In case you missed the news, Zantac (generic Ranitidine – an H2 blocker used to treat acid reflux / heartburn symptoms) now has undergone an FDA recall due to the same alphabet soup carcinogens that have plagued certain anti-hypertensive medications (highlighted in prior posts). Attached is an excellent summary article by @JoshuaJGagne.

Part of the difficulty with this finding is that primary care providers like myself and our Gastroenterology colleagues have been increasingly recommending Zantac as a safer alternative to proton pump inhibitors such as Prilosec, Nexium and Dexilant for acid reflux. Why? This is because long term use of PPIs has been associated with: C. diff colitis, low magnesium, B12 malabsorption, iron malabsorption, hypergastrinemia, bone fracture and kidney dysfunction. Those aren’t sufficient reasons? OK – more recent studies have suggested an increased risk of pneumonia and dementia. Oh, and studies conflict as to whether or not there is an increased risk of death too.

But the risks of persistent acid over-secretion themselves are significant and include gastric ulcer, erosive esophagitis and even esophageal cancer. The discomfort of heartburn itself notwithstanding.

So have we painted ourselves into a corner? Certainly recommending a PPI doesn’t seem right given the above, although perhaps for short term use, such may be a reasonable choice. There are also other H2 blockers unaffected by the FDA recall. These are: cimetidine, famotidine, and nizatidine.

But perhaps the best advice comes in the final paragraph of the attached article – embracing lifestyle change. While not always realistic, there are particular dietary steps that one can take to limit acid reflux. Room temperature beverages can be helpful and limiting spicy dishes, coffee, alcohol, chocolate, tomatoes and other high acidity foods. In other words, anything good.