The availability of ranitidine is now extremely limited and famotidine is currently only funded for hospital use. PHARMAC is actively trying to source an alternative H2-antagonist (likely famotidine) to fund for community patients and have suggested it may be available on 1st Dec 2019. However, they will notify health professionals and update the online Schedule when an alternative is officially funded.
See Medsafe’s statement for more details on the product recall – https://www.medsafe.govt.nz/safety/Alerts/MedicinesAndNDMA.asp
Alternative management options are limited:
Gastroesophageal reflux disease (GORD):
- consider trialling cessation of H2-antagonist therapy
- lifestyle modification (e.g. avoiding foods that trigger symptoms, such as alcohol and caffeine)
- antacids e.g. aluminium (e.g. Alu-tab 600 mg tablets – fully funded).
- alginates (Gaviscon Double Strength®tablets and Acidex® liquid – partially funded)
- proton-pump inhibitors – omeprazole, pantoprazole and lansoprazole are all fully funded. Also suitable to use in pregnancy.
- See HealthPathways for more guidance https://canterbury.communityhealthpathways.org/24341.htm (Canterbury only)
Treatment options for patients who do not tolerate proton-pump inhibitors (e.g. due to hyponatraemia) are very limited. Famotidine and cimetidine can be procured via usual pharmaceutical suppliers if a patient is willing to self-fund; however, these are expensive. Application for funding via a Named Patient Pharmaceutical Assessment (NPPA – https://www.pharmac.govt.nz/tools-resources/forms/exceptional-circumstances/nppa-tips/) could be considered.
- non-sedating oral antihistamines are first-line (note higher doses than that used in allergic rhinitis are often used, e.g. up to 20 mg twice a day of cetirizine or loratadine). See HealthPathways https://canterbury.communityhealthpathways.org/20869.htm (Canterbury only) or Dermnet dermnetnz.org
- consider referral to Dermatology department.