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Zantac Alternatives

The U.S. Food and Drug Administration told all manufacturers to withdraw all prescription and OTC Zantac (ranitidine) from the market. FDA has listed several drug alternatives. These include proton pump inhibitors such as Prilosec and Nexium as well as other H2 blockers such as Pepcid and Tagamet.

In September 2019, manufacturers began recalling lots of brand name Zantac and its generic, ranitidine, from the market after FDA received reports of N-nitrosodimethylamine (NDMA) contamination.

In April 2020, the agency requested that all manufacturers withdraw all ranitidine products from the market immediately. The FDA’s investigation determined that NDMA increased over time in some ranitidine products and could expose consumers to unacceptable levels.

Since ranitidine is no longer on the market, consumers may be searching for alternatives. In addition to FDA-recommended Zantac alternatives, consumers may be able to make diet and lifestyle changes to manage heartburn.

People who want to switch medications should speak with their medical providers before stopping any medications.

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Proton Pump Inhibitors

Proton pump inhibitors, also called PPIs, are a class of medications that work by targeting proton pumps. Proton pumps are enzymes responsible for creating stomach acid. PPIs cause proton pumps to reduce the amount of acid they produce.

PPIs are available in prescription strength and OTC formulas. Prescription PPIs treat a wide variety of serious acid-related conditions, including GERD, H. pylori bacterial infections, gastric ulcers and erosive esophagitis. Over-the-counter PPIs treat frequent heartburn.

FDA-recommended PPI alternatives to Zantac include:

FDA recommends these medications as prescription-strength Zantac alternatives because it hasn’t found any NDMA in these PPIs.

Prilosec, Nexium and Prevacid vs Zantac

Prilosec, Nexium and Prevacid are in a different class of drugs than Zantac and they work differently. PPIs and histamine H2-receptor antagonists, or H2 blockers, like Zantac have advantages and disadvantages.

PPIs are powerful acid reducers and can control acid for up to 24 hours when used daily, but they don’t work immediately. Patients may need to take them for a day or more before they start working.

Common PPI side effects include:
  • Diarrhea
  • Dizziness
  • Dry mouth
  • Headache
  • Joint pain
  • Nausea
  • Stomach pain
  • Vomiting

Serious PPI side effects include kidney problems, bone fractures and gastric cancer.

In contrast, H2 blockers like Zantac can only control acid for up to 12 hours. But ranitidine works in as little as 30 minutes, making it more effective for sudden heartburn. Common Zantac side effects are similar to those of PPIs.

Common Zantac side effects include:
  • Constipation
  • Diarrhea
  • Nausea
  • Vomiting
  • Stomach pain
  • Headache

Serious side effects include rare instances of liver failure, blood disorders and pancreatitis.

The drug’s prescription information has never listed cancer as a side effect. But in the wake of the recalls, some people filed Zantac lawsuits claiming the NDMA in the drug caused their cancer and drug manufacturers failed to warn the public.

Lawsuit Information
People filing Zantac and ranitidine lawsuits claim these drugs contained unacceptable levels of the probable carcinogen NDMA, which caused them to develop cancer.
View Lawsuits

Other Histamine H2-receptor Antagonists

In addition to PPIs, the FDA recommends other H2 blockers as Zantac alternatives. These include Pepcid (famotidine) and Tagamet (cimetidine).

H2 blockers block histamine from cells in the stomach called parietal cells. This prevents stimulation of proton pump enzymes and reduces stomach acid production.

Because H2 blockers work faster than PPIs, they might be better for sudden occasional heartburn or acid reflux. If you took OTC Zantac, these OTC alternatives are a good choice.

Side effects from H2 blockers are rare, according to the U.S. National Library of Medicine.

Pepcid’s most common side effect is headache. Tagamet has more side effects, and these include diarrhea, dizziness, headache, rash and gynecomastia — a condition that causes men to develop breasts.

Natural Alternatives

For most people, diet and lifestyle changes can prevent and manage acid reflux, according to Cleveland Clinic. For more serious diseases, people may have to consult their medical provider.

For example, eating smaller, low-fat meals more often instead of three large meals may help. A good example of a smaller, low-fat meal is one that contains about 500 calories and no more than 15 grams of fat, according to Cleveland Clinic gastroenterologist Scott Gabbard.

Natural remedies for acid reflux include:
  • Eat a low-fat diet
  • Don’t go to bed on a full stomach and eat at least three hours before bed
  • Move more throughout the day and avoid reclining and sitting
  • Cut back on portion sizes and overeating
  • Eat more slowly
  • Exercise regularly
  • Maintain a healthy weight
  • Avoid acid reflux triggers such as alcohol, fatty meals, raw onions and excessive caffeine
  • Don’t exercise right after eating; wait at least two hours
  • Eat smaller meals
  • Stop smoking; nicotine can weaken the esophageal sphincter

Certain foods may also help prevent heartburn or GERD. These include high fiber foods such as whole grain cereals, root vegetables and green vegetables.

Watery foods like celery, cucumber, lettuce, watermelon and herbal teas such as ginger tea may weaken stomach acid.

Please seek the advice of a medical professional before making health care decisions.

Michelle Llamas, Senior Content Writer
Written By Michelle Llamas Senior Writer

Michelle Llamas has been writing articles and producing podcasts about drugs, medical devices and the FDA for nearly a decade. She focuses on various medical conditions, health policy, COVID-19, LGBTQ health, mental health and women’s health issues. Michelle collaborates with experts, including board-certified doctors, patients and advocates, to provide trusted health information to the public. Some of her qualifications include:

  • Member of American Medical Writers Association (AMWA) and former Engage Committee and Membership Committee member
  • Centers for Disease Control and Prevention (CDC) Health Literacy certificates
  • Original works published or cited in The Lancet, British Journal of Clinical Pharmacology and the Journal for Palliative Medicine
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  1. Cleveland Clinic. (2019, November 15). Have Heartburn? Here’s How to Find Relief for Your Acid Reflux Symptoms. Retrieved from https://health.clevelandclinic.org/heartburn-lifestyle-changes-to-reduce-acid-reflux-symptoms/
  2. Cleveland Clinic. (n.d.). Heartburn: Care and Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/9617-heartburn-overview/care-and-treatment
  3. Johns Hopkins. (n.d.). GERD Diet: Foods That Help with Acid Reflux (Heartburn). Retrieved from https://www.hopkinsmedicine.org/health/wellness-and-prevention/gerd-diet-foods-that-help-with-acid-reflux-heartburn
  4. U.S. Food and Drug Administration. (2019, September 13). Statement alerting patients and health care professionals of NDMA found in samples of ranitidine. Retrieved from https://www.fda.gov/news-events/press-announcements/statement-alerting-patients-and-health-care-professionals-ndma-found-samples-ranitidine
  5. U.S. Food and Drug Administration. (2020, April 1). FDA Requests Removal of All Ranitidine Products (Zantac) from the Market. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-requests-removal-all-ranitidine-products-zantac-market
  6. U.S. Food and Drug Administration. (2020, April 16). FDA Updates and Press Announcements on NDMA in Zantac (ranitidine). Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-zantac-ranitidine
  7. U.S. Library of Medicine. (2020, October 2). H2 Blockers. Retrieved from https://medlineplus.gov/ency/patientinstructions/000382.htm
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