Ranitidine is a
histamine H 2-receptor antagonist which, on the basis of its well established tolerability and efficacy profile, has been widely prescribed for the treatment of
ulcer disease and mild to moderate reflux oesophagitis. However, the advent of more powerful gastric acid inhibitors (e.g.
acid pump inhibitors) and the realisation of the role of Helicobactor pylori
infection in
duodenal ulcer disease could have considerable clinical and economic implications for the use of
ranitidine (and other H 2-receptor antagonists). Simulation modelling studies based on current pricing policies in Europe predict that
ranitidine-based treatment will be less cost effective than
omeprazole in the short term healing of
duodenal ulcer and reflux oesophagitis disease. During longer term treatment,
omeprazole is expected to be the dominating strategy over
ranitidine-based
therapy in Europe and the US. However, the inherent limitations of modelling studies reinforce the need for randomised prospective trials, preferably conducted in a general practice setting and including a quality-of-life analysis. Of the currently accepted approaches for the long term management of recurrent
duodenal ulcer disease, daily maintenance
therapy with
ranitidine has been shown to be more cost effective than intermittent treatment for up to 2 years in the US. The annual cost of providing continuous maintenance
therapy with
ranitidine 150 mg/day is higher than with
cimetidine 400 mg/day, although the extra benefits include a reduced risk of
pain and discomfort from an expected lower rate of
ulcer recurrence with
ranitidine. Simultaneous
ulcer healing and eradication of H. pylori markedly reduces relapse rates and is likely to become the management strategy of choice in H. pylori-positive patients, particularly with the advent of more convenient, well tolerated and effective regimens. Moreover, widespread clinical acceptance of H. pylori eradication may yield substantial cost savings to society by reducing the overall need for long term antisecretory
therapy. Nonetheless, maintenance
therapy with
histamine H 2-receptor antagonists remains indicated for patients at high risk of
ulcer recurrence who are poorly responsive to or cannot tolerate H. pylori eradication regimens. In summary, the proven efficacy and tolerability of
ranitidine will ensure its continued use in the treatment of many patients with
duodenal ulcer and mild to moderate reflux oesophagitis. However, there is increasing clinical and economic data favouring the selection of
omeprazole in patients with more severe symptoms of these diseases.(ABSTRACT TRUNCATED AT 400 WORDS)