Anaphylactic shock following intravenous
ranitidine in rural Nepal: a case report

Anaphylactic shock following intravenous
ranitidine in rural Nepal: a case report

Ranitidine, Anaphylaxis, Epinephrine, Shock

Abstract
Background Ranitidine, a histamine-2 (H2) receptor antagonist, is widely used for acid-peptic disorders. Although
generally safe, it is a rare but recognized cause of drug-induced anaphylaxis, with an estimated incidence of 0.2–0.7%
for H2 receptor blockers and proton pump inhibitors. We report a near-fatal case of ranitidine-induced anaphylactic
shock successfully managed in a rural hospital.
Case presentation A 35-year-old female developed sudden shortness of breath, hypotension, and drowsiness within
minutes of receiving a 50 mg intravenous (IV) dose of ranitidine for epigastric discomfort at a local clinic. She had no
prior exposure to ranitidine or known allergies. On arrival, her blood pressure was 60 mmHg systolic, pulse 130/min,
and SpO2 60%. She had diffused urticaria and wheezing. A diagnosis of anaphylactic shock was made. Immediate
management included high-flow oxygen, intramuscular epinephrine (0.5 mg, 1:1000), followed by intravenous
hydrocortisone. Significant improvement occurred within 10 minutes and she was discharged after 24 hours of
observation.
Conclusion This case highlights that ranitidine, although commonly used, can rarely trigger severe anaphylactic
shock even in patients without prior exposure or known allergies. Early recognition of the reaction and timely
administration of intramuscular epinephrine were key to the patient’s rapid recovery. Awareness of this potential
adverse reaction is important for all clinicians who administer H2-receptor antagonists.
Keywords Ranitidine, Anaphylaxis, Epinephrine, Shock

Rojee Shrestha1*, Ashal Timalsina1*, Arjun Gaire1

, Roshan Acharya1

, Anupa Subedi1

and Aayusha Suwal1

https://doi.org/10.1186/s12245-025-01101-0

2026

peri irawan

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