Question about drug abuse

[Umairshariff23]

Hi guys, I am an intern at my college in India and have been exposed to the front of medicine for just over a couple of months and I am curious about a behaviour of my attending. They prescribe ranitidine to almost every patient that comes in.

The only few scenarios when my attending has refrained from prescribing ranitidine is when a patient just needs multivitamins, some of the common prescriptions are:

Diclofenac + ranitidine
Paracetamol + ranitidine
Any antibiotic + Rani
Amlodipine + Rani

I figured it were the action of an individual, but I have worked under 5 attending so far and all have similar approach.

On asking the attending the reason behind this, I was told that it is to avoid gastritis or gastric erosions caused due to nsaids.

I find the reasoning riddled with plot holes and feel that this practice is unnecessary, until and unless the patient comes with a complaint of gastric distress and refuse to over prescribe medication to my patients.

I would appreciate it if someone can provide me with some information as to the effects of such continued practice.

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[FarmD711]

I wouldn't call this drug abuse. What are you worried is going to happen? How are you weighing the risk of stress ulcers vs the risk of ranitidine therapy?

What prophylactic treatments are you ok with? Do you refuse to give antibiotics to heart valve patients receiving dental work until they present with endocarditis?


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[mik30102]

You are absolutely correct.

Out of of your examples:
For diclofenac it makes sense. However its something you consider for chronic users, not short term people taking it for a few days for pain.
No reason to give it with paracetamol or amlodipine or any antibiotic...

As far as long term effects, nothing terrible, just a waste of money.

 

[Dred Pirate]

You are absolutely correct.

Out of of your examples:
For diclofenac it makes sense. However its something you consider for chronic users, not short term people taking it for a few days for pain.
No reason to give it with paracetamol or amlodipine or any antibiotic...

As far as long term effects, nothing terrible, just a waste of money.

well - there is a risk of thrombocytopenia - rare but considering the use of rani is not needed in most of these cases, that risk does not outweigh the benefit

 

[Umairshariff23]

I wouldn't call this drug abuse. What are you worried is going to happen? How are you weighing the risk of stress ulcers vs the risk of ranitidine therapy?

What prophylactic treatments are you ok with? Do you refuse to give antibiotics to heart valve patients receiving dental work until they present with endocarditis?


Sent from my iPhone using SDN mobile

I am not in a very rich neighborhood, most of the patients I get earn enough per day to barely get by, I just dont want to give them unnecessary medications for which they will have to sacrifice. The scenario you mentioned advocates use of antibiotics and I wont go against it at all, but ranitidine with almost every other drug is simply ridiculous.

You are absolutely correct.

Out of of your examples:
For diclofenac it makes sense. However its something you consider for chronic users, not short term people taking it for a few days for pain.
No reason to give it with paracetamol or amlodipine or any antibiotic...

As far as long term effects, nothing terrible, just a waste of money.

Yes exactly, most of the patients that get diclo, get it for a week tops. Seems like a waste on the part of the patient and (according to me) shows that a physician is not confident with his/her prescriptions

 

[gwarm01]

What sort of unit are you rounding in? In my experience, the majority of ICU patients will either be on an H2 inhibitor or PPI. Although I have seen some push back on PPIs due to a few cases of C. Diff that were arguably attributable to pantoprazole.

 

[Umairshariff23]

What sort of unit are you rounding in? In my experience, the majority of ICU patients will either be on an H2 inhibitor or PPI. Although I have seen some push back on PPIs due to a few cases of C. Diff that were arguably attributable to pantoprazole.

Community Medicine, we are sent off to one of the four villages our hospital has centres in for 15 days on a stretch