What to do about the heartburn medication recall

Some drugs that contain ranitidine (best known as Zantac) have been found by the FDA to have unacceptable amounts of N-nitrosodimethylamine (NDMA), a possible cancer-causing chemical (which also triggered recalls of certain lots of the blood pressure drugs called angiotensin-receptor blockers).

On April 1, 2020, the FDA requested that all forms of ranitidine (Zantac, generic versions), including prescription and over-the-counter products, be removed from the market. They may contain unacceptable levels of a potential cancer-causing substance known as NDMA, or N-Nitrosodimethylamine. In some samples tested by the FDA, the impurity appears to increase over time, especially when stored at higher temperatures. So far, tests of other acid blockers do not show this potential increased cancer risk. 

People using over-the-counter ranitidine should stop taking it and consider a different acid blocking therapy, such as famotidine (Pepcid) or cimetidine (Tagamet). They're all in a class of medications known as H2 blockers, which block a chemical that signals the stomach to produce acid. "They're fairly interchangeable, working equally well for most people," says Dr. Kyle Staller, a gastroenterologist with Harvard-affiliated Massachusetts General Hospital.

Stronger heartburn medications include a class of drugs called proton-pump inhibitors, or PPIs, such as over-the-counter lansoprazole (Prevacid) or omeprazole (Prilosec). Long-term use of PPIs has been linked to reduced blood levels of vitamin B₁₂  and magnesium. While the possibility of other health risks has been raised in the past, Dr. Staller says the data supporting those risks aren't conclusive. There's no evidence of risks from long-term use of H2 blockers.

For those taking prescription ranitidine, they should contact their doctor for advice.

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