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Ranitidine parenteral

Updated 2 Feb 2023 | H2 receptor antagonists


Solution for injection containing ranitidine (as the hydrochloride).

Drugs List

  • ranitidine 50mg/2ml injection
  • Therapeutic Indications


    Acid aspiration during labour: prophylaxis
    Before general anaesthesia in patients at risk of acid aspiration
    Duodenal ulcer
    Gastric ulcer
    Gastro-oesophageal reflux disease
    Prophylaxis of recurrent haemorrhage in bleeding peptic ulcers
    Prophylaxis of stress induced GI haemorrhage in the seriously ill
    Reflux oesophagitis
    Zollinger-Ellison syndrome (and other hypersecretory conditions)



    By slow intravenous injection (over at least 2 minutes):
    50mg, after dilution to a volume of 20ml per 50mg dose, every 6 to 8 hour.

    By intermittent intravenous infusion:
    25mg per hour for 2 hours, every 6 to 8 hours.

    By intramuscular injection:
    50mg (2ml) every 6 to 8 hours.

    In the prophylaxis of haemorrhage from stress ulceration in seriously ill patients or the prophylaxis of recurrent haemorrhage in patients bleeding from peptic ulceration, parenteral administration may be continued until oral feeding commences. Patients considered to be still at risk may then be treated with ranitidine tablets 150mg twice daily.

    In prophylaxis of upper gastrointestinal haemorrhage from stress ulceration in seriously ill patients a priming dose of 50mg as a slow intravenous injection followed by a continuous intravenous infusion of 125 to 250microgram/kg/hour may be preferred.

    In patients considered to be at risk of developing acid aspiration (Mendelson's syndrome), ranitidine 50mg may be administered intramuscularly or by slow intravenous injection 45 to 60 minutes before induction of general anaesthesia.


    (See Dosage; Adult)


    Children aged 12 years and older
    (See Dosage; Adult)

    Children aged 6 months to 12 years
    Up to a maximum of 50mg (over 2 minutes) by slow intravenous injection every 6 to 8 hours.

    Treatment of Acute Peptic Ulcer disease and Gastro-oesophageal Reflux
    Initial dose 2mg/kg or 2.5mg/kg up to a maximum of 50mg may be administered as a slow intravenous infusion over 10 minutes.
    This may be with a syringe pump followed by a 3ml flush with normal saline over 5 minutes, or by slow intravenous injection following dilution with normal saline to 20ml. The maintenance of pH greater than 4 can be achieved by intermittent infusion of 1.5mg/kg every 6 to 8 hours.

    Alternatively, administer a loading dose of 0.45mg/kg followed by a continuous infusion of 0.15mg/kg/hour.

    Alternative sources suggest the following doses in reflux oesophagitis, benign gastric and duodenal ulceration, prophylaxis of stress ulceration and other conditions where gastric acid reduction is beneficial:

    Children aged 6 months to 11 years
    1mg/kg (up to a maximum of 50mg) every 6 to 8 hours.
    Alternatively, intermittent infusion of 25mg/hour.

    Children aged 1 month to 6 months (unlicensed)
    1mg/kg (up to a maximum of 50mg) every 6 to 8 hours.
    Alternatively, intermittent infusion of 25mg/hour.


    Alternative sources suggest the following unlicensed dose for neonates in reflux oesophagitis, benign gastric and duodenal ulceration, prophylaxis of stress ulceration and other conditions where gastric acid reduction is beneficial:

    Neonate (unlicensed)
    0.5 to 1mg/kg every 6 to 8 hours.

    Patients with Renal Impairment

    It is recommended that ranitidine injection be administered in doses of 25mg in patients with renal impairment (creatinine clearance less than 50ml/minute).

    Alternative sources suggest that the dose may need to be reduced by 50% in patients with glomerular filtration rate less than 10ml/minute.


    For slow intravenous injection or infusion, and intramuscular administration.


    None known

    Precautions and Warnings

    Children under 6 months
    Patients over 50 years
    Acute porphyria
    Chronic respiratory impairment
    Diabetes mellitus
    Renal impairment - creatinine clearance below 50ml/minute

    May mask symptoms of serious disease of the stomach and delay diagnosis
    Reduce dose in patients with severe renal impairment
    Exclude gastric cancer before commencing treatment
    Monitor for signs/symptoms of pneumonia in patients at risk
    Not licensed for all indications in all age groups
    Avoid long term use

    In patients with factors predisposing to cardiac rhythm disturbances, bradycardia has rarely been reported when ranitidine injection has been rapidly administered. Recommended rates of administration should not be exceeded.

    In patients over 50 years of age, half-life is prolonged and renal clearance is reduced, which is consistent with age declining renal function. However, systemic exposure and accumulation of the drug are 50% higher. This indicates increased bioavailability in older patients which exceeds the effect of declining renal function.

    The manufacturer advises to avoid in patients with a history of acute porphyria. Rare clinical reports suggest ranitidine may precipitate acute porphyric attacks. However, the Welsh Medicines Information Centre considers the drug to be safe in acute porphyria. NAPOS website classifies the drug as probably not porphyrinogenic, to be used as a first hand choice with no precautions needed. This is based on uneventful clinical experiences which points to non-porphyrinogenicity. They question the causality of the few case reports which pointed the drug as porphyrinogenic.

    Pregnancy and Lactation


    Ranitidine should be used with caution in pregnancy.

    There is consensus that ranitidine may be used during pregnancy and Schaefer concludes that it may be prescribed where antacids have failed.

    Animal studies have shown no evidence of teratogenicity or impairment of fertility. Available data on human pregnancies suggests that ranitidine is not a major teratogen. Ranitidine crosses the placenta but therapeutic doses administered to obstetric patients in labour or undergoing caesarean section have been used without any adverse effect on labour, delivery or subsequent neonatal progress

    Current practice guidelines also state that ranitidine is considered safe for use during pregnancy on the basis of several years of use without incidence and supporting evidence from observational studies.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Ranitidine should be used with caution in breastfeeding.

    Ranitidine is excreted in breast milk although the amount present in breast milk is lower than the paediatric dose. Since ranitidine has been widely used in paediatrics without significant side effects and exposure levels via breast milk are sub-therapeutic, there is consensus that ranitidine may be used during breastfeeding. Schaefer concludes that ranitidine may be used during lactation but other drugs of the same class that are excreted into breast milk at lower levels should be preferred. LactMed (via Toxnet) concludes that maternal ranitidine would not be expected to cause any adverse effects in breastfed infants.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal pain
    Acute pancreatitis
    Altered liver function tests
    Anaphylactic shock
    Angioneurotic oedema
    Atrioventricular block
    Blurred vision
    Bone marrow aplasia
    Bone marrow hypoplasia
    Breast symptoms in men
    Chest pain
    Erythema multiforme
    Hypersensitivity reactions
    Interstitial nephritis
    Involuntary movement disorders
    Serum creatinine increased


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: January 2016

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Summary of Product Characteristics: Ranitidine 50mg/2ml Solution for Injection and Infusion. Alliance Pharmaceuticals. Revised February 2015

    Summary of Product Characteristics: Ranitidine Injection 25mg/ml Solution for Injection. Amdipharm Mercury Company Limited. Revised November 2015

    Summary of Product Characteristics: Zantac Injection 50mg/2ml. GlaxoSmithKline UK. Revised October 2015

    NICE Evidence Services Available at: Last accessed: 12 September 2017

    The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Last revised: March 10, 2015
    Last accessed: January 14, 2016

    The Welsh Medicines Information Centre (WMIC) - Porphyria Information Service.
    Available at:
    Last revised: May, 2016
    Last accessed: January 14, 2016

    The Norwegian Porphyria Centre (NAPOS).
    Available at:
    Last revised: January 11, 2012
    Last accessed: January 14, 2016

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