Curbside Consultation in GERD: 49 Clinical Questions

Philip O. Katz, MD

Question 12: Dr. Smith Suggested That I Add Ranitidine 150 Mg At Bedtime To A Regimen Of Bid Esomeprazole. Is There Any Evidence That This Helps Patients With Symptoms Of Gerd? (continued)

The use of H2 receptor antagonists (H2RAs) given at bedtime in addition to twice-daily proton pump inhibitor (PPI) was popularized in the late 1990s after a publication demonstrating that the overnight recovery of gastric acid secretion seen in patients on twice-daily proton pump inhibitors could be reduced to a greater extent with a bedtime dose of ranitidine 150 or 300 mg compared to an additional dose of a proton pump inhibitor at bedtime. The maximal effect on overnight pH is with the first dose, with a decrease in efficacy in pH control over time (tachyphylaxis) (Figure