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Ifyou
donothaveadosemeasuringdevice,askyourpharmacistforone.
Itmaytakeupto8weeksbeforeyourulcerheals.Keepusingthemedicationasdirectedandtellyour
doctorifyoursymptomsdonotimproveafter6weeksoftreatment.
Thismedicationcancauseunusualresultswithcertainmedicaltests.Tellanydoctorwhotreatsyou
thatyouareusingranitidine.
Storeranitidineatroomtemperatureawayfrommoisture,heat,andlight.
Seealso:DosageInformation(inmoredetail)
kidney disease;
liver disease; or
porphyria.
FDApregnancycategoryB.Ranitidineisnotexpectedtobeharmfultoanunbornbaby.Tellyour
doctorifyouarepregnantorplantobecomepregnantduringtreatment.Ranitidinepassesintobreast
milk.Donottakeranitidinewithouttellingyourdoctorifyouarebreastfeedingababy.
Seealso:Pregnancyandbreastfeedingwarnings(inmoredetail)
Usingranitidinemayincreaseyourriskofdevelopingpneumonia.Symptomsofpneumoniainclude
chestpain,fever,feelingshortofbreath,andcoughingupgreenoryellowmucus.Talkwithyour
doctoraboutyourspecificriskofdevelopingpneumonia.
Donotusethismedicationifyouareallergictoranitidine.
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The Dangers Of DVT: Don't Ignore The Signs
Askadoctororpharmacistifitissafeforyoutotakethismedicineifyouhavekidneydisease,liver
disease,orporphyria.
Heartburnisoftenconfusedwiththefirstsymptomsofaheartattack.Seekemergencymedical
attentionifyouhavechestpainorheavyfeeling,painspreadingtothearmorshoulder,nausea,
sweating,andageneralillfeeling.
Ranitidinegranulesandeffervescenttabletsmustbedissolvedinwaterbeforeyoutakethem.Your
doctormayrecommendanantacidtohelprelievepain.Carefullyfollowyourdoctor'sdirectionsabout
thetypeofantacidtouse,andwhentouseit.Avoiddrinkingalcohol.Itcanincreasetheriskof
damagetoyourstomach.Itmaytakeupto8weeksofusingthismedicine
What is ranitidine?
Ranitidineisinagroupofdrugscalledhistamine2blockers.Ranitidineworksbyreducingtheamount
ofacidyourstomachproduces.
Ranitidineisusedtotreatandpreventulcersinthestomachandintestines.Italsotreatsconditionsin
whichthestomachproducestoomuchacid,suchasZollingerEllisonsyndrome.Ranitidinealsotreats
gastroesophagealrefluxdisease(GERD)andotherconditionsinwhichacidbacksupfromthestomach
intotheesophagus,causingheartburn.
UnitedStates.78Thesubjectsreceivedpirenzipine0.5%forthefirstweek,1.0%forthesecondweek,
and2.0%foranadditional2weeks.Anotherstudyof49adultmalevolunteersfoundthatpirenzepine
ophthalmicgelat0.5%,1.0%,and2.0%waswelltolerated,producedminimalmydriasis,andtheonly
adverseeventnotedwasatransientunilaterallossofvisualacuityinonepatientwhichrecoveredby
thenextvisit.79Althoughrandomisedclinicaltrialsarecurrentlyinprogress,efficacydataarenotyet
available.
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dosesofatropine(1%atropine)may,however,beassociatedwithanincreasedincidenceandseverity
oflocaleffects(examplesincludemydriasis,photophobia,blurredvision,allergicdermatitis)and
systemiceffects34,68,69;lowerdosesofatropine(0.5%,0.25%,0.1%)werebettertolerated.68Thelong
termsideeffectsofatropineeyedropsinchildrenarerelativelyunknownandtheremaybeariskof
longtermultravioletlightrelatedretinaldamageandcataractformationasaresultofchronicpupillary
dilatation.64
PirenzipineisarelativelyselectiveM1subtypemuscarinicreceptorantagonistandM1receptorsare
foundintheciliaryprocesses.7074Inbothavianandmammalianmodels,pirenzipinehasbeenshownto
blockformdeprivationmyopiaandaxialelongation.7577Thetolerabilityofpirenzipinegelformulation
wastestedinadoublemaskedplacebocontrolledrandomisedclinicaltrialofchildrenaged912years
inthe
Atropinesuppressesgrowthhormonesecretionfromthepituitaryglandwhichcoulddisturbnormal
eyegrowth.57,58
ThefirstreportsofatropinetreatmentformyopiawerebyWellsinthe19thcentury.3In1979,
Bedrossianevaluatedtheeffectof1%atropineointmentinstilledonceatnightinoneeyefor1year
withthefelloweyeasthecontrolinanonrandomisedtrial.After1year,treatmentwasswitchedtothe
felloweye,andthecontroleyesshowedsignificantincreasesintherateofmyopia. 59However,the
felloweyemaynotbesuitableasacontrolastheremaybesystemicresidualeffectsofatropineonthe
felloweye.Severalotherstudieshaveevaluatedtopicalatropinetherapybutunfortunatelyhad
sufficientmethodologicalflawstoprecludeanyreliableconclusions.15,16,6067Arangeofconcentrations
(0.1%to1%)ofatropineeyedropsweretestedinthreerandomisedclinicaltrialsofschoolchildrenin
Taiwanandtherateofprogressionofmyopiaintheatropinegroupwassignificantlylowercompared
withthecontrolgroup.34,68,69Higher
tropineisanalkaloidfromthedeadlynightshadeAtropabelladonnaandhasseveralproposed
mechanismsofaction.Firstly,atropinemayblockaccommodationandreducetheputativeeffectsof
excessiveaccommodationontheprogressionofmyopia.11Secondly,atropineisanonselective
muscarinicantagonistandithasbeenobservedthatinanimalstreatedwithatropine,formdeprivation
myopiamaybesuppressedwithretardationofaxiallengthelongation.5355Atropinealsoaffects
dopamineneurotransmitterreleasefromcellularstoresandthusmayinfluenceretinalsignalsthat
controlthegrowthoftheeye.56Thirdly,atropinemayreachsufficientlevelsinthebloodstreamtohave
systemiceffects.
usuallywornovernight,withthepotentialcomplicationsofinfectivekeratitisrelatingtoclosedeye
contactlenswear.However,cornealflatteningdoesnottreattheintrinsiccauseofmyopiaandmaybe
aremedyratherthanacure.IntheBerkeleyOrthokeratologyStudy,80subjectswererandomisedto
orthokeratologyoracontrolgroupwearingcontactlensesfittedinthestandardclinicalmanner.There
wasasignificantlylargerreductioninmyopiaforthepatientsrandomisedtoorthokeratology,butthe
reductiondidnotpersistafterorthokeratology.52Thus,orthokeratologyhaslittleclinicalvalueforthe
retardationofmyopiaprogression.
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ORTHOKERATOLOGY
Thetechniqueknownasorthokeratologyhasbeenpractisedfordecades:thecorneaisflattenedby
fittingprogressivelyflatterrigidcontactlensesuntilthecornealshapeissufficientlyalteredtoachieve
myopiareduction.52Thetemporaryalterationofcornealshapeandhencecorrectionofmyopiaallows
forperiodsofclearunaidedvisionduringthedaywithouttheuseoflenses,butrequiresconstantuseof
retainerlens,
Inthe3yearHoustonstudyofrigidgaspermeablecontactlenses,100myopicchildrenaged813
yearswerefittedwithParapermoxygenpluscontactlensesandwerecomparedwith20spectacle
wearers.Theaverageprogressionofmyopiawassignificantlydifferent:0.48Dperyearforrigid
contactlenswearerscomparedwith1.53Dperyearforspectaclewearers.50However,theallocation
oftreatmentwasnotrandomised.Itwasalsoobservedthatapproximatelyhalfoftheeffectofrigidgas
permeablecontactlenseswasduetotransientcornealflattening.Inanonrandomisedstudyof45rigid
contactlenswearersand45spectaclewearersinSingapore10yearoldchildren,themeanincreasein
myopiaovera3yearperiodof
polymethylmethacrylate(PMMA)hardcontactlenses,thusalteringtheshapeofthecornea. 49
However,therewerehypoxiarelatedcornealchanges.Newrigidgaspermeablelenseswithhigh
oxygenpermeabilityareasuitableandsaferalternative.45Thepotentialmechanismsofactionofrigid
contactlensesincludetransientflatteningofthecornea,andimprovedqualityoftheretinalimagewith
reducedperipheralimageblur.Perhapsrigidcontactlensesmayevenretardaxialelongation.
However,thepermanenceofthesemechanismsofactionisstillunknown.
Ininfantprimateswearingminuscontactlenses,compensatoryoculargrowthmayleadtofunctional
myopia.38,39Alargenumberofreportsontheefficacyofvarioustypesofcontactlenses(silicone
acrylatecontactlenses,hydrophiliccontactlenses,hydrogellenses)werenotrandomised,hadsmall
samplesizes,andhighdropoutrates.4047Inarandomisedclinicaltrialoftheefficacyofsoftcontact
lensesin175childrenbyHornerandassociatesintheUnitedStates,therewasnosignificantdifference
intherateofprogressionofmyopiabetweenthecontactlens(0.36Dperyear)andcontrolgroup
(0.30Dperyear).48
Morrisonin1956fitted1021myopicchildren(79years)flatterthantheflattestcurvaturewith