Can I Take Tums and Zantac Together While Pregnant
Should Pregnant Women Avoid Zantac?
The F.D.A. has found low levels of a cancer-causing chemical in samples of the drug, and some experts are advising expectant mothers to use alternative forms of relief.
This story was originally published on Oct. 1, 2019 in NYT Parenting.
Chest pain. Burning in the throat. Difficulty swallowing. Heartburn affects up to half of pregnant women, and for decades, doctors have advised expectant mothers to seek relief with prescription and over-the-counter medications, including histamine blockers like Zantac (which is sold generically under the name ranitidine).
But when the Food and Drug Administration announced in September that some samples of ranitidine tablets had tested positive for low levels of a cancer-causing contaminant called N-nitrosodimethylamine, or NDMA, pregnant women in the United States may have wondered: Should I avoid Zantac entirely?
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Ranitidine has been available for decades and studies have found it to be safe for use during pregnancy. But while the F.D.A. said that it was not necessary for everyone to avoid all medications containing ranitidine, some medical doctors had suggested that it might be a good idea for pregnant women, at least for now, to be cautious about taking them.
"For safety, it's probably best to discontinue that medication, which is what I'm advising my patients now," Dr. Nicole Smith, a maternal-fetal medicine specialist at Brigham and Women's Hospital in Boston, said on Monday. "They can just switch to one of the other acid blockers instead."
What happened
Last month, the F.D.A. announced that it had detected low levels of NDMA — an environmental contaminant that can also be found in water, meat, dairy and vegetables — in over-the-counter ranitidine tablets manufactured by Apotex and labeled by Walgreens, Walmart and Rite-Aid. Valisure, an online pharmacy company, alerted the F.D.A. in June that it had found "extremely high" levels of NDMA in batches of ranitidine "across multiple manufacturers."
According to the F.D.A., early testing has indicated that levels of NDMA in ranitidine "barely exceed amounts you might expect to find in common foods."
CVS, Rite Aid and Walgreens recently stopped selling the drug, and other countries have taken steps to either ban it or pull it off the shelves. On Sept. 23, the drug maker Sandoz issued a voluntary recall after finding NDMA contamination in batches of its prescription ranitidine capsules and Dr. Reddy's Laboratories, which also makes ranitidine, has halted distribution of the drug.
Dr. Christopher M. Zahn, who oversees clinical guidelines at the American College of Obstetricians and Gynecologists, encouraged patients to speak with their OB/GYNs about other types of medications if they are looking for an alternative.
"Women struggling with gastric reflux and nausea during pregnancy should know that they have options during this recall," Dr. Zahn said.
Why are experts concerned about NDMA?
According to the Centers for Disease Control and Prevention, NDMA can be particularly harmful to the liver. When administered to lab animals, either through food, water or the air they breathed, the animals have developed conditions including liver disease, liver cancer and lung cancer.
And while NDMA has not been shown to cause cancer in humans, "it is reasonable" to expect that it could, according to the C.D.C.
This is not the first time NDMA has been found in a popular drug. Last year, the discovery of NDMA in some versions of valsartan, a blood-pressure drug that goes by the brand name Diovan, led to several recalls.
Other ways to relieve heartburn
Heartburn is one of the most common types of pain that pregnant women face; and if you have had it in the past, you are more likely to get it when you are pregnant. It's believed that pregnancy hormones, such as progesterone, can relax the muscular valve in the stomach, which usually closes to prevent stomach acids from backflowing into the esophagus.
And as the baby grows, the fetus can create upward pressure, pushing on the abdomen. "The food goes north rather than south," said Dr. Joel E. Richter, the director of the division of gastroenterology and nutrition at the University of South Florida who has studied the effects of heartburn medications taken during pregnancy.
If you are looking for relief, certain dietary changes such as avoiding spicy, acidic or fatty foods; limiting caffeine and eating smaller, more frequent meals can help.
It's also best to remain upright for a couple of hours after eating.
If those changes do not make a difference, Dr. Richter said, the first line of defense during pregnancy is typically to use sucralfate (Carafate), a prescription ulcer medication that is sometimes used for treating reflux disease; or antacids that do not contain aspirin (such as Tums, Mylanta or Gaviscon).
If these measures are not enough, doctors typically advise pregnant women to take histamine blockers like ranitidine to reduce the amount of acid in the stomach, or a different class of drugs called proton pump inhibitors, which inhibit the secretion of stomach acid, such as Prilosec (omeprazole).
Alternative histamine blockers like famotidine (Pepcid) and cimetidine (Tagamet) have so far not been found to contain NDMA, Dr. Smith said, and neither has Prilosec nor other proton pump inhibitors.
If you are pregnant and have been taking ranitidine, Dr. Smith said, try not to worry. "The likelihood of harm if you've been taking ranitidine is extremely small," she said.
The F.D.A. is still investigating the safety of ranitidine, as are various drug manufacturers.
"The overall message is there are a lot of environmental exposures that we're getting whether they're due to contamination of medications we take or due to plastics that are in our food from the way it's packaged," Dr. Smith said.
[Read more about which plastics to avoid .]
"It's nice to avoid exposures as much as we can," she added, so it's reasonable to avoid ranitidine right now because there is potential for contamination. "But we may never get as definitive an answers as we would like in terms of things like 'What is safe? How much is safe?'"
Can I Take Tums and Zantac Together While Pregnant
Source: https://www.nytimes.com/2020/04/18/parenting/pregnancy/zantac-recall.html