zantac pepcid familial dysautonomia

Recent news reports indicate that Zantac contains a very small amount of a carcinogen called NDMA.  After spending several hours trying to learn more about the risks associated with the ingestion of NDMA, I am finding that the information currently available provides no clear answers. There is no question in my mind that Zantac (and perhaps all sources of ranitidine, the generic form of Zantac, available on the market) is contaminated with NDMA. The amount present is apparently very small, but the risks of ingesting this every day over a long period of time are impossible to assess.

Not taking an antacid for those with FD is not an option. Zantac/ranitidine mediates its antacid effect by acting as a H2 blocker. While many of the other antacids that are currently on the market do not work by this mechanism (and I, therefore, do not recommend their use), the other H2 blocker that is readily available by prescription and “over the counter” is Pepcid/famotidine. Pepcid/famotidine has been shown to be as effective at blocking acid production as Zantac/ranitidine. Pepcid/famotidine has been used successfully by some with FD. The dose (amount of milligrams, commonly abbreviated “mg”) of Pepcid/famotidine that is needed to control acid production is lower than the amount of Zantac/ranitidine needed. 20 mg of Pepcid/famotidine is equivalent to 75 mg of Zantac/ranitidine. Just to clarify the matter, if someone with FD is, for example, is taking a 150 mg dose of Zantac/ranitidine, he/she would need to take 40mg of Pepcid/famotidine.

As those with FD are doing well, I am always hesitant to change their therapeutic protocol; that having been said, the risks associated with switching to Pepcid/famotidine are truly minimal, while the impact of an ongoing exposure to NDMA might pose a long-term risk. After much consideration, I would like to suggest, in tandem with your medical team, switching to the Pepcid/famotidine formulation.

Dr. Berish Rubin
Head, Laboratory for Familial Dysautonomia Research
Fordham University, NY, USA