The use of intravenous H-2-receptor antagonists in a tertiary care hospital

OBJECTIVE: The rationale for the widespread use of intravenous H-2 receptor antagonists (IVH2 RA) in hospitalized patients is not clear. We therefore examined prescribing pat terns and, using strict criteria, determined wheth er use was appropriate. Cost of administration and potential savings were a lso determined. METHODS: Data were obtained prospectively on 100 consecutive patients presc ribed intravenous ranitidine and retrospectively on patients admitted with gastrointestinal (GI) bleeding. RESULTS: For the prospective study, various indications for prescribing int ravenous ranitidine were given, including postoperative patients and patien ts treated with steroids. Using criteria from published literature 80% of t he use was considered inappropriate. Nearly 40% of the doses were given whi le the patient was tolerating oral intake. Creatinine clearance was impaire d in 26% of patients, though only one had dosage reduction. Estimated annua l cost of intravenous ranitidine was $317,000. The retrospective study of 8 6 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), mo diagnosis (three), and jejunal ulcer (one). CONCLUSIONS: Inappropriate use of intravenous ranitidine is common. This in cludes inappropriate indication, dosage, and duration of use. Large financi al benefits could have been obtained if close attention was given to prescr ibing patterns. (Am J Gastroenterol 1999;94:3473-3477. (C) 1999 by Am. Coll . of Gastroenterology).