Ranitidine vs. omeprazole: Differences, similarities, and which one is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

In April 2020, Zantac (ranitidine) was recalled by the FDA. Consult your doctor about which medication is right for you. Read more about the recall here. The original post has been preserved for informational purposes only.

Ranitidine and omeprazole are two medications used to treat gastroesophageal reflux disease, commonly referred to as GERD, heartburn, or acid reflux. Gastroesophageal reflux (GER) occurs when your stomach contents come back up into the esophagus. When this occurs regularly over a long period of time, this is known as GERD. When untreated or inadequately treated, GERD can lead to serious complications such as esophagitis, esophageal stricture, and Barrett’s Esophagus. Uncontrolled GERD can also lead to abdominal pain, asthmatic symptoms, voice hoarseness, laryngitis, and dental decay. It is estimated that about 20% of Americans suffer from GERD. Some risk factors for GERD include being overweight, being a smoker, or being pregnant. 

There are a variety of treatment options available for GERD across multiple classes of medications. There are short-term, fast-acting relief options available without a prescription such as Tums or Maalox for occasional or breakthrough acid reflux symptom relief. Ranitidine and omeprazole were formerly prescription-only options for GERD, but are now available without a prescription as well. 

What are the main differences between ranitidine vs. omeprazole

Ranitidine is a medication available over-the-counter or by prescription for the treatment of gastroesophageal reflux. It belongs to a class of drugs known as histamine type 2-receptor antagonists (H2RAs), and is sometimes better known by the brand name of Zantac. Ranitidine binds to gastrointestinal histamine receptors that are responsible for the release of stomach acid secretion. This includes baseline secretions as well as those released in response to stimuli such as food. Ranitidine and famotidine, another H2RA, have little effect on the cytochrome P450 enzyme system, and therefore have fewer drug interactions than the third H2RA, cimetidine. Ranitidine is available as an oral tablet or capsule. Solid oral dosage forms are available over-the-counter or by prescription in strengths of 75mg and 150mg. There is a 300 mg dose that is prescription only. An injectable version of ranitidine is available as well and is typically only used in medical facilities.

Omeprazole is a medication available over-the-counter or by prescription for the treatment of gastroesophageal reflux. It belongs to a class of drugs known as proton pump inhibitors (PPIs), and is sometimes referred to as the brand name of Prilosec. Omeprazole inhibits the final step of acid secretion into the stomach by irreversibly blocking the pump responsible for secreting the acid known as the H+/ K+ /ATPase pump. While omeprazole was the first PPI on the market and the first to go over-the-counter, there are others in the class such as pantoprazole, esomeprazole, lansoprazole, and dexlansoprazole. Omeprazole has many dosage forms available including oral tablets, capsules, granules, and powder for reconstitution. The capsules come in 10 mg, 20 mg, and 40 mg strengths, and the tablets are available in a 20 mg form. 

Conditions treated by ranitidine and omeprazole

Ranitidine and omeprazole each work to decrease the production of stomach acid, and therefore are each used to treat or prevent some of the same or similar disorders. Pyrosis, better known as heartburn, that occurs twice or more per week can be treated with either ranitidine or omeprazole. Both drugs also are indicated to treat gastroesophageal reflux disease, whether erosive or non-erosive. Only omeprazole is approved by the Food and Drug Administration (FDA) to be used in the treatment of gastric and duodenal ulcers, though ranitidine is sometimes used. Use without FDA approval is known as off-label use. 

One distinguishing feature of omeprazole is its indication to treat Helicobacter Pylori infection (H. Pylori infection), the bacteria responsible for the development of many ulcers. Omeprazole is used as a part of a multiple-drug regimen to eliminate H. pylori.

The following table is a list of approved and potential uses for ranitidine and omeprazole. Only your physician can determine if they are an appropriate choice for your condition.

Is Eliquis or Warfarin more effective?

An early study comparing ranitidine and omeprazole for their efficacy in treating acid reflux or heartburn found that significantly more patients were still experiencing moderate to severe heartburn symptoms after eight weeks of treatment with ranitidine versus omeprazole. Almost 70% of patients treated with omeprazole experienced little to no symptoms after eight weeks of treatment.

There have been many clinical trials comparing ranitidine and omeprazole with respect to reflux esophagitis. A comparison of these studies found omeprazole to be twice as effective at healing mucosal defects and lesions of the esophagus.

The availability of ranitidine has been plagued by large-scale, multi-manufacturer recalls withdrawing the prescription and over-the-counter ranitidine products due to the presence of a chemical known as N-nitrosodimethylamine (NDMA) which has been linked to many types of cancer. It has been discovered that NDMA contamination can occur during manufacturing. The FDA has determined that a very small amount of NDMA is acceptable, but many ranitidine products were found to have more than the acceptable amount. 

Given the factors for overall safety and efficacy, your gastroenterology specialist may choose to initiate omeprazole therapy over ranitidine for many indications. Ultimately, only your doctor can choose which medication is right for you.

Coverage and cost comparison of ranitidine vs. omeprazole

Ranitidine is not available at this time.

Omeprazole is both a prescription and over-the-counter medication. Its coverage by commercial and Medicare insurance plans also varies because it too is available without a prescription. The average retail price for Prilosec can be over $80, but with a generic coupon from SingleCare, you could pay as little as $5. 

Common side effects of ranitidine vs. omeprazole

Many of the common side effects of both ranitidine and omeprazole are similar. Somnolence, confusion, and agitation have been linked to both drugs, and though the manufacturers do not provide a frequency, they state these are rare. Heart-related conditions such as bradycardia, a lower heart rate, and tachycardia, an increased heart rate, have also been linked to ranitidine and omeprazole.

Omeprazole does not appear to be linked to as many gastrointestinal side effects as ranitidine such as nausea, vomiting, and diarrhea.

The following list is not intended to be a complete list of potential side effects. Please consult your pharmacist or other healthcare professional for a complete list.

Source: Ranitidine (DailyMed) Omeprazole (DailyMed)

Drug interactions of ranitidine vs. omeprazole

Ranitidine and omeprazole share some common drug interactions. Both drugs alter the absorption of a class of drugs known as bisphosphonates used to treat osteoporosis. These include alendronate and risedronate. While they are sometimes used with bisphosphonates, they may decrease the efficacy of the drug and leave patients more prone to fracture.

Ranitidine is known to increase the absorption and decrease the clearance of sulfonylureas such as glimepiride and glyburide. This can lead to low blood sugar, known as hypoglycemia. Omeprazole does not alter the absorption of sulfonylureas. Omeprazole may be a better option for diabetics taking sulfonylureas. Blood sugar levels should be monitored if ranitidine is determined to be necessary.

This list is not meant to be all-inclusive of drug interactions for ranitidine or omeprazole. Please consult your pharmacist or health care professional for a complete list.

Warnings of ranitidine and omeprazole

Ranitidine should not be taken if you have ever had an allergic reaction to ranitidine or any other H2RA. The same is true of omeprazole as it should not be taken if you have ever had an allergic reaction to any PPI.

If you take either ranitidine or omeprazole over-the-counter and you have indigestion, heartburn, or acid reflux symptoms that persist beyond two weeks of continuous treatment, you should consult your physician. There may be more complicated or serious underlying issues.

Long-term use of ranitidine and omeprazole, as well as other drugs in similar classes, increase the risk of overgrowth of dangerous flora (bacteria) in the intestinal tract. By decreasing acid in the digestive tract, the pH of the tract is lowered, making it easier for bacteria like Clostridium difficile (C. diff) or Escherichia coli (E. coli) to proliferate. These infections can be serious and very difficult to treat.

Ranitidine and omeprazole can impair hepatic liver function. Caution should be used in recommending these drugs in patients with pre-existing liver disease or hepatic impairment. Patients with renal disease may not clear ranitidine efficiently, leading to an accumulation of ranitidine. 

Long term use of ranitidine and/or omeprazole has been correlated to cyanocobalamin (vitamin B12) deficiency.

Long term treatment with PPIs like omeprazole also leads to an increased risk of bone fracture, especially of the hip, wrist, and spine. If you have a justified need for long-term PPI therapy, calcium and vitamin D supplementation may be necessary to decrease the risk of osteoporosis and osteopenia associated with PPI therapy.

Long term treatment with omeprazole and other PPIs is linked to gastric polyps, or fundic gland polyps. These are typically asymptomatic but can be seen upon endoscopy.

Frequently asked questions about ranitidine vs. omeprazole

What is ranitidine?

Ranitidine is a histamine type 2-receptor antagonist that is available over the counter or by prescription. It is available in tablet, capsule, and injectable forms.

What is omeprazole?

Omeprazole is a proton pump inhibitor that is also available over the counter or by prescription. It is available in tablets, capsules, granules, and powder for reconstitution.

Are ranitidine and omeprazole the same?

Ranitidine and omeprazole have similar indications for use, but they are not the same. Ranitidine is a histamine type 2-receptor antagonist while omeprazole is a proton pump inhibitor. Both work to decrease stomach acid secretion, but they do with different mechanisms of action.

Is ranitidine or omeprazole better?

Studies have shown omeprazole to be superior to ranitidine at reducing symptoms to mild or undetectable at the 8-week mark of treatment. This data combined with recent recalls of ranitidine products make omeprazole a good choice for acid reflux treatment.

Can I use ranitidine or omeprazole while pregnant?

There are no adequate, well-controlled studies of ranitidine or omeprazole in pregnant women. Both drugs have been shown to cross the placenta. Ranitidine and omeprazole should not be used without your doctor’s recommendation when you are pregnant. The risks must be compared to the benefits for each individual. 

Ranitidine is not recommended for breastfeeding mothers. Omeprazole is also not recommended. Short-acting antacids like Tums may be preferred.

Can I use ranitidine or omeprazole with alcohol?

Some studies have shown that ranitidine gastric alcohol dehydrogenase is responsible for first-pass metabolism of alcohol. This could lead to prolonged elevated serum levels of alcohol, and for that reason, concurrent use of alcohol and ranitidine is not recommended. This interaction does not exist with omeprazole, though alcohol should still be consumed in limited quantities.