塩酸ラニチジン、ラニチジン塩酸塩

関: ranitidine

WordNet

a histamine blocker and antacid (trade name Zantac) used to treat peptic ulcers and gastritis and esophageal reflux (同)Zantac
a complex consisting of an organic base in association with hydrogen chloride

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/11/30 23:44:28」(JST)

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Ranitidine, sold under the trade name Zantac among others, is a medication that decreases stomach acid production.^[1] It is commonly used in treatment of peptic ulcer disease, gastroesophageal reflux disease, and Zollinger–Ellison syndrome.^[1] There is also tentative evidence of benefit for hives.^[2] It can be taken by mouth, by injection into a muscle, or into a vein.^[1]

Common side effects include headaches and pain or burning if given by injection. Serious side effects may include liver problems, a slow heart rate, pneumonia, and the potential of masking stomach cancer.^[1] It is also linked to an increased risk of Clostridium difficile colitis.^[3] It is generally safe in pregnancy. Ranitidine is an H₂ histamine receptor antagonist that works by blocking histamine and thus decreasing the amount of acid released by cells of the stomach.^[1]

Ranitidine was discovered in 1976 at Glaxo Pharmaceuticals, now a part of GlaxoSmithKline.^[4]^[5] It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.^[6] It is available as a generic medication.^[1] The wholesale price in the developing world is about 0.01 to 0.05 USD per pill.^[7] In the United States it is about 0.05 USD per dose.^[1]

1 Medical uses
- 1.1 Preparations
- 1.2 Dosing
2 Contraindications
3 Adverse effects
- 3.1 Central nervous system
- 3.2 Cardiovascular
- 3.3 Gastrointestinal
- 3.4 Liver
- 3.5 Lungs
- 3.6 Blood
- 3.7 Skin
4 Warnings and precautions
- 4.1 Disease-related concerns
- 4.2 Pregnancy
- 4.3 Lactation
- 4.4 Children
5 Pharmacology
- 5.1 Mechanism of action
- 5.2 Pharmacokinetics
  - 5.2.1 Elderly
  - 5.2.2 Children
6 History
7 See also
8 References
9 External links

Medical uses

Relief of heartburn
Short-term and maintenance therapy of gastric and duodenal ulcers
Ranitidine can also be given with NSAIDs to reduce the risk of ulceration. Proton-pump inhibitors (PPIs) are more effective for the prevention of NSAID-induced ulcers.^[8]
Pathologic gastrointestinal (GI) hypersecretory conditions such as Zollinger–Ellison syndrome
Gastroesophageal reflux disease (GERD)
Erosive esophagitis
Part of a multidrug regimen for Helicobacter pylori eradication to reduce the risk of duodenal ulcer recurrence
Recurrent postoperative ulcer
Upper GI bleeding
Prevention of acid-aspiration pneumonitis during surgery: ranitidine can be administered preoperatively to reduce the risk of aspiration pneumonia. The drug not only increases gastric pH, but also reduces the total output of gastric juice. In a 2009 meta-analysis comparing the net benefit of proton pump inhibitors and ranitidine to reduce the risk of aspiration before anesthesia, ranitidine was found to be more effective than proton pump inhibitors in reducing the volume of gastric secretions.^[9] Ranitidine may have an antiemetic effect when administered preoperatively.
Prevention of stress-induced ulcers in critically ill patients^[10]

Preparations

Certain preparations of ranitidine are available over the counter (OTC) in various countries. In the United States, 75- and 150-mg tablets are available OTC. Zantac OTC is manufactured by Boehringer Ingelheim. In Australia and the UK, packs containing seven or 14 doses of the 150-mg tablet are available in supermarkets, small packs of 150-mg and 300-mg tablets are schedule 2 pharmacy medicines. Larger doses and pack sizes still require a prescription.

Dosing

For ulcer treatment, a night-time dose is especially important — as the increase in gastric/duodenal pH promotes healing overnight when the stomach and duodenum are empty. Conversely, for treating reflux, smaller and more frequent doses are more effective.

Ranitidine used to be administered long-term for reflux treatment, sometimes indefinitely. However, PPIs have taken over this role. In addition, a fairly rapid tachyphylaxis can develop within 6 weeks of initiation of treatment, further limiting its potential for long-term use.^[11]

People with Zollinger–Ellison syndrome have been given very high doses without any harm.^[12]

Contraindications

Ranitidine is contraindicated for patients known to have hypersensitivity to the drug.

Adverse effects

The following adverse effects have been reported as events in clinical trials:

Central nervous system

Rare reports have been made of malaise, dizziness, somnolence, insomnia, and vertigo. In severely ill, elderly patients, cases of reversible mental confusion, agitation, depression, and hallucinations have been reported.^[13] Ranitidine causes fewer CNS adverse reactions and drug interactions compared to cimetidine.^{[citation needed]}

Cardiovascular

Arrhythmias such as tachycardia, bradycardia, atrioventricular block, and premature ventricular beats have also been reported.^[13]

Gastrointestinal

All drugs in its class have the potential to cause vitamin B₁₂ deficiency secondary to a reduction in food-bound vitamin B₁₂ absorption.^[14] Elderly patients taking H₂ receptor antagonists are more likely to require B₁₂ supplementation than those not taking such drugs.^[15] H₂ blockers may also reduce the absorption of drugs (azole antifungals, calcium carbonate) that require an acidic stomach.^[16] In addition, multiple studies suggest the use of H₂ receptor antagonists such as raniditine may increase the risk of infectious diarrhoea, including traveller's diarrhoea and salmonellosis.^[17]^[18]^[19]^[20]^[21] Finally, by suppressing acid-mediated breakdown of proteins, ranitidine may lead to an elevated risk of developing food or drug allergies, due to undigested proteins then passing into the gastrointestinal tract, where sensitisation occurs. Patients who take these agents develop higher levels of immunoglobulin E against food, whether they had prior antibodies or not.^[22] Even months after discontinuation, an elevated level of IgE in 6% of patients was still found in this study.

Liver

Cholestatic hepatitis, liver failure, hepatitis, and jaundice have been noted, and require immediate discontinuation of the drug.^[13] Blood tests can reveal an increase in liver enzymes or eosinophilia, although in rare instances, severe cases of hepatotoxicity may require a liver biopsy.^[23]

Lungs

Ranitidine and other histamine H₂ receptor antagonists may increase the risk of pneumonia in hospitalized patients.^[24] They may also increase the risk of community-acquired pneumonia in adults and children.^[25]

Blood

Thrombocytopenia is a rare but known side effect. Drug-induced thrombocytopenia usually takes weeks or months to appear, but may appear within 12 hours of drug intake in a sensitized individual. Typically, the platelet count falls to 80% of normal, and thrombocytopenia may be associated with neutropenia and anemia.^[26]

Skin

Rash, including rare cases of erythema multiforme and rare cases of hair loss and vasculitis have been seen.^[13]

Warnings and precautions

Disease-related concerns

With gastric malignancies, relief of symptoms due to the use of ranitidine does not exclude the presence of a gastric malignancy. In addition, with kidney or liver impairment, ranitidine must be used with caution. Finally, ranitidine should be avoided in patients with porphyria, as it may precipitate an attack.^[27]

Pregnancy

This drug is rated pregnancy category B in the United States.

Lactation

Ranitidine enters breast milk, with peak concentrations seen at 5.5 hours after the dose in breast milk. Caution should be exercised when prescribed to nursing women.^[28]

Children

In children, the use of gastric acid inhibitors has been associated with an increased risk for development of acute gastroenteritis and community-acquired pneumonia.^[29] A cohort analysis including over 11,000 neonates reported an association of H₂ blocker use and an increased incidence of necrotizing enterocolitis in very-low-birth-weight (VLBW) neonates.^[30] In addition, about a sixfold increase in mortality, necrotizing enterocolitis, and infection (such as sepsis, pneumonia, urinary tract infection) was reported in patients receiving ranitidine in a cohort analysis of 274 VLBW neonates.^[31]

Pharmacology

Mechanism of action

Ranitidine is a competitive, reversible inhibitor of the action of histamine at the histamine H₂ receptors found in gastric parietal cells. This results in decreased gastric acid secretion and gastric volume, and reduced hydrogen ion concentration.

Pharmacokinetics

Absorption: Oral: 50% Protein binding: 15% Metabolism: N-oxide is the principal metabolite. Half-life elimination: With normal renal function, ranitidine taken orally has a half-life of 2.5–3.0 hours. If taken intravenously, the half-life is generally 2.0–2.5 hours in a patient with normal creatinine clearance. Excretion: The primary route of excretion is the urine. In addition, about 30% of the orally administered dose is collected in the urine as non-absorbed drug in 24 hours.

Elderly

In the elderly population, the plasma half-life of ranitidine is prolonged to 3–4 hours secondary to decreased kidney function causing decreased clearance.^[32]

Children

In general, studies of pediatric patients (aged 1 month to 16 years) have shown no significant differences in pharmacokinetic parameter values in comparison to healthy adults, when correction is made for body weight.^[32]

History

Zantac (ranitidine) 300-mg tablets

Ranitidine was first prepared as AH19065 by John Bradshaw in the summer of 1977 in the Ware research laboratories of Allen & Hanburys Ltd, part of the Glaxo organization.^[33]^[34] Its development was a response to the first in class histamine H₂ receptor antagonist, cimetidine, developed by Sir James Black at Smith, Kline and French, and launched in the United Kingdom as Tagamet in November 1976. Both companies would eventually become merged as GlaxoSmithKline following a sequence of mergers and acquisitions starting with the integration of Allen & Hanbury's Ltd and Glaxo to form Glaxo Group Research in 1979, and ultimately with the merger of Glaxo Wellcome and SmithKline Beecham in 2000. Ranitidine was the result of a rational drug-design process using what was by then a fairly refined model of the histamine H₂ receptor and quantitative structure-activity relationships.

Glaxo refined the model further by replacing the imidazole ring of cimetidine with a furan ring with a nitrogen-containing substituent, and in doing so developed ranitidine. Ranitidine was found to have a far-improved tolerability profile (i.e. fewer adverse drug reactions), longer-lasting action, and 10 times the activity of cimetidine. Ranitidine has 10% of the affinity that cimetidine has to CYP450, so it causes fewer side effects, but other H₂ blockers famotidine and nizatidine have no CYP450 significant interactions.^[35]

Ranitidine was introduced in 1981 and was the world's biggest-selling prescription drug by 1987. It has since largely been superseded by the even more effective proton-pump inhibitors, with omeprazole becoming the biggest-selling drug for many years. When omeprazole and ranitidine were compared in a study of 144 people with severe inflammation and erosions or ulcers of the esophagus, 85% of those treated with omeprazole healed within eight weeks, compared to 50% of those given ranitidine. In addition, the omeprazole group reported earlier relief of heartburn symptoms.^[36]

References

^ ^a ^b ^c ^d ^e ^f ^g "Ranitidine". The American Society of Health-System Pharmacists. Retrieved Dec 1, 2015.
^ Fedorowicz, Z; van Zuuren, EJ; Hu, N (14 March 2012). "Histamine H2-receptor antagonists for urticaria.". The Cochrane database of systematic reviews. 3: CD008596. doi:10.1002/14651858.CD008596.pub2. PMID 22419335.
^ Tleyjeh, IM; Abdulhak, AB; Riaz, M; Garbati, MA; Al-Tannir, M; Alasmari, FA; Alghamdi, M; Khan, AR; Erwin, PJ; Sutton, AJ; Baddour, LM (2013). "The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.". PLOS ONE. 8 (3): e56498. doi:10.1371/journal.pone.0056498. PMC 3587620. PMID 23469173.
^ Fischer, Janos (2010). Analogue-based Drug Discovery II. John Wiley & Sons. p. 4. ISBN 9783527632121.
^ Hara, Takuji (2003). Innovation in the pharmaceutical industry the process of drug discovery and development. Cheltenham, U.K.: Edward Elgar. p. 94. ISBN 9781843765660.
^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
^ "Ranitidine". International Drug Price Indicator Guide. Retrieved 1 December 2015.
^ "Reflux Remedies: ranitidine". PharmaSight OTC Health. PharmaSight.org. Retrieved 16 November 2011.
^ Clark, K.; Lam, L. T.; Gibson, S.; Currow, D. (2009). "The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials". Anaesthesia. 64: 652–657. doi:10.1111/j.1365-2044.2008.05861.x.
^ Dellinger, R. Phillip; et al. (2013). "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012". Intensive Care Medicine. 39 (2): 165–228.
^ Lightdale, J. R.; Gremse, D. A.; Heitlinger, L. A.; Cabana, M.; Gilger, M. A.; Gugig, R.; Hill, I. D. (2013). "Gastroesophageal reflux: management guidance for the pediatrician". Pediatrics. 131 (5): e1684–e1695. doi:10.1542/peds.2013-0421.
^ "Ranitidine Drug Information". Lexicomp. Retrieved 20 April 2014.
^ ^a ^b ^c ^d "ZANTAC Drug Insert" (PDF). GlaxoSmithKline. Retrieved 19 April 2014.
^ Force, R. W., and M. C. Nahata. "Effect of histamine H2-receptor antagonists on vitamin B₁₂ absorption." The Annals of Pharmacotherapy 26.10 (1992): 1283-1286.
^ Mitchell SL, Rockwood K (2001). "The association between antiulcer medication and initiation of cobalamin replacement in older persons". J Clin Epidemiol. 54 (5): 531–534. doi:10.1016/S0895-4356(00)00340-1.
^ "Reflux Remedies: ranitidine". PharmaSight OTC Health. PharmaSight.org. Retrieved 16 November 2011.
^ Cobelens FG, Leentvarr-Kuijpers A, Kleijnen J, Coutinho RA (1998). "Incidence and risk factors of diarrhoea in Dutch travellers: Consequences for priorities in pre-travel health advice". Trop Med Intern Health. 3: 896–903.
^ Neal KR, Briji SO, Slack RC, et al. (1994). "Recent treatment with H2-antagonists and antibiotics and gastric surgery as risk factors for Salmonella infection". Br Med J. 308 (6922): 176. doi:10.1136/bmj.308.6922.176. PMID 7906170.
^ Neal KR, Scott HM, Slack RC, Logan RF (1996). "Omeprazole as a risk factor for Campylobacter gastroenteritis: Case-control study". BMJ. 312 (7028): 414–415. doi:10.1136/bmj.312.7028.414. PMID 8601113.
^ Wickramasinghe LS, Basu SK (1984). "Salmonellosis during treatment with ranitidine". Br Med J. 289 (6454): 1272. doi:10.1136/bmj.289.6454.1272.
^ Ruddell WS, Axon AT, Findlay JM, et al. (1980). "Effect of cimetidine on gastric bacterial flora". Lancet. i: 672–674. doi:10.1016/s0140-6736(80)92826-3.
^ Untersmayr E, Bakos N, Scholl I, et al. (2005). "Anti-ulcer drugs promote IgE formation toward dietary antigens in adult patients". FASEB J. 19 (6): 656–658. doi:10.1096/fj.04-3170fje. PMID 15671152.
^ "Ranitidine: Hepatotoxicity". NIH official website. June 28, 2016. Retrieved August 25, 2016.
^ Mallow S, Rebuck JA, Osler T, et al. (2004). "Do proton pump inhibitors increase the incidence of nosocomial pneumonia and related infectious complications when compared with histamine-2 receptor antagonists in critically ill trauma patients?". Curr Surg. 61 (5): 452–458. doi:10.1016/j.cursur.2004.03.014. PMID 15475094.
^ Canani RB, Cirillo P, Roggero P, Romano C, Malamisura B, Terrin G, Passariello A, Manguso F, Morelli L, Guarino A (May 2006). "Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children.". Pediatrics. 117 (5): e817–20. doi:10.1542/peds.2005-1655. PMID 16651285.
^ Amit V Bangia; Narendra Kamath; Vidushi Mohan (2011). "Ranitidine-induced thrombocytopenia: A rare drug reaction". Indian J Pharmacol. 43 (1): 76–7. doi:10.4103/0253-7613.75676. PMC 3062128. PMID 21455428.
^ "Ranitidine Drug Information". Lexicomp. Retrieved 19 April 2014.
^ "Ranitidine". Lexicomp. Retrieved 19 April 2014.
^ Canani, RB; Cirillo, P; Roggero, P; et al. (2006). ", "Therapy With Gastric Acidity Inhibitors Increases the Risk of Acute Gastroenteritis and Community-Acquired Pneumonia in Children". Pediatrics. 117 (5): e817–20. doi:10.1542/peds.2005-1655. PMID 16651285.
^ Guillet, R; Stoll, BJ; Cotten, CM; et al. (2006). "Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants". Pediatrics. 117 (2): 137–42. doi:10.1542/peds.2005-1543. PMID 16390920.
^ Terrin, G; Passariello, A; De Curtis, M; et al. (2012). "Ranitidine Is Associated With Infections, Necrotizing Enterocolitis, and Fatal Outcome in Newborns". Pediatrics. 129 (1): 40–5. doi:10.1542/peds.2011-0796. PMID 22157140.
^ ^a ^b "Zantac Package Insert" (PDF). FDA.
^ Lednicer, Daniel (Editor). Chronicles of Drug Discovery. ACS Professional Reference Books, Volume 3, pages 45-81 1993. ISBN 0-8412-2733-0.
^ US patent US4128658, "Aminoalkyl furan derivatives", 1978
^ Laurence Brunton; John Lazo; Keith Parker (August 2005). Goodman & Gilman's The Pharmacological Basis of Therapeutics (11 ed.). McGraw-Hill. p. 972. doi:10.1036/0071422803. ISBN 0-07-142280-3.
^ Pelot, Daniel, (M.D.). "Digestive System : New Drug for Heartburn". The New Book of Knowledge : Medicine & Health, Grolier : Danbury, Connecticut. 1990. p.262. ISBN 0-7172-8244-9. Library of Congress 82-645223

External links

U.S. National Library of Medicine: Drug Information Portal – Ranitidine

UpToDate Contents

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English Journal

Effects of ranitidine (antacid), food, and formulation on the pharmacokinetics of fostamatinib: results from five phase I clinical studies.

Flanagan T1, Martin P2, Gillen M3, Mathews D4, Lisbon E4, Kruusmägi M5.
European journal of clinical pharmacology.Eur J Clin Pharmacol.2017 Feb;73(2):185-195. doi: 10.1007/s00228-016-2156-4. Epub 2016 Nov 17.
PURPOSE: Fostamatinib is an orally dosed phosphate prodrug that is cleaved by intestinal alkaline phosphatase to the active metabolite R406. Clinical studies were performed to assess the effect of food and ranitidine on exposure, to support in vitro-in vivo relationships (IVIVR) understanding and fo
PMID 27858108

Ponciretin attenuates ethanol-induced gastric damage in mice by inhibiting inflammatory responses.

Kang GD1, Kim DH2.
International immunopharmacology.Int Immunopharmacol.2017 Feb;43:179-186. doi: 10.1016/j.intimp.2016.12.021. Epub 2016 Dec 22.
BACKGROUND: Poncirin (PO) and isosakuranetin (or ponciretin [PT]) are compounds found in fruits of the genus Citrus. They are frequently used in traditional Chinese medicine for the treatment of inflammation and asthma. Therefore, we examined their anti-gastritis effects in vitro and in vivo.METHODS
PMID 28013186

Histamine Increases Neuronal Excitability and Sensitivity of the Lateral Vestibular Nucleus and Promotes Motor Behaviors via HCN Channel Coupled to H2 Receptor.

Li B1, Zhang XY1, Yang AH2, Peng XC1, Chen ZP1, Zhou JY1, Chan YS3, Wang JJ1, Zhu JN1.
Frontiers in cellular neuroscience.Front Cell Neurosci.2017 Jan 10;10:300. doi: 10.3389/fncel.2016.00300. eCollection 2016.
Histamine and histamine receptors in the central nervous system actively participate in the modulation of motor control. In clinic, histamine-related agents have traditionally been used to treat vestibular disorders. Immunohistochemical studies have revealed a distribution of histaminergic afferents
PMID 28119568

Japanese Journal

Collagenous colitis を合併した血液透析患者の1例

若杉三奈子,市川紘将,本間照 [他],若木邦彦,本間則行
日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 43(12), 999-1003, 2010-12-28
症例は83歳，女性．83歳から慢性腎不全のため，血液透析を導入．透析導入時の血液検査で，高ガンマグロブリン血症と抗核抗体320倍を認めたが，その他自己免疫疾患を示唆する所見は認めなかった．また，慢性腎不全の原疾患は不明であった．週3回の外来血液透析を継続中，平成20年6月末から水様性下痢（5～6行/日）が出現．整腸剤，塩酸ロペラミド，バンコマイシンなどの内服を行ったが，下痢は慢性再発性に出現を繰り …
NAID 10027725144

Drug eruption caused by ranitidine hydrochloride (Zantac) which showed a strong reaction in a drug-induced lymphocyte stimulation test

OKAMOTO Osamu,FUJIWARA Sakuhei
Journal of dermatology 34(1), 74-79, 2007-01-01
NAID 10019992406

Ion-Selective Electrodes for Potentiometric Determination of Ranitidine Hydrochloride, Applying Batch and Flow Injection Analysis Techniques

Issa Yousry M.,Badawy Sayed S.,Mutair Ali A.
Analytical sciences : the international journal of the Japan Society for Analytical Chemistry 21(12), 1443-1448, 2005-12-10
NAID 10016889319

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★リンクテーブル★

リンク元	「ラニチジン」
関連記事	「hydrochloride」

「ラニチジン」

Ranitidine
Clinical data
Pronunciation	/rəˈnɪtᵻdiːn/
Trade names	Zantac, others
AHFS/Drugs.com	Monograph
MedlinePlus	a601106
License data	US FDA: Ranitidine;
Pregnancy; category	AU: B1; US: B (No risk in non-human studies); ;
Routes of; administration	Oral, IV
ATC code	A02BA02 (WHO); A02BA07 (WHO) (ranitidine bismuth citrate)
Legal status
Legal status	AU: S2 (Pharmacy only); UK: General sales list (GSL, OTC); US: OTC/RX;
Pharmacokinetic data
Bioavailability	39 to 88%
Protein binding	15%
Metabolism	Hepatic: FMOs, including FMO3; other enzymes
Biological half-life	2–3 hours
Excretion	30–70% Renal
Identifiers
	'Systematic (IUPAC) name: N-(2-[(5-[(dimethylamino)methyl]furan-2-yl)methylthio]ethyl)-N-methyl-2-nitroethene-1,1-diamine
Synonyms	Dimethyl [(5-{[(2-{[1-(methylamino)-; 2-nitroethenyl]amino}ethyl)sulfanyl]; methyl}furan-2-yl)methyl]amine
CAS Number	66357-35-5
PubChem (CID)	3001055
IUPHAR/BPS	1234
DrugBank	DB00863
ChemSpider	4863
UNII	884KT10YB7
KEGG	D00422
ChEBI	CHEBI:8776
ChEMBL	CHEMBL1790041
Chemical and physical data
Formula	C13H22N4O3S
Molar mass	314.4 g/mol
3D model (Jmol)	Interactive image
	SMILES CNC(=C[N+](=O)[O-])NCCSCc1ccc(o1)CN(C)C ;
	InChI InChI=1S/C13H22N4O3S/c1-14-13(9-17(18)19)15-6-7-21-10-12-5-4-11(20-12)8-16(2)3/h4-5,9,14-15H,6-8,10H2,1-3H3 ; Key:VMXUWOKSQNHOCA-UHFFFAOYSA-N ;
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　　[★]

英: ranitidine
化: 塩酸ラニチジン ranitidine hydrochloride
商: ザンタック Zantac、ツルデック、ブラウリベラ、ラデン、ラニザック、ラニタック、ラニチザン

消化性潰瘍治療薬

攻撃因子抑制剤

H2ブロッカー

「hydrochloride」

　　[★] 塩酸塩、ハイドロクロライド　

[AHFS2015-1] ^ ^a ^b ^c ^d ^e ^f ^g "Ranitidine". The American Society of Health-System Pharmacists. Retrieved Dec 1, 2015.

[2] Fedorowicz, Z; van Zuuren, EJ; Hu, N (14 March 2012). "Histamine H2-receptor antagonists for urticaria.". The Cochrane database of systematic reviews. 3: CD008596. doi:10.1002/14651858.CD008596.pub2. PMID 22419335.

[3] Tleyjeh, IM; Abdulhak, AB; Riaz, M; Garbati, MA; Al-Tannir, M; Alasmari, FA; Alghamdi, M; Khan, AR; Erwin, PJ; Sutton, AJ; Baddour, LM (2013). "The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.". PLOS ONE. 8 (3): e56498. doi:10.1371/journal.pone.0056498. PMC 3587620. PMID 23469173.

[4] Fischer, Janos (2010). Analogue-based Drug Discovery II. John Wiley & Sons. p. 4. ISBN 9783527632121.

[5] Hara, Takuji (2003). Innovation in the pharmaceutical industry the process of drug discovery and development. Cheltenham, U.K.: Edward Elgar. p. 94. ISBN 9781843765660.

[6] "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.

[7] "Ranitidine". International Drug Price Indicator Guide. Retrieved 1 December 2015.

[8] "Reflux Remedies: ranitidine". PharmaSight OTC Health. PharmaSight.org. Retrieved 16 November 2011.

[9] Clark, K.; Lam, L. T.; Gibson, S.; Currow, D. (2009). "The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials". Anaesthesia. 64: 652–657. doi:10.1111/j.1365-2044.2008.05861.x.

[10] Dellinger, R. Phillip; et al. (2013). "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012". Intensive Care Medicine. 39 (2): 165–228.

[11] Lightdale, J. R.; Gremse, D. A.; Heitlinger, L. A.; Cabana, M.; Gilger, M. A.; Gugig, R.; Hill, I. D. (2013). "Gastroesophageal reflux: management guidance for the pediatrician". Pediatrics. 131 (5): e1684–e1695. doi:10.1542/peds.2013-0421.

[12] "Ranitidine Drug Information". Lexicomp. Retrieved 20 April 2014.

[ZANTAC_Drug_Insert-13] "ZANTAC Drug Insert" (PDF). GlaxoSmithKline. Retrieved 19 April 2014.

[14] Force, R. W., and M. C. Nahata. "Effect of histamine H2-receptor antagonists on vitamin B₁₂ absorption." The Annals of Pharmacotherapy 26.10 (1992): 1283-1286.

[15] Mitchell SL, Rockwood K (2001). "The association between antiulcer medication and initiation of cobalamin replacement in older persons". J Clin Epidemiol. 54 (5): 531–534. doi:10.1016/S0895-4356(00)00340-1.

[16] "Reflux Remedies: ranitidine". PharmaSight OTC Health. PharmaSight.org. Retrieved 16 November 2011.

[17] Cobelens FG, Leentvarr-Kuijpers A, Kleijnen J, Coutinho RA (1998). "Incidence and risk factors of diarrhoea in Dutch travellers: Consequences for priorities in pre-travel health advice". Trop Med Intern Health. 3: 896–903.

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[21] Ruddell WS, Axon AT, Findlay JM, et al. (1980). "Effect of cimetidine on gastric bacterial flora". Lancet. i: 672–674. doi:10.1016/s0140-6736(80)92826-3.

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v t e Drugs for peptic ulcer and GERD/GORD (A02B)

H₂ antagonists ("-tidine")	Cimetidine Famotidine Lafutidine Lavoltidine (loxtidine) Niperotidine Nizatidine Ranitidine Roxatidine

Prostaglandins (E)/analogues ("-prost-")	Misoprostol Enprostil

Proton-pump inhibitors ("-prazole")	Dexlansoprazole Esomeprazole Ilaprazole Lansoprazole Omeprazole Pantoprazole Picoprazole Rabeprazole Tenatoprazole Timoprazole

Potassium-competitive acid blockers ("-prazan")	Linaprazan Revaprazan Soraprazan Vonoprazan

Others	Aceglutamide aluminum Acetoxolone Alginic acid Arbaclofen placarbil Carbenoxolone Cetraxate Gefarnate Lesogaberan Pirenzepine Proglumide Rebamipide Sucralfate Sulglicotide Telenzepine Teprenone Troxipide Zinc L-carnosine Zolimidine

Combinations	Bismuth subcitrate/metronidazole/tetracycline

See also: Helicobacter pylori* eradication protocols*

v t e Steroid hormone metabolism modulators

HMGCR	Inhibitors: Atorvastatin Cerivastatin Fluvastatin Lovastatin Mevastatin Pitavastatin Pravastatin Rosuvastatin Simvastatin

FPS	Inhibitors: Alendronic acid Clodronic acid Etidronic acid Ibandronic acid Incadronic acid Pamidronic acid Risedronic acid Tiludronic acid Zoledronic acid

24-DHCR24	20,25-Diazacholesterol Clomifene Triparanol

20,22-Desmolase (P450scc)	Inhibitors: 22-ABC 3,3′-Dimethoxybenzidine 3-Methoxybenzidine Aminoglutethimide Canrenone Cyanoketone Danazol Etomidate Ketoconazole Mitotane Spironolactone Trilostane

17α-Hydroxylase, 17,20-Lyase	Inhibitors: 22-ABC 22-Oxime Δ⁴-Abiraterone Abiraterone Abiraterone acetate Amphenone Bifluranol Bifonazole Canrenone CFG-920 Clotrimazole Cyanoketone Cyproterone acetate Danazol Econazole Flutamide Galeterone Gestrinone Isoconazole Ketoconazole L-39 Levoketoconazole Liarozole LY-207,320 MDL-27,302 Miconazole Mifepristone Nilutamide Orteronel Pioglitazone Prochloraz Rosiglitazone Seviteronel Spironolactone Stanozolol SU-9055 SU-10603 TGF-β Tioconazole Troglitazone VN/87-1 YM116

3α-HSD	Inhibitors: Coumestrol Daidzein Genistein Indomethacin Medroxyprogesterone acetate Inducers: Fluoxetine Fluvoxamine Mirtazapine Paroxetine Sertraline Venlafaxine

3β-HSD	Inhibitors: 4-MA Δ⁴-Abiraterone Abiraterone Abiraterone acetate Azastene Cyanoketone Cyproterone acetate Danazol Epostane Genistein Gestrinone Medrogestone Medroxyprogesterone acetate Metyrapone Norethisterone Oxymetholone Pioglitazone Rosiglitazone Trilostane Troglitazone

11β-HSD	Inhibitors: 11α-Hydroxyprogesterone 11β-Hydroxyprogesterone 18α-Glycyrrhizic acid ABT-384 Acetoxolone Carbenoxolone Enoxolone (glycyrrhetinic acid) Epigallocatechin gallate Glycyrrhizin (glycyrrhizic acid) Progesterone

21-Hydroxylase	Inhibitors: Aminoglutethimide Amphenone B Bifonazole Canrenone Clotrimazole Diazepam Econazole Genistein Isoconazole Ketoconazole Levoketoconazole Metyrapone Miconazole Midazolam Spironolactone Tioconazole

11β-Hydroxylase	Inhibitors: Δ⁴-Abiraterone Abiraterone Abiraterone acetate Aminoglutethimide Canrenone Etomidate Fadrozole FETO Ketoconazole Levoketoconazole Metomidate Metyrapol Metyrapone Mitotane Potassium canrenoate Spironolactone Trilostane

18-Hydroxylase	Inhibitors: 18-Ethynylprogesterone (18-ethinylprogesterone) 18-Vinylprogesterone Aminoglutethimide Canrenone FAD286 Fadrozole Ketoconazole LCI699 Metyrapone Mespirenone Potassium canrenoate Spironolactone

17β-HSD	Inhibitors: Danazol Simvastatin

5α-Reductase	Inhibitors: 22-Oxime Δ⁴-Abiraterone Abiraterone Abiraterone acetate Alfatradiol Azelaic acid β-Sitosterol Bexlosteride Chlormadinone acetate Cl-4AS-1 Dutasteride Epitestosterone Epristeride Fatty acids (α-linolenic acid, linoleic acid, γ-linolenic acid, monolinolein, oleic acid) Finasteride Ganoderic acid Gestodene Izonsteride L-39 Lapisteride Oxendolone Saw palmetto TFM-4AS-1 Turosteride Vitamin B6 Zinc

Aromatase	Inhibitors: 4-AT 4-Cyclohexylaniline 4-Hydroxytestosterone 5α-DHNET 20α-Dihydroprogesterone Abyssinone II Aminoglutethimide Anastrozole Ascorbic acid (vitamin C) Atamestane ATD Bifonazole CGP-45,688 CGS-47,645 Chalconoids (e.g., isoliquiritigenin) Clotrimazole Corynesidone A Coumestrol DHT Difeconazole Econazole Ellagitannins Endosulfan Exemestane Fadrozole Fatty acids (e.g., conjugated linoleic acid, linoleic acid, linolenic acid, palmitic acid) Fenarimol Finrozole Flavonoids (e.g., 7-hydroxyflavone, 7-hydroxyflavanone, 7,8-DHF, acacetin, apigenin, baicalein, biochanin A, chrysin, EGCG, gossypetin, hesperetin, liquiritigenin, myricetin, naringenin, pinocembrin, rotenone, quercetin, sakuranetin, tectochrysin) Formestane Imazalil Isoconazole Ketoconazole Letrozole Liarozole Melatonin MEN-11066 Miconazole Minamestane Nimorazole NKS01 Norendoxifen ORG-33,201 Penconazole Phenytoin Prochloraz PGE2 (dinoprostone) Plomestane Prochloraz Propioconazole Pyridoglutethimide Quinolinoids (e.g., berberine, casimiroin, triptoquinone A, XHN22, XHN26, XHN27) Resorcylic acid lactones (e.g., zearalenone) Rogletimide Stilbenoids (e.g., resveratrol) Talarozole Terpenoids (e.g., dehydroabietic acid, (–)-dehydrololiolide, retinol (vitamin A), Δ⁹-THC, tretinoin) Testolactone Tioconazole Triadimefon Triadimenol Troglitazone Valproic acid Vorozole Xanthones (e.g., garcinone D, garcinone E, α-mangostin, γ-mangostin, monodictyochrome A, monodictyochrome B) YM-511 Zinc Inducers: Atrazine Flavonoids (e.g., genistein, quercetin)

SST/EST	4′OH-CB79 6-Hydroxyflavone 2,6-Dichloro-4-nitrophenol (DCNP) Equol Galangin Genistein Parabens (e.g., butylparaben) Pentachlorophenol (PCP) Triclosan

STS	AHBS Danazol Estrone-3-O-sulfamate (EMATE) Irosustat (STX64, 667 Coumate, BN-83495) KW-2581 Progestogens SR-16157 STX213 STX681 STX1938

27-Hydroxylase	Inhibitors: Anastrozole Bicalutamide Dexmedetomidine Fadrozole Posaconazole Ravuconazole

Others	Inhibitors: Inhibit estradiol degradation: Cimetidine

See also: Androgenics • Estrogenics • Glucocorticoidics • Mineralocorticoidics • Progestogenics

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ranitidine hydrochloride

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