Can intake of ranitidine (Zantac Brus) cause an increased blood glucose level? Can aspartame increa

Fråga: Can intake of ranitidine (Zantac Brus) cause an increased blood glucose level? Can aspartame increase blood glucose? (Zantac Brus contains aspartame (30 mg) as a sweetener).

A 70-year-old woman with non-insulin-dependent diabetes was treated with ranitidine (Zantac Brus) 150 mg twice daily. After three days treatment an increased level of blood glucose was measured in the evening (16 mmol/L, not a fasting test). The next morning the level was still increased (17 mmol/L, fasting test). Treatment was stopped and the blood glucose level decreased to 6.5 mmol/L in the morning (fasting test) and 6.9 mmol/L in the evening (not a fasting test).

Sammanfattning: There is no evidence for significant increase of blood glucose in treatment with ranitidine containing aspartame. However, since the blood glucose level decreased in this case after withdrawal of ranitidine a cause relationsship cannot be excluded.

Svar: A search in the databases Drugline, The Swedish Adverse Drug Reaction Advisory Committee (SADRAC) and pharmacological handbooks has not revealed any information indicating increased blood glucose levels in patients treated with ranitidine.

A search in Medline has revealed only two articles.

In one study, nine healthy volunteers received ranitidine infusion. No significant increase of blood glucose was seen. However, based on the knowledge that insulin and C-peptide are produced in equimolar rate, a significant increase in the levels of insulin but not of C-peptid indicates that ranitidine does not affect the release of pancreatic insulin nor peripheral glucose utilization. It could rather be that ranitidine influences the hepatic clearance of glucose and insulin both of which undergo high first-pass extraction (1).

In a placebo controlled study, 62 subjects with insulin-dependent and non-insulin-dependent diabetes were treated with aspartame (2.7 grams) for 18 weeks and no significant difference in blood glucose levels was seen in the aspartame treated group compared to placebo (2).

We recommend this case be reported to SADRAC. 1 Gentile S, Marmo R, Costume A, Orlando C, D´Alessandro R, De Bellis G, Porcellini M: The role of ranitidine infusion on glucose, insulin and c-peptide serum levels induced by oral glucose tolerance test in healthy subjects. Acta Diabetol Lat 1986; 23: 165-170 2 Nehrling JK, Kobe P, McLane MP, Olson RE, Kamath S, Horwitz DL: Aspartame use by persons with diabetes. Diabetes Care 1995; 8: