DRUG OF THE MONTH:ZANTAC

Zantac (ranitidine), the ulcer drug, is one of the world’s top bestsellers. Consequently, the recent news that most ulcers are caused by the helicobacter pylori bug and can be cured with a one-time drug treatment has come as a bit of a blow to ulcer-

Glaxo has been advertising Zantac to treat ulcers caused by nonsteroidal anti-inflammatory drugs, painkillers mainly used for arthritis-before they’ve even appeared. A recent ad in the BMJ read: “Successfully healing both duodenal and gastric ulcers. . . used as prophylaxis [that is, just-in-case treatment], Zantac can actually prevent NSAID-associated duodenal ulcers. In fact it’s the only [ulcer drug] licensed to do this.” This raised the hackles of Findlay M Hickley, the pharmaceutical prescribing adviser of the Grampian Health Board in Aberdeen, Scotland, who pointed out that the most likely site of damage caused by NSAIDS is the stomach mucosa, not the small intestine (duodenum). He notes that the British National Formulary states: “Therapy [with H2 antagonists] can promote the healing of NSAID-associated ulcers but there is no proof that the ulcer complications [ie, bleeding or perforation] are prevented.” He also notes that Zantac is only licensed as a just-in-case remedy against duodenal ulcers, not stomach ones (BMJ, 20/27 August 1994). Needless to say, Glaxo replied that the ad doesn’t actually say that it can prevent gastric ulcers (although the first part of the ad clearly suggests that by implication).

This use of of an H2 antagonist is of concern because some acid-blocking drugs are being released over the counter.

If you’re contemplating using this drug to control stomach side effects from NSAIDS, you should know that Zantac can cause nausea, vomiting, abdominal discomfort and pain.