Use of Ranitidine subcutaneously for intractable dyspeptic pain in
Palliative care and discontinuation of Ranitidine leading to a vacuum
Background: Dyspepsia is a common problem and is frequently caused by
gastro-oesophageal reflux disease (GORD) or gastritis. It is also
related to cancer of upper Gastrointestinal tract as well as gastric
stasis due to bowel obstruction. Subcutaneous Ranitidine was used
subcutaneously with success in Palliative care. However, it is now
withdrawn globally due to its association with cancer due an element in
its composition. This paper presents the data from its use and argues
that medications like Ranitidine should be allowed in Palliative care as
these achieve comfort for patients at the end of life and Palliative
care professionals should be consulted while withdrawing such drugs.
Aims: To observe the response of dyspeptic pain in patients with
malignant diseases when they are unable to tolerate oral medications.
Patients and Methods: Prospective study of 22 consecutively admitted
patients with Ranitidine syringe driver over one year period. Results:
Out of 22, there were 13 males and 9 females with an average age of 68
years (range= 46 to 81). They were diagnosed to have Gastric cancer
(10), Oesophageal cancer (6) or Malignant Bowel obstruction (6). Pain
was recorded by Numeric Rating Scale (NRS 0 –10, with 0 being no pain).
4/22 started Ranitidine subcutaneously 50 mg whereas 18/22 were started
on 150 mg. Other medications used in same syringe driver were
Metoclopramide, Cyclizine, Haloperidol, Midazolam, Hyoscine Butyl
Bromide, Octreotide or Levomepromazine. 10/22 reported improvement in
NRS (2 – 8 drop). 4/22 improved on non-verbal assessment as they were
too poorly to score. It was not possible to record response in 6/22.
2/22 continued to have same degree of pain. Local skin reactions were
noted in 4/22 patients. Conclusion: Patients with dyspeptic pain may
respond to Subcutaneous Ranitidine when oral route is not appropriate.
Ranitidine can be mixed with most medication in Syringe driver. Local
reactions or side-effects were not clinically significant. It is a
useful medication in Palliative care but its withdrawn has now caused a
vacuum in symptom management.