlicensed]
· GORD, 150mg twice daily or 300mg at night

Cautions

  • Ranitidine is currently unavailable. This is due to a possible risk with the ingredients
  • H2-receptor antagonists might mask the symptoms of gastric cancer. Particular care is required in patients presenting with alarm features. In such cases gastric malignancy should be ruled out before treatment.

Alarm Features

NICAN Northern Ireland Referral Guidance for Suspected Cancer (www.nican.hscni.net)

  • Red flag referral for endoscopy / referral to specialist, patients of any age with dyspepsia and any of the following:
    • chronic gastrointestinal bleeding
    • dysphagia
    • progressive unintentional weight loss
    • persistent vomiting
    • iron deficiency anaemia
    • epigastric mass
    • suspicious barium meal results
  • Red flag referral for patients presenting with:
    • dysphagia
    • unexplained upper abdominal pain and weight loss, with or without back pain
    • upper abdominal mass without dyspepsia
    • obstructive jaundice (depending on clinical state) – consider urgent ultrasound if available
  • Consider red flag referral for patients presenting with:
    • persistent vomiting and weight loss in the absence of dyspepsia
    • unexplained weight loss or iron deficiency anaemia in the absence of dyspepsia
    • unexplained worsening of dyspepsia and:
      • barrett’s oesophagus
      • known dysplasia, atrophic gastritis or intestinal metaplasia
      • peptic ulcer surgery over 20 years ago
  • Urgent endoscopy:
    • patients aged 55 years and older with unexplained and persistent recent-onset dyspepsia alone