EMA’s human medicines committee (CHMP) has recommended the suspension of all ranitidine medicines in the EU due to the presence of low levels of an impurity called N-nitrosodimethylamine (NDMA).

NDMA is classified as a probable human carcinogen (a substance that could cause cancer) based on animal studies. It is present in some foods and water supplies and is not expected to cause harm when ingested at very low levels.

Available safety data do not show that ranitidine increases the risk of cancer, and any possible risk is likely to be very low. However, NDMA has been found in several ranitidine medicines above levels considered acceptable, and there are unresolved questions about the source of the impurities.

There is some evidence that NDMA may form from the degradation of ranitidine itself with increasing levels seen over its shelf life. It is not clear whether NDMA can also be formed from ranitidine inside the body. Some studies suggest that it can while others do not. Given the uncertainties, the CHMP has recommended a precautionary suspension of these medicines in the EU.

Ranitidine medicines are used for reducing levels of stomach acid in patients with conditions such as heartburn and stomach ulcers. Alternatives are available and patients should contact their healthcare professionals if they need advice about which medicine to take.

Many ranitidine medicines have not been available in the EU for several months. This is because national authorities have recalled them as a precaution while the EMA review was ongoing.

EMA has also recommended conditions for lifting the suspension of ranitidine medicines, including requirements for companies to provide more data.

Since 2018 NDMA and similar compounds known as nitrosamines have been detected in a number of medicines, with EU regulators taking action to identify possible sources of the impurities and set strict new requirements for manufacturers.

EMA will continue working with national authorities, EDQM the European Commission and international partners to make sure that effective measures are taken to prevent the presence of these impurities in medicines.

Posted on the EMA website on 30 April 2020