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| Interactions: | Alendronate
Adverse Effect: Increased alendronate bioavailability
Atracurium
Adverse Effect: Antagonism of neuromuscular blockade
Ceftibuten
Adverse Effect: Increase in C max and AUC of Ceftibuten # Clinical Management: Monitor the patients and adjust the dosage if necessary.
Cyclosporin
Adverse Effect: Nephrotoxicity #Clinical Management: Monitor for signs and symptoms of nephrotoxicity and administer the drug with caution.
Diltiazem
Adverse Effect: Increased diltiazem concentrations and possible cardiovascular toxicity Clinical Management: Monitor the cardiovascular response (blood pressure, heart rate) of the calcium channel blocker if ranitidine is added to the regimen. Famotidine may be considered as alternative H-2 antagonist therapy with a similarly low potential for clinically significant interactions with calcium channel blockers, although famotidine has inherent negative inotropic effects which may be harmful in selected patients.
Glipizide
Adverse Effect: hypoglycemia Clinical Management: Concurrent administration of glipizide and ranitidine is not recommended. If concurrent use cannot be avoided, monitor blood glucose for signs of hypoglycemia upon initiation of ranitidine. Reduce dose of glipizide as needed on the basis of serum blood glucose concentrations. Suggest switching to another anti-ulcer medication (eg, sucralfate) which has less potential to alter the pharmacokinetics of glipizide.
Itraconazole
Adverse Effect: loss of itraconazole efficacy Clinical Management: Itraconazole should be administered with a cola beverage if the patient is receiving an H2 receptor antagonist, such as ranitidine.
Ketoconazole
Adverse Effect: decreased ketoconazole effectiveness Clinical Management: Concurrent administration of ketoconazole and ranitidine is not recommended. If concurrent use cannot be avoided, ranitidine should be taken at least two hours after ketoconazole. Because staggered administration may not be completely reliable, aggressively monitor these patients for continued antifungal efficacy.
Metformin
Adverse Effect: an increased risk of lactic acidosis Clinical Management: In patients receiving metformin and Ranitidine , closely monitor serum glucose levels. Metformin doses may need to be reduced.
Midazolam
Adverse Effect: Midazolam toxicity (prolonged sedation, confusion)
Pancuronium
Adverse Effect: Antagonism of neuromuscular blockade
Phenytoin
Adverse Effect: Increased phenytoin concentrations Clinical Management: Clinicians should be aware of the potential of increased phenytoin concentrations, though the significance of this interaction has not been established. No special monitoring appears necessary, though all patients should be followed for signs of phenytoin toxicity throughout their course of therapy.
Theophylline
Adverse Effect: Theophylline toxicity (nausea, vomiting, palpitations, seizures) Clinical Management: Theophylline serum concentrations should be closely monitored when ranitidine is added, discontinued, or when dosing changes occur. Dosing adjustments of theophylline may be necessary
Warfarin
Adverse Effect: an increased risk of bleeding Clinical Management: Use of ranitidine in patients requiring anticoagulant therapy with warfarin should be accompanied by frequent monitoring of the prothrombin time until any effect on the anticoagulant response is manifested and is stabilized. In patients whose prothrombin times are unstable while receiving warfarin and ranitidine, consider using an H2-antagonist less likely to interact with warfarin, such as famotidine or nizatidine.
Antacids: Decreased ranitidine ab-sorption. Separate administration times by at least 1 hour.
Diazepam: Decreased absorption of diazepam. Monitor child.
Glipizide: Increased hypoglycemic effect. Dosage adjustment of glipizide may be needed.
Procainamide, warlarin: Decreased renal clear-ance of these drugs. Monitor serum levels and adjust dosages as needed. |
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