With the 2019 voluntary recall of ranitidine (brand name Zantac) and nizatidine (brand name Axid) products in the U.S. well underway due to contamination by the carcinogen NDMA, the FDA has listed several alternative drugs to treat heartburn and related conditions.

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are a class of drugs that work by irreversibly blocking the secretion of acid into the stomach by specific enzymes. They are more commonly used by patients than the class of drugs that ranitidine and nizatidine belong to as PPIs have been noted to be more effective. 

There are three PPIs that the FDA lists as alternatives for ranitidine and nizatidine: esomeprazole (brand name Nexium), lansoprazole (brand name Prevacid), omeprazole (brand name Prilosec).

PPIs may increase the risk of gastric infections and can also reduce the absorption of magnesium and vitamin B12. 

Other H2 Histamine Receptor Antagonists

Both ranitidine and nizatidine are H2 histamine receptor antagonists, which work by blocking histamine from activating the stomach lining cells that create and secrete acid into the stomach. 

Fortunately, NDMA contamination appears to just be limited to ranitidine and nizatidine, and there are two other drugs from this class that can work as alternatives. The FDA lists famotidine (brand name Pepcid) and cimetidine (brand name Tagamet).

H2 histamine receptor antagonists are pretty well tolerated in general, but cimetidine is particularly associated with a range of adverse effects including gynecomastia, impotence, vitamin B12 deficiency, anemia, thrombocytopenia, neutropenia, and pancytopenia. H2 histamine receptor antagonists can also be associated with altered mental status, headaches, dizziness, and restlessness, especially in older patients.

Both classes of drugs should only be taken under physician advisement for the appropriate dose and duration of treatment. Long-term inappropriate use of either drug class can increase the risk of adverse effects. The use of these drugs should also be paired with appropriate lifestyle modifications to reduce exacerbation of stomach acid conditions.