Just after that third slice of pizza, a pain ignites in your chest and creeps up your throat. A splash of acid has escaped your stomach. You have heartburn.
Many people experience heartburn, and some of us have it every day. It can make it hard to swallow and sometimes it interrupts our sleep. A small number of people with chronic heartburn are also at risk of developing oesophageal cancer.
Medicines that reduce stomach acid can help manage heartburn. One such medicine is ranitidine, with low strength tablets available over-the-counter from pharmacies, and stronger products available on prescription.
Recently, some medicines with ranitidine were removed from the Australian market over concerns about contamination with N-Nitrosodimethylamine, or NDMA.
NDMA is an organic chemical found in foods like bacon, cheese and whiskey. Long-term exposure to this chemical can increase your risk of cancer, particularly at higher doses.
NDMA is not part of the normal formulation of ranitidine. Contamination of ranitidine products with NDMA was discovered through testing by the United States Food and Drug Administration, and could be due to the manufacture or storage of the medicine.
While there is no immediate health risk from the short-term use of ranitidine products for heartburn, some products have been removed from the market to protect public health while the Therapeutic Goods Administration and other regulators investigate this contamination.
We have tested 135 different batches of ranitidine medicines, and found that while 75% of medicines have heightened NDMA, the risk is very small. If you were to take a ranitidine tablet every day of your life for 70 years, then you would have an increased cancer risk of about one in 100,000.
But if you have painful or persistent heartburn, you still need relief. Your doctor or pharmacist can advise you on whether to continue with a ranitidine product, try an alternative medication, or explore lifestyle changes to better manage your heartburn.
With some ranitidine products no longer available, there is a shortage of these medicines in Australia. For some products, this is expected to continue into mid-2020.
We are working with international regulators and companies on this issue to ensure that heartburn products that contain ranitidine are safe and effective. This will enable you to access the heartburn treatment you need, without needlessly risking your health.