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Boxes of Zantac 150 on a supermarket shelf

On April 3, 2020, The European Medicines Agency (EMA)—the European equivalent of the U.S. Food and Drug Administration (FDA)—recommended the suspension of all ranitidine (Zantac) medicines due to the presence of N-nitrosodimethylamine (NDMA), a cancer-causing agent.

The FDA had made a similar move on April 1, 2020, just two days earlier. Independent tests showed that the levels of NDMA could increase in ranitidine medications over time and with exposure to high temperatures, so the FDA requested the recall of all ranitidine medications from the U.S. market.

At the request of a ranitidine manufacturer, the EMA recently re-examined its position. On September 18, 2020, it released a letter confirming the recommendation that all ranitidine medications remain suspended in the European Union (EU).

Can NDMA Form in the Body After Ingestion of Ranitidine?

In its initial recommendation, the EMA’s Committee for Medicinal Products for Human Use (CHMP) recommended the suspension of ranitidine (Zantac) medicines because investigators had found unsafe levels of NDMA in several of the products. It also reported “unresolved questions about the source of the impurities.”

Those unresolved questions included concerns about how the NDMA ended up in the drugs in the first place. The EMA acknowledged the research showing NDMA could form from the degradation of ranitidine even under normal storage conditions. But might the impurity also form within the human body?

Valisure, the online pharmacy that first detected NDMA, argued that the ranitidine molecule itself was unstable, and could form NDMA during human digestion. The FDA, however, was unable to confirm that finding in its own studies.

“It is not clear whether NDMA can also be formed from ranitidine inside the body,” the EMA stated. “Some studies suggest that it can while others do not. Given the uncertainties, the CHMP has recommended a precautionary suspension of these medicines in the EU.”

At the time, the EMA recommended conditions for lifting the suspension of ranitidine medications and pledged to continue working with national authorities to address the problem of NDMA and other impurities in prescription drugs.

EMA Confirms Suspension of All Ranitidine Medications

After the initial suspension, one of the companies marketing ranitidine asked the CHMP to re-examine its conclusions. On September 18, 2020, following this re-examination, the CHMP confirmed its recommendation:

“EMA’s human medicines committee (CHMP) has confirmed its recommendation to suspend all ranitidine medicines in the EU due to the presence of low levels of an impurity called N-nitrosodimethylamine (NDMA),” the letter reads.

The CHMP also maintained the conditions for lifting the suspension, including requirements for companies to provide more data on the possible formation of NDMA from ranitidine inside the body. The organization did slightly amend those conditions for ranitidine medicines given by injection or infusion, as the formation of NDMA with these one-time single doses is expected to be very low.

In the meantime, the EMA advised patients to talk to their doctors about alternative medicines for reducing stomach acid.

In the U.S., the FDA has recalled all forms of ranitidine from the market after determining the drug presented more risks than benefits to the general population.


One Comment

  1. Gravatar for Zayd Depaor
    Zayd Depaor

    The problem is no drug successfully replaces Ranitidine for efficacy, control and is very cheap and gives a patient a lot of control in their dosage as high doses prior to NDMA driven recall were not dangerous and low doses 75mg were effective. The usual preferred drug to H2 blockers are PPIs (proton pump inhibitors) but they are much more expensive and associated with more detrimental side effects as they involve much greater reduction of stomach acid, but stomach acid is needed to absorb certain minerals and vitamins, break down protein and provide immunity (killing bacteria, viruses etc)...none of the other H2 blockers are as cheap as Ranitidine or seem to work as well. It should be remembered that Ranitine (Xantac commercial name in USA) was once the best selling drug in the world. Millions of people have been affected by the withdrawal of ranitidine. In UK you could buy 12x75mg for just £1.

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