Alternative parenteral acid suppressants in children

Alternative parenteral acid suppressants covering main indications of intravenous ranitidine in children

I am pleased to share this guidance produced by the Neonatal and Paediatric Pharmacists Group (NPPG) on alternative parenteral acid suppressants to intravenous ranitidine for use in children, which was previously published on the Specialist Pharmacy Service (SPS) website in November 2020.

All formulations of ranitidine have been withdrawn in the European Union due to ongoing regulatory investigations into the presence of the contaminant, N-nitrosodimethylamine (NDMA), in samples of ranitidine active substance. Clinical advice on alternatives of ranitidine preparations for adults (intravenous and oral) and children (oral only) were shared in a Medicine Supply Notification, which was most recently updated on 22 May 2020.

Clinical advice on alternatives of intravenous ranitidine preparations for use in children was lacking. Therefore, NPPG produced the guidance below. The need for a parenteral treatment should be assessed and if considered necessary the  injectable proton pump inhibitors in the table may be considered to offer a suitable clinical alternative to intravenous ranitidine, in conjunction with the reader’s own professional knowledge and clinical judgement, the circumstances of the individual patient and all relevant pharmaceutical and healthcare literature and guidelines, or following and in conjunction with consultation with a qualified medical professional.

The recommendations on alternative oral acid suppressants for use in children can be accessed via the Royal College of Paediatrics and Child Health (RCPCH) website.

I hope that all organisations find the information contained in this guidance useful.

Anna Burgess
NPPG Information Officer
5th October 2021

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