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Use of Ranitidine subcutaneously for intractable dyspeptic pain in Palliative care and discontinuation of Ranitidine leading to a vacuum
  • Syed Abbas
Syed Abbas
St Clare Hospice

Corresponding Author:[email protected]

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Abstract

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 However, it is now withdrawn globally due to its association with cancer due an element in its composition.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 It is a useful medication in Palliative care but its withdrawn has now caused a vacuum in symptom management.