The use of intravenous H2-receptor antagonists in a tertiary care hospital.
OBJECTIVE
The rationale for the widespread use of intravenous H2 receptor antagonists(IVH2 RA) in hospitalized patients is not clear. We therefore examined prescribing patterns and, using strict criteria, determined whether use was appropriate. Cost of administration and potential savings were also determined.


METHODS
Data were obtained prospectively on 100 consecutive patients prescribed intravenous ranitidine and retrospectively on patients admitted with gastrointestinal (GI) bleeding.


RESULTS
For the prospective study, various indications for prescribing intravenous ranitidine were given, including postoperative patients and patients treated with steroids. Using criteria from published literature 80% of the use was considered inappropriate. Nearly 40% of the doses were given while the patient was tolerating oral intake. Creatinine clearance was impaired in 26% of patients, though only one had dosage reduction. Estimated annual cost of intravenous ranitidine was $317,000. The retrospective study of 86 consecutive patients admitted with GI bleeding revealed that all patients received intravenous ranitidine on admission, none of which was considered appropriate. The final diagnoses were peptic ulcer (49), colonic process (11), esophagitis (seven), gastric erosions (five), esophageal varices (five), Mallory-Weiss tears (four), duodenitis (two), no diagnosis (three), and jejunal ulcer (one).


CONCLUSIONS
Inappropriate use of intravenous ranitidine is common. This includes inappropriate indication, dosage, and duration of use. Large financial benefits could have been obtained if close attention was given to prescribing patterns.
Dettmer
R M
RM
Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York, USA.
Riley
T H
TH
Byfield
F
F
Green
P H
PH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D006635:Histamine H2 Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009519:New York City; D011446:Prospective Studies; D011899:Ranitidine / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D012189:Retrospective Studies; D014600:Utilization Review
D006635:Histamine H2 Antagonists; D011899:Ranitidine