Ranitidine use in conjuction with NSAID use

[SuckerForHorses]

Some backstory to my question:

While at the doc office the other day for some neck issues I’ve been having, he suggested ibuprofen and taking omeprazole to battle the gut rage that NSAIDS give me. I said that the only thing I had on hand was ranitidine (because my horses get it :lol:)

He said “Raniditine won’t prevent your stomach from getting irritated by NSAID use. The reason you would need to take omeprazole is because NSAID use essentially lessens or destroys the stomach’s moucous lining, and you need omeprazole to stop the acid production in there. Ranitidine won’t do that.”

This got me thinking, of course.

I know that omeprazole is a proton pump inhibitor. Ranitidine is an H2-receptor antagonist.

But both essentially decrease the stomach acid produced - just in different ways; and I consider omeprazole the “stronger” of the two.

But using ranitidine DOES decrease the amount of acid the stomach produces; so why wouldn’t it work for stomach protection in the case of NSAID use?

Less acid = less likely to irritate the compromised stomach/lining. No?

Thoughts?

[Simkie]

According to this study, omeprazole is just MORE effective:

http://www.jwatch.org/jw199803170000001/1998/03/17/nsaid-induced-ulcers-omeprazole-vs-ranitidine

Your doctor seems to be wrong about ranitidine being totally ineffective.

[SuckerForHorses]

[QUOTE=Simkie;8185994]
According to this study, omeprazole is just MORE effective:

http://www.jwatch.org/jw199803170000001/1998/03/17/nsaid-induced-ulcers-omeprazole-vs-ranitidine

Your doctor seems to be wrong about ranitidine being totally ineffective.[/QUOTE]

(I can’t see the journal article) but that is what I was thinking - sure, omeprazole is the better choice, but ranitidine is not entirely ineffective.

[joiedevie99]

Yeah - I think you’re correct. The both work - omeprazole is just a bit stronger (imho), and can be dosed less often.

[Simkie]

Oh, funny–direct link says subscription only, but if you click through from google it comes up. Here’s what it says:

AS Brett reviewing Yeomans ND et al. N Engl J Med 1998 Mar 12.

Ideally, nonsteroidal antiinflammatory drugs (NSAIDs) would be stopped when gastroduodenal side effects occur, but many patients depend on these drugs. This randomized trial compared omeprazole (20 mg or 40 mg daily) and ranitidine (150 mg twice a day) in 541 patients who had endoscopically diagnosed gastroduodenal ulcers or erosions while taking NSAIDs, and who needed ongoing NSAID therapy (usually for arthritis). Most patients had dyspeptic symptoms.
At eight weeks, the rate of success (defined as ulcer healing, fewer than five erosions, and no more than mild dyspepsia) was significantly higher with omeprazole than ranitidine (80 percent vs. 63 percent). The 20 mg dose of omeprazole was as good as the 40 mg dose. Omeprazole was superior to ranitidine for all types of lesions (gastric ulcer, duodenal ulcer, and erosions).
In a second phase of the study, those responding in the first phase were randomized to maintenance therapy with omeprazole or ranitidine. At six months, the rate of continued remission was significantly higher with omeprazole than with ranitidine (72 percent vs. 59 percent).

• See more at: http://www.jwatch.org/jw199803170000001/1998/03/17/nsaid-induced-ulcers-omeprazole-vs-ranitidine#sthash.aSRWE4Y8.dpuf

And here’s the article this author is reviewing: http://www.ncbi.nlm.nih.gov/pubmed/9494148