Zantac (Ranitidine) 75 mg / 150 mg / 300 mg Tablets: OTC and Prescription H2 Receptor Blocker Withdrawn from US Market 2020 — Current OTC Alternatives: Famotidine, Cimetidine

Information last reviewed: May 2026 — for educational purposes only.

Zantac (ranitidine hydrochloride) was once one of the best-selling drugs in the world — a histamine H2-receptor antagonist (H2 blocker) used for over four decades to treat heartburn, GERD, and peptic ulcers. In April 2020, the FDA requested the withdrawal of all prescription and OTC ranitidine products from the US market after testing revealed that ranitidine molecules are inherently unstable and can degrade over time — or in the body — to produce unacceptable levels of N-nitrosodimethylamine (NDMA), a probable human carcinogen. Ranitidine is no longer sold in the United States in any form.

What Was Ranitidine (Zantac)?

Ranitidine was a histamine H2-receptor antagonist — the leading member of the H2 blocker class for many years. H2 blockers work by blocking histamine's action on H2 receptors of gastric parietal cells, reducing acid secretion. They are less potent and have a shorter duration of action than proton pump inhibitors (PPIs), but act faster (within 30–60 minutes) for symptomatic relief of heartburn and were widely used for mild-to-moderate GERD, peptic ulcer healing, and prevention of stress ulcers.

Ranitidine was available in 75 mg OTC tablets (Zantac 75) and 150 mg and 300 mg prescription tablets. Original Zantac (brand) had been sold since the 1980s and was the world's best-selling drug in 1987. Generic ranitidine became available after patent expiry and was widely prescribed.

What Is NDMA and Why Was Ranitidine Withdrawn?

NDMA (N-nitrosodimethylamine) is a probable human carcinogen classified as an environmental contaminant. In 2019, researchers and the FDA discovered that ranitidine's molecular structure is inherently unstable — the drug can generate NDMA in both storage conditions (particularly at elevated temperatures) and through endogenous metabolism in the human body. Unlike the NDMA found in some batches of valsartan or metformin (which arose from manufacturing contamination), ranitidine's NDMA problem was intrinsic to the ranitidine molecule itself. There was no way to reformulate or purify it to remove the risk. This led to the unprecedented complete market withdrawal in April 2020.

Current Alternatives to Ranitidine

Patients who were using ranitidine for heartburn and GERD now have several safe H2 blocker alternatives that do not produce NDMA, as well as OTC PPIs:

• Famotidine (Pepcid) — the main H2 blocker replacement for ranitidine; OTC at 10 mg and 20 mg; Rx at 20–40 mg. Does not degrade to NDMA. Available as Pepcid AC (OTC), generic famotidine, and combined with calcium carbonate (Pepcid Complete). Faster heartburn relief than PPIs for acute symptoms.
• Cimetidine (Tagamet) — OTC H2 blocker; 200 mg; less preferred due to multiple drug interactions (inhibits CYP1A2, CYP2C19, CYP2D6, CYP3A4) but remains available and does not have NDMA concerns.
• Nizatidine (Axid) — H2 blocker; OTC 75 mg and Rx 150/300 mg; also withdrawn from US market in 2020 due to NDMA concerns similar to ranitidine (nizatidine has a related chemical structure). No longer available in the US.
• OTC PPIs — For patients with GERD requiring more potent acid suppression: omeprazole 20 mg (Prilosec OTC), esomeprazole 20 mg (Nexium 24HR), or lansoprazole 15 mg (Prevacid 24HR) are all available OTC and are more effective for healing erosive disease.

Is There a "Zantac 360" Now?

Yes — Sanofi (the company that previously marketed Zantac) launched Zantac 360 in 2022 using famotidine as the active ingredient, trading on the Zantac brand name recognition. Zantac 360 contains famotidine 20 mg (OTC) — it contains no ranitidine and carries no NDMA risk. It functions identically to generic famotidine (Pepcid AC). The brand name change has caused some consumer confusion, as patients may assume the "new Zantac" contains the same molecule as the original product.

Frequently Asked Questions

Is ranitidine still available anywhere?

Ranitidine is not available in the US, Canada, Australia, or the European Union, where similar withdrawals occurred. It may theoretically be obtainable in some markets with less stringent pharmaceutical regulation, but its use is not recommended anywhere given the established NDMA generation issue.

Should patients who took Zantac for years be concerned about cancer?

The FDA's concern was precautionary based on calculated NDMA exposure estimates over time. Many large epidemiological studies have found no definitive elevation in cancer rates specifically attributable to ranitidine use, but the inherent uncertainty led to the precautionary withdrawal. Patients concerned about prior ranitidine use should discuss cancer screening recommendations appropriate to their age and risk profile with their physician.

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