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How safe is ranitidine for infant acid reflux?

QOne of my patients, a four-month-old baby, was admitted with vomiting and failure to thrive and discharged on ranitidine for reflux. How safe is this?

AGastro-oesophageal reflux is a normal phenomenon which if frequent and prolonged becomes gastro-oesophageal reflux disease (GORD) and may cause a variety of symptoms, including vomiting and failure to thrive. The most useful information is gained from history and examination; investigation is reserved for those where there is diagnostic uncertainty or little response to management.

Acid reflux may be painful enough to put babies off their feeds, which along with vomiting can stop them thriving. Cow's milk intolerance underlies many cases of GORD.

Antacid and anti-emetic medications are usually indicated if there is failure to thrive. Ranitidine is widely used in this situation and has a good safety record. It has a licence for prescription but is not OTC and is available as an oral solution. Omeprazole may be more effective but does not have a paediatric licence or a liquid preparation. Domperidone is used for its anti-emetic effects, though it has no licence for this use.

Babies with GORD complicated by failure to thrive should receive shared care between primary and secondary services and each of these drugs could be safely used in that setting.

The issue of prescribing unlicensed drugs in paediatric practice is under review. Medicines for Children is an excellent prescribing guide; a pocket version is available for £15 via

Dr Patrick Miller is

consultant paediatrician,

Stepping Hill Hospital, Stockport

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