After the regulator kicked ranitidine and nizatidine out of the market due to carcinogen risks, pharmaceutical companies engaged in a silent war to sell their alternative drugs in the 260 billion won ($222.8 million) ranitidine market.

Some drug companies quickly responded and boosted earnings by nearly five folds in two months, while others failed in the severe competition and slid in sales rankings.

As the health authorities detected N-Nitrosodimethylamine (NDMA), a carcinogen, in ranitidine heartburn drugs in late September, they banned all ranitidine-using medicines. In November, the regulator also ordered a recall of some nizatidine drugs that have a similar chemical structure to ranitidine.

As physicians prescribe about 260 billion won worth ranitidine drugs a year, pharmaceutical firms suffered massive losses. From October, where no ranitidine was available, drugmakers started to fight for a larger market share in the ranitidine alternatives market.

According to U-BIST data on outpatient prescription sales of gastric ulcer treatments, Boryung Pharmaceutical and Hanmi Pharmaceutical won the early competition.

Boryung put forward Stogar, a lafutidine-containing H2 blocker in the same class as ranitidine. In the wake of ranitidine recall, Boryung emphasized that it conducted an impurity test on Stogar, and the medicine had no safety issue. Based on this strategy, Boryung was able to secure the ranitidine market rapidly.

Prescriptions of Stogar surged 57.7 percent in two months, from 1.1 billion won in September to 1.7 billion won in November.

Hanmi also enjoyed sales growth due to the ranitidine recall. Physicians increased prescriptions of Hanmi Famotidine and Esomezol to replace ranitidine drugs. Hami Famotidine’s sales jumped nearly five folds from less than 100 million won in September to more than 400 million won in November. Esomezol prescriptions went up 24 percent to 3.5 billion won in November.

Daewoong Pharmaceutical, one of the pharmaceuticals that suffered the most due to the ranitidine ban, was able to offset some losses with Nexium sales.

Daewoong could not sell Albis (ranitidine combo drug), which used to rake in several billions of won in revenue per year. The company decided to boost the sales of Nexium, as it co-promotes the product with AstraZeneca. Nexium is leading the proton pump inhibitor (PPI) market. After the ranitidine recall, Nexium’s sales rose 38.5 percent from 2.9 billion won in September to 4 billion won in November.

Dong-A ST’s Gaster (ingredient: famotidine), Il-yang Pharmaceutical’s Noltec (ilaprazole), and Daewon Pharmaceutical’s Eswonamp also saw prescriptions expand rapidly during the two months.

Roxatidine drugs are showing fast growth, but they do not take up much proportion in the H2 blocker market.

Cimetidine-based medicines showed sales decreases, except for Bukwang Pharm’s Cimet, apparently due to an unstable supply of raw materials.

PPIs are in severe competition, too. While Nexium, Esomezol, Noltec, Eswonamp, and Rabiet (by Ildong Pharmaceutical) achieved two-digit sales growth in the two months, Takeda (Lanston LFDT, Dexilant DR) and Janssen’s Pariet failed to cash in on the ranitidine ban and lost in ranking competition against local drugmakers.

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