Pepcid vs Zantac: What's the difference?
An estimated 15 to 30 percent of Americans have gastroesophageal reflux disease (GERD), meaning they experience heartburn or indigestion at least twice per week. A number of factors has contributed to the skyrocketing rates of GERD in the United States over the past several decades, including the rising obesity epidemic, as people who are overweight or obese are more likely to suffer from the condition. Over the counter (otc) medications like Pepcid and Zantac offer relief of mild to moderate occasional symptoms of GERD for some people, while others require prescription medications to help control their symptoms. Regardless of the type of medication used to treat GERD, the condition usually does not resolve without substantial lifestyle changes and dietary changes as well. Pepcid and Zantac both offer relief from GERD symptoms, but there are differences between the two medications.
Pepcid, sold under the generic name famotidine, and Zantac, sold under the generic name ranitidine hydrochloride, both belong to a class of medications called Histamine-2 receptor blockers, or H-2 blockers. Both medications are available over the counter and prescription forms. H-2 blockers (sometimes called H-2 antagonists) were the original form of treatment for ulcers and were the most popular form of treatment for ulcers and GERD in the 1980s.
Pepcid and Zantac both treat similar conditions, including GERD, Zollinger-Ellison Syndrome, stomach ulcers, esophagitis, and other digestive conditions.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease, also known as GERD or heartburn, is a condition in which stomach acid and digestive enzymes flow backward from the stomach into the esophagus. Most people occasionally experience symptoms of heartburn or acid reflux, but people with gastroesophageal reflux disease experience these symptoms multiple times per week over a long period of time. Often, the condition results from dysfunction in the esophageal sphincter. The muscular ring, or sphincter, that seals off the esophagus from the stomach is designed to prevent food and any amount of acid from coming back up into the esophagus, but people with GERD often have an esophageal sphincter that does not function properly and does not seal tightly enough. When this happens, the sphincter remains relaxed between swallows, allowing food and digestive juices to enter the esophagus. Stomach acid is dangerous to the esophagus, so over time, the condition can cause damage, inflammation, narrowing, development of open sores, or a condition called Barrett’s esophagus, which increases the risk of esophageal cancer. People with GERD often experience some or all of the following symptoms:
- A repeated sour or bitter taste in the mouth
- Sharp or burning pain behind the breast bone
- Tightness in the chest or upper abdomen
- Difficulty swallowing
- Sore throat
- Coughing, wheezing or needing to clear your throat
Zollinger-Ellison syndrome is a rare condition that causes tumors to form in your pancreas or upper small intestines. Tumors associated with Zollinger-Ellison syndrome secrete large amounts of a hormone called gastrin, which causes overproduction of acid in the stomach. The extra acid eventually leads to peptic ulcers, diarrhea, and other symptoms. While the majority of diagnoses are made between the ages of 20 and 50, the disease may present at any time in life. Symptoms associated with Zollinger-Ellison syndrome include:
- Abdominal pain
- Burning, aching, or discomfort in the upper abdomen
- Nausea and vomiting
- Acid reflux and heartburn
- Bleeding in the digestive tract
- Decreased appetite
How it Works
H-2 blockers like Pepcid and Zantac act on histamine receptors in the body. Histamine is a chemical in the body that directs the stomach lining to produce hydrochloric acid; it is also responsible for producing allergic reactions to allergens in certain individuals. The H-2 blockers work by binding to the H-2 receptors within the stomach, preventing histamine from binding and directing the production of hydrochloric acid. With the production of hydrochloric acid diminished, peptic ulcers are given time to heal, and excess acid is not produced, helping to prevent heartburn and GERD.
Pepcid comes in oral tablets with strengths of 10 mg, 20 mg, and 40 mg. Doses depend on the condition being treated, with ulcers typically treated by a 40 mg oral tablet taken once daily or 20 mg taken twice daily for up to eight weeks and GERD being treated with 20 mg taken twice daily for up to six weeks. Patients with Zollinger-Ellison syndrome generally take an initial dose of 20 mg taken every six hours, with a maximum dosage of 160 mg every six hours.
Zantac comes in oral tablets with strengths of 75 mg, 150 mg, and 300 mg. The standard dose of Zantac for treatment of an ulcer is 150 mg taken twice daily, although some patients may be able to receive effective treatment from one 300 mg dose taken after dinner or at bedtime. Patients being treated for Zollinger-Ellison syndrome and GERD are recommended to take 150 mg twice daily.
H-2 blockers like Zantac and Pepcid are considered effective at lowering acidity and relieving heartburn symptoms for patients with mild to moderate symptoms that occur less than twice a week. The medications can (and should) be taken on an empty stomach to allow them to work their best. Compared to Pepcid, Zantac has been shown to be more effective at lowering acidity and relieving symptoms associated with heartburn; it also works faster. However, H-2 blockers only work effectively for two to six weeks before the stomach adjusts to the medication and begins working around it, so it is important that these medications only be taken for short term use.
The side effects for Pepcid and Zantac are similar to most other H-2 blockers, although there are some key difficulties between the two. Common side effects associated with Pepcid include:
- Muscle pain or cramps
- Dry mouth
- Mood changes
- Joint pain
Common side effects associated with Zantac include:
- Decreased sex drive
- Difficulty having an orgasm
- Swollen or tender breasts (in men)
- Headache (sometimes severe)
- Muscle pain
- Stomach pain
Drug interactions for both Pepcid and Zantac are relatively minimal, but patients should still make sure to discuss all medications and supplements taken with their health care professional, as some drug interactions may occur. Drug interactions associated with Pepcid include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve and ibuprofen
Drugs that may interact with Zantac include:
- Blood thinners, such as warfarin
Use in Pregnant and Breastfeeding Women
Pepcid is considered a FDA Class B medication for pregnant women, meaning that no harm has been shown to occur to an unborn child when taken during pregnancy. However, the manufacturer advises that each woman speak with their healthcare provider or pharmd before taking any new medications during pregnancy. Pepcid ac has been found to pass through breast milk to nursing infants, but no problems have been reported to occur in infants whose mothers nursed while taking Pepcid.
Like Pepcid, Zantac is also considered an FDA Class B medication for pregnant women, as no harm has been shown to occur to unborn children when taken during pregnancy. However, the manufacturer advises that each woman speak with their doctor for medical advice before taking any new medications during pregnancy. Zantac has been found to pass through breastmilk to nursing infants, but no problems have been reported to occur in infants whose mothers nursed while taking Zantac. Some infants suffer from acid reflux and receive a small dose of Zantac as treatment for the condition; the dose given to infants is less than the amount that passes through breast milk.
Recall of Zantac
It should be noted that Zantac and all other ranitidine products were recalled by the U.S. Food and Drug Administration (FDA) in April 2020 due to the presence of a nitrosamine impurity called N-nitrosodimethylamine (NDMA) in some ranitidine products. NDMA levels were found to increase over time in normal storage conditions and increase at a higher rate when the medication is stored at high temperatures. Nitrosamine impurities, like NDMA, may increase the risk of cancer in people who are exposed to them at levels above what is recommended and over long periods of time. NDMA is considered safe at or below the recommended daily intake level, which would allow a patient to intake the acceptable amount of NDMA every day for 70 years without an increased risk of cancer. However, NDMA levels were found to be unacceptably high in some ranitidine products, prompting a total recall of all ranitidine products by the FDA.
Alternatives to Zantac include other H2 blocker heartburn medications, such as Pepcid and Tagamet. Antacids like Tums, Mylanta, and Rolaids can provide fast-acting relief for indigestion and heartburn on a temporary basis; however, these medications work temporarily and may only offer relief for 30 to 60 minutes at a time. For more persistent cases of GERD, proton pump inhibitors (PPIs) like Nexium, Prevacid, and Prilosec are also an option, although long term use of PPIs is not without risks. It’s recommended that you talk to a healthcare professional about alternatives of Zantac that might be able to help provide relief from your symptoms.