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Question about medication and stomach acid production

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Posted 4/13/2011 3:09 PM (GMT 0)
My doctor switched me from Dexilant 60mg (1/day) to Zantac 300 (1/day). His reason was that my symptoms are under control with Dexilant, a PPI, so he wanted to see how I would do with Zantac, an lower-potency H2 blocker.

I'm confused about why I would take Zantac 300 once a day vs Zantac 150 twice a day. The Dexilant was time-released; thus, one pill a day provided the equivalent of two doses in 24 hours.

But the Zantac is not time released, and I've read that it's effective for 6-8 hours. So, if I take the Zantac at 9:00 at night, it should be ineffective during the day, right?

Also, I've read that the stomach goes through "gastric emptying" every couple of hours and recreates stomach acid in each cycle. If that's right, then what effect could Zantac 300 possibly have during the hours of, say, 9:00 AM to 9:00 PM?
Posted 4/14/2011 3:29 PM (GMT 0)
I think you're right about ranitidine/Zantac. My doc says I can take them as I need to. Kat x
Posted 4/14/2011 8:08 PM (GMT 0)
Hi miketx,

You're right about the timing of Zantac is very important. It's common to take 300mg at bedtime, but it should be at the latest possible time, because as you said, it's not time released.

The other option (if you're having trouble during the day) is to try taking another 300mg in the morning. Here's a good discussion about the uses of drugs that are effective in treating GERD and esophageal erosion.
www.medicinenet.com/gastroesophageal_reflux_disease_gerd/page6.htm

Good luck working it out! You might try discussing it with your pharmacist. They're often very helpful and have lots of information at their fingertips.

Take care,
Denise
Posted 4/14/2011 11:09 PM (GMT 0)
I recently read a study showing that symptom control was better on 150 mg twice a day as opposed to 300 mg at night. However the difference between the two groups was not huge. I did the 300 mg at night and definitely felt a "gap" during the day. However, I had only just stopped the ppi, so hard to say for sure. In know at first I was worried about night time damage so i took 300 mg at night, then after a week I changed to 150 mg at night and again early afternoon whenever I was aware of the breakthrough. I also bought some over the counter 75 mg tabs so that i can try very slow step downs. Acid rebound coming off ppi was not fun.

If I can find the study again I'll put the link on the thread. Good luck with the 'withdrawal phase' x
Posted 4/14/2011 11:13 PM (GMT 0)
PS: it takes about 90 minutes for ranitidine to reach peak effect, so I take mine about 9 or 10 pm at the latest.
Posted 4/15/2011 8:39 AM (GMT 0)
Can't find the one I read but this one says there's no difference between 300 mg as a single dose compared with split dose.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420131/pdf/gut00407-0046.pdf
Although this study was looking at duodenal ulcer treatment not reflux.
Rebound acid from stopping ppis can last a couple of months, during which time it's going to be hard to know what's going on!
Posted 4/15/2011 3:02 PM (GMT 0)
Hi miketx,
I never had to make that decision, as my doctors always prescribed 300mg morning and night. Why not try the suggested protocol, then if you have problems during the day, see if your doc will try you on an additional dose in the morning?
Hope everything works out well for you!
Denise
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