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Medication Safety Issues
Sound-alike/look-alike issues:
Cimetidine may be confused with simethicone
Pronunciation
(sye MET i deen)
U.S. Brand Names
Generic Available
Yes
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Short-term treatment of active duodenal ulcers and benign gastric ulcers; long-term prophylaxis of duodenal ulcer; gastric hypersecretory states; gastroesophageal reflux; prevention of upper GI bleeding in critically-ill patients; labeled for OTC use for prevention or relief of heartburn, acid indigestion, or sour stomach
Use: Unlabeled/Investigational
Part of a multidrug regimen for H. pylori eradication to reduce the risk of duodenal ulcer recurrence
Pregnancy Risk Factor
B
Pregnancy Considerations
Teratogenic events were not observed in animal studies.
Lactation
Enters breast milk/not recommended
Contraindications
Hypersensitivity to cimetidine, any component of the formulation, or other H2 antagonists
Warnings/Precautions
Concerns related to adverse effects:
• Confusion: Reversible confusional states, usually clearing within 3-4 days after discontinuation, have been linked to use. Increased age (>50 years) and renal or hepatic impairment are thought to be associated.
Disease-related concerns:
• Gastric malignancy: Relief of symptoms does not preclude the presence of a gastric malignancy.
• Hepatic impairment: Use with caution in patients with hepatic impairment; dosage adjustment recommended.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.
Concurrent drug therapy issues:
• Drugs metabolized through P450 system: Dosage should be adjusted in patients receiving drugs metabolized through the P450 system.
Other warnings/precautions:
• I.V. administration: Rapid intravenous administration has been associated with rare cases of arrhythmia and/or hypotension.
• OTC labeling: Should not be taken by individuals experiencing painful swallowing, vomiting with blood, or bloody or black stools; medical attention should be sought. A healthcare provider should be consulted prior to use when pain in the stomach, shoulder, arms or neck is present; if heartburn has occurred for >3 months; or if unexplained weight loss, or nausea and vomiting occur. Frequent wheezing, shortness of breath, lightheadedness, or sweating, especially with chest pain or heartburn, should also be reported. Consultation of a healthcare provider should occur by patients if also taking theophylline, phenytoin, or warfarin; if heartburn or stomach pain continues or worsens; or if use is required for >14 days. OTC cimetidine is not approved for use in patients <12 years of age.
Adverse Reactions
1% to 10%:
Central nervous system: Headache (2% to 4%), dizziness (1%), somnolence (1%), agitation
Endocrine & metabolic: Gynecomastia (<1% to 4%)
Gastrointestinal: Diarrhea (1%)
Frequency not defined:
Cardiovascular: AV block, bradycardia, hypotension, tachycardia, vasculitis
Central nervous system: Confusion, fever
Dermatologic: Alopecia, erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, rash
Endocrine & metabolic: Edema of the breasts, sexual ability decreased
Gastrointestinal: Nausea, pancreatitis, vomiting
Hematologic: Agranulocytosis, aplastic anemia, hemolytic anemia (immune-based), neutropenia, pancytopenia, thrombocytopenia
Hepatic: ALT increased, AST increased, hepatic fibrosis (case report)
Neuromuscular & skeletal: Arthralgia, myalgia, polymyositis
Renal: Creatinine increased, interstitial nephritis
Miscellaneous: Anaphylaxis, pneumonia (causal relationship not established)
Metabolism/Transport Effects
Inhibits CYP1A2 (moderate), 2C9 (weak), 2C19 (moderate), 2D6 (moderate), 2E1 (weak), 3A4 (moderate)
Drug Interactions
Alfentanil: Cimetidine may decrease the metabolism of Alfentanil. Risk C: Monitor therapy
Amiodarone: Cimetidine may decrease the metabolism of Amiodarone. Consider using an alternative H2 antagonist. Risk D: Consider therapy modification
Anticonvulsants (Hydantoin): Cimetidine may decrease the metabolism of Anticonvulsants (Hydantoin). Exceptions: Ethotoin. Risk D: Consider therapy modification
Antifungal Agents (Azole Derivatives, Systemic): H2-Antagonists may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Atazanavir: H2-Antagonists may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Benzodiazepines (metabolized by oxidation): Cimetidine may decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapy
Calcium Channel Blockers: Cimetidine may decrease the metabolism of Calcium Channel Blockers. Exceptions: AmLODIPine; Clevidipine; NiCARdipine. Risk D: Consider therapy modification
CarBAMazepine: Cimetidine may increase the serum concentration of CarBAMazepine. The serum carbamazepine concentration might return to normal within one week of starting cimetidine. Risk C: Monitor therapy
Carmustine: Cimetidine may decrease the metabolism of Carmustine. Risk C: Monitor therapy
Carvedilol: Cimetidine may decrease the metabolism of Carvedilol. Risk C: Monitor therapy
Cefpodoxime: H2-Antagonists may decrease the absorption of Cefpodoxime. Separate oral doses by at least 2 hours. Risk C: Monitor therapy
Cefuroxime: H2-Antagonists may decrease the absorption of Cefuroxime. Separate oral doses by at least 2 hours. Risk C: Monitor therapy
Cisapride: Cimetidine may decrease the metabolism of Cisapride. Risk D: Consider therapy modification
Clopidogrel: CYP2C19 Inhibitors (Moderate) may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Risk X: Avoid combination
Clozapine: Cimetidine may decrease the metabolism of Clozapine. Risk D: Consider therapy modification
Codeine: CYP2D6 Inhibitors (Moderate) may diminish the therapeutic effect of Codeine. These CYP2D6 inhibitors may prevent the metabolic conversion of codeine to its active metabolite morphine. Risk C: Monitor therapy
Colchicine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Colchicine. Management: Reduce colchicine (adult) dose as directed when using with a moderate CYP3A4 inhibitor, and increase monitoring for colchicine-related toxicity. Use extra caution in patients with impaired renal and/or hepatic function. Risk D: Consider therapy modification
CYP1A2 Substrates: CYP1A2 Inhibitors (Moderate) may decrease the metabolism of CYP1A2 Substrates. Risk C: Monitor therapy
CYP2C19 Substrates: CYP2C19 Inhibitors (Moderate) may decrease the metabolism of CYP2C19 Substrates. Risk C: Monitor therapy
CYP2D6 Substrates: CYP2D6 Inhibitors (Moderate) may decrease the metabolism of CYP2D6 Substrates. Exceptions: Tamoxifen. Risk C: Monitor therapy
CYP3A4 Substrates: CYP3A4 Inhibitors (Moderate) may decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Dasatinib: H2-Antagonists may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Delavirdine: H2-Antagonists may decrease the serum concentration of Delavirdine. Management: Chronic therapy with H2-antagonists should be avoided in patients who are being treated with delavirdine. The clinical significance of short-term H2-antagonist therapy with delavirdine is uncertain, but such therapy should be undertaken with caution. Risk X: Avoid combination
Dofetilide: Cimetidine may increase the serum concentration of Dofetilide. This is likely via inhibition of dofetilide renal tubular secretion (primarily) and inhibition of dofetilide metabolism. Risk X: Avoid combination
Eplerenone: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Eplerenone. Management: A lower starting dose of eplerenone (25 mg once daily for adults) is recommended in patients with hypertension who are also taking drugs that are moderate inhibitors of CYP3A4. Risk D: Consider therapy modification
Erlotinib: H2-Antagonists may decrease the serum concentration of Erlotinib. Risk X: Avoid combination
Everolimus: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Everolimus. Risk X: Avoid combination
FentaNYL: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of FentaNYL. Risk D: Consider therapy modification
Fesoterodine: CYP2D6 Inhibitors may increase serum concentrations of the active metabolite(s) of Fesoterodine. Risk C: Monitor therapy
Fosamprenavir: H2-Antagonists may decrease the serum concentration of Fosamprenavir. Cimetidine may also inhibit the metabolism of the active metabolite amprenavir, making its effects on fosamprenavir/amprenavir concentrations difficult to predict. Risk C: Monitor therapy
Halofantrine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Halofantrine. Risk D: Consider therapy modification
Indinavir: H2-Antagonists may decrease the serum concentration of Indinavir. Risk C: Monitor therapy
Iron Salts: H2-Antagonists may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk C: Monitor therapy
Mesalamine: H2-Antagonists may diminish the therapeutic effect of Mesalamine. Histamine H2-Antagonist-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Consider avoiding concurrent administration of high-dose histamine H2-receptor antagnists with sustained-release mesalamine products. Risk D: Consider therapy modification
MetFORMIN: Cimetidine may decrease the excretion of MetFORMIN. Risk C: Monitor therapy
Moclobemide: Cimetidine may decrease the metabolism of Moclobemide. Risk D: Consider therapy modification
Moricizine: Cimetidine may decrease the metabolism of Moricizine. Risk D: Consider therapy modification
Nebivolol: CYP2D6 Inhibitors (Moderate) may increase the serum concentration of Nebivolol. Risk C: Monitor therapy
Nelfinavir: H2-Antagonists may decrease the serum concentration of Nelfinavir. Concentrations of the active M8 metabolite may also be reduced. Risk C: Monitor therapy
Nicotine: Cimetidine may decrease the metabolism of Nicotine. Risk C: Monitor therapy
Pentoxifylline: Cimetidine may increase the serum concentration of Pentoxifylline. Risk C: Monitor therapy
P-Glycoprotein Inducers: May decrease the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
P-Glycoprotein Inhibitors: May increase the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
Pimecrolimus: CYP3A4 Inhibitors (Moderate) may decrease the metabolism of Pimecrolimus. Risk C: Monitor therapy
Praziquantel: Cimetidine may decrease the metabolism of Praziquantel. Risk C: Monitor therapy
Procainamide: Cimetidine may decrease the excretion of Procainamide. Risk D: Consider therapy modification
Propafenone: Cimetidine may increase the serum concentration of Propafenone. Risk D: Consider therapy modification
QuiNIDine: Cimetidine may decrease the metabolism of QuiNIDine. Risk D: Consider therapy modification
QuiNINE: Cimetidine may increase the serum concentration of QuiNINE. Risk D: Consider therapy modification
Ranolazine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ranolazine. Management: Limit the ranolazine adult dose to a maximum of 500 mg twice daily in patients concurrently receiving moderate CYP3A4 inhibitors (e.g., diltiazem, verapamil, erythromycin, etc.). Risk D: Consider therapy modification
Salmeterol: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Salmeterol. Risk C: Monitor therapy
Saquinavir: H2-Antagonists may increase the serum concentration of Saquinavir. Risk C: Monitor therapy
Saxagliptin: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Saxagliptin. Risk C: Monitor therapy
Selective Serotonin Reuptake Inhibitors: Cimetidine may decrease the metabolism of Selective Serotonin Reuptake Inhibitors. Risk D: Consider therapy modification
Sulfonylureas: Cimetidine may increase the serum concentration of Sulfonylureas. Risk C: Monitor therapy
Tamoxifen: CYP2D6 Inhibitors (Moderate) may decrease the metabolism of Tamoxifen. Specifically, CYP2D6 inhibitors may decrease the formation of highly potent active metabolites. Risk D: Consider therapy modification
Theophylline Derivatives: Cimetidine may decrease the metabolism of Theophylline Derivatives. Exceptions: Dyphylline. Risk D: Consider therapy modification
Thioridazine: CYP2D6 Inhibitors may decrease the metabolism of Thioridazine. Risk X: Avoid combination
Tolvaptan: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Tolvaptan. Risk X: Avoid combination
TraMADol: CYP2D6 Inhibitors (Moderate) may diminish the therapeutic effect of TraMADol. These CYP2D6 inhibitors may prevent the metabolic conversion of tramadol to its active metabolite that accounts for much of its opioid-like effects. Risk C: Monitor therapy
Tricyclic Antidepressants: Cimetidine may decrease the metabolism of Tricyclic Antidepressants. Risk C: Monitor therapy
Vitamin K Antagonists (eg, warfarin): Cimetidine may enhance the anticoagulant effect of Vitamin K Antagonists. Risk D: Consider therapy modification
Zaleplon: Cimetidine may decrease the metabolism of Zaleplon. Risk D: Consider therapy modification
Zolmitriptan: Cimetidine may increase the serum concentration of Zolmitriptan. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may enhance gastric mucosal irritation).
Food: Cimetidine may increase serum caffeine levels if taken with caffeine. Cimetidine peak serum levels may be decreased if taken with food.
Herb/Nutraceutical: St John's wort may decrease cimetidine levels.
Storage
Tablet: Store between 15°C and 30°C (59°F to 86°F). Protect from light.
Solution for injection/infusion: Intact vials should be stored at room temperature, between 15°C and 30°C (59°F to 86°F); protect from light. May precipitate from solution upon exposure to cold, but can be redissolved by warming without degradation.
Stability at room temperature:
Prepared bags: 7 days
Premixed bags: Manufacturer expiration dating and out of overwrap stability: 15 days
Stable in parenteral nutrition solutions for up to 7 days when protected from light.
Compatibility
Stable in D5LR, D51/4NS, D51/2NS, D5NS, D5W, D10W, D10NS, LR, sodium bicarbonate 5%, NS; variable stability (consult detailed reference) in TPN.
Y-site administration: Compatible: Acyclovir, amifostine, aminophylline, atracurium, aztreonam, cisatracurium, cisplatin, cladribine, clarithromycin, cyclophosphamide, cytarabine, diltiazem, docetaxel, doxorubicin, doxorubicin liposome, enalaprilat, esmolol, etoposide, filgrastim, fluconazole, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, haloperidol, heparin, hetastarch, idarubicin, inamrinone, labetalol, levofloxacin, linezolid, melphalan, meropenem, methotrexate, midazolam, milrinone, ondansetron, paclitaxel, pancuronium, piperacillin/tazobactam, propofol, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa, tolazoline, topotecan, vecuronium, vinorelbine, zidovudine. Incompatible: Allopurinol, amphotericin B cholesteryl sulfate complex, amsacrine, cefepime, indomethacin, warfarin. Variable (consult detailed reference): TPN.
Compatibility in syringe: Compatible: Atropine, butorphanol, diatrizoate meglumine and diatrizoate sodium, diatrizoate sodium, diazepam, diphenhydramine, doxapram, droperidol, fentanyl, glycopyrrolate, heparin, hydromorphone, hydroxyzine, iohexol, iopamidol, iothalamate meglumine, lorazepam, meperidine, midazolam, morphine, nafcillin, nalbuphine, penicillin G sodium, pentazocine, perphenazine, prochlorperazine edisylate, promazine, promethazine, scopolamine, sodium acetate, sodium chloride, sodium lactate. Incompatible: Atropine with pentobarbital, cefamandole, cefazolin, chlorpromazine, ioxaglate meglumine and ioxaglate sodium, pentobarbital, secobarbital.
Compatibility when admixed: Compatible: Acetazolamide, amikacin, aminophylline, ampicillin, atracurium, cefoperazone, cefoxitin, ceftazidime, chlorothiazide, clindamycin, colistimethate, cryptenamine, dexamethasone sodium phosphate, digoxin, epinephrine, erythromycin lactobionate, ethacrynate sodium, floxacillin, flumazenil, furosemide, gentamicin, insulin (regular), isoproterenol, lidocaine, lincomycin, meropenem, metaraminol, methylprednisolone sodium succinate, metoclopramide, norepinephrine, penicillin G potassium, phytonadione, polymyxin B sulfate, potassium chloride, protamine, quinidine gluconate, sodium nitroprusside, tacrolimus, vancomycin, verapamil, vitamin B complex, vitamin B complex with C. Incompatible: Amphotericin B, barbiturates. Variable (consult detailed reference): Cefamandole, cefazolin.
Mechanism of Action
Competitive inhibition of histamine at H2 receptors of the gastric parietal cells resulting in reduced gastric acid secretion, gastric volume and hydrogen ion concentration reduced
Pharmacodynamics/Kinetics
Onset of action: 1 hour
Duration: 4-8 hours
Absorption: Rapid
Distribution: Crosses placenta; enters breast milk
Protein binding: 20%
Metabolism: Partially hepatic, forms metabolites
Bioavailability: 60% to 70%
Half-life elimination: Neonates: 3.6 hours; Children: 1.4 hours; Adults: Normal renal function: 2 hours
Time to peak, serum: Oral: 1-2 hours
Excretion: Primarily urine (48% as unchanged drug); feces (some)
Dosage
Children: Oral, I.M., I.V.: 20-40 mg/kg/day in divided doses every 6 hours
Children ?12 years and Adults: Oral: Heartburn, acid indigestion, sour stomach (OTC labeling): 200 mg up to twice daily; may take 30 minutes prior to eating foods or beverages expected to cause heartburn or indigestion
Adults:
Short-term treatment of active ulcers:
Oral: 300 mg 4 times/day or 800 mg at bedtime or 400 mg twice daily for up to 8 weeks
Note: Higher doses of 1600 mg at bedtime for 4 weeks may be beneficial for a subpopulation of patients with larger duodenal ulcers (>1 cm defined endoscopically) who are also heavy smokers (?1 pack/day).
I.M., I.V.: 300 mg every 6 hours or 37.5 mg/hour by continuous infusion; I.V. dosage should be adjusted to maintain an intragastric pH ?5
Prevention of upper GI bleed in critically-ill patients: 50 mg/hour by continuous infusion; I.V. dosage should be adjusted to maintain an intragastric pH ?5
Note: Reduce dose by 50% if Clcr <30 mL/minute; treatment >7 days has not been evaluated.
Duodenal ulcer prophylaxis: Oral: 400 mg at bedtime
Gastric hypersecretory conditions: Oral, I.M., I.V.: 300-600 mg every 6 hours; dosage not to exceed 2.4 g/day
Gastroesophageal reflux disease: Oral: 400 mg 4 times/day or 800 mg twice daily for 12 weeks
Helicobacter pylori eradication (unlabeled use): 400 mg twice daily; requires combination therapy with antibiotics
Dosing adjustment/interval in renal impairment: Children and Adults:
Clcr 10-50 mL/minute: Administer 50% of normal dose
Clcr <10 mL/minute: Administer 25% of normal dose
Hemodialysis: Slightly dialyzable (5% to 20%); administer after dialysis
Dosing adjustment/comments in hepatic impairment: Usual dose is safe in mild liver disease but use with caution and in reduced dosage in severe liver disease; increased risk of CNS toxicity in cirrhosis suggested by enhanced penetration of CNS
Administration: Oral
Give with meals so that the drug's peak effect occurs at the proper time (peak inhibition of gastric acid secretion occurs at 1 and 3 hours after dosing in fasting subjects and approximately 2 hours in nonfasting subjects. This correlates well with the time food is no longer in the stomach offering a buffering effect). Stagger doses of antacids with cimetidine.
Administration: I.V.
May be administered as a slow I.V. push or preferably as an I.V. intermittent or I.V. continuous infusion. Administer each 300 mg (or fraction thereof) over a minimum of 5 minutes when giving I.V. push. Rapid intravenous administration has been associated with rare cases of arrhythmia and/or hypotension. Give intermittent infusion over 15-30 minutes for each 300 mg dose. Intermittent infusions are administered over 15-30 minutes at a final concentration not to exceed 6 mg/mL; for patients with an active bleed, preferred method of administration is continuous infusion.
Administration: I.V. Detail
Rapid infusion may cause cardiac arrhythmias and hypotension.
pH: 3.8-6.0 (injection); 5-7 (premixed infusion)
Monitoring Parameters
CBC, gastric pH, occult blood with GI bleeding; monitor renal function to correct dose.
Patient Education
Do not take any new medication during therapy unless approved by prescriber. Take with meals. Do not increase dose or frequency without consulting prescriber. To be effective, continue to take for the prescribed time (possibly several weeks) even though symptoms may have improved. Smoking decreases the effectiveness of cimetidine (stop smoking if possible). Avoid excess alcohol and caffeine. May cause headache, dizziness, agitation (use caution when driving or engaging in any potentially hazardous tasks until response to drug is known); nausea or vomiting (small, frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); or diarrhea. Report chest pain or palpitations; CNS changes (confusion, agitation); persistent diarrhea, nausea, vomiting, or heartburn; black tarry stools or coffee ground-like emesis; rash; unusual bleeding or bruising; sore throat; or fever; unexplained weight lose or other adverse effects.
Geriatric Considerations
Patients diagnosed with PUD should be evaluated for Helicobacter pylori. H2 blockers are the preferred drugs for treating PUD in elderly due to cost and ease of administration. These agents are no less or more effective than any other therapy. The preferred agents, due to favorable pharmacokinetic, side effect and drug interaction profiles are ranitidine, famotidine, and nizatidine. Due to the potential for confusion and drug interactions, cimetidine has been identified by a panel of experts as a drug to avoid in the elderly. Consider evaluating creatinine clearance before initiating H2-blocker therapy.
Anesthesia and Critical Care Concerns/Other Considerations
The 2008 Surviving Sepsis Campaign guidelines recommend that stress ulcer prophylaxis using an H2 blocker (Grade 1A) or proton pump inhibitor (Grade 1B) be given to patients with severe sepsis to prevent upper GI bleed. Benefit of prevention of upper GI bleed must be weighed against potential effect of increased stomach pH on development of ventilator-associated pneumonia.
Cardiovascular Considerations
Cimetidine has extensive drug interactions, particularly with antiarrhythmics (lidocaine, phenytoin, procainamide, quinidine) and may also increase the likelihood of theophylline and cyclosporine toxicity. Because of inhibition of warfarin metabolism, cimetidine may increase INR in patients on anticoagulation therapy.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause agitation or drowsiness; rare reports of confusion
Mental Health: Effects on Psychiatric Treatment
Rare reports of agranulocytosis; use caution with clozapine and carbamazepine; may inhibit the metabolism of TCAs and benzodiazepines; monitor for adverse effects
Nursing: Physical Assessment/Monitoring
Use caution in presence of renal or hepatic impairment. Assess other pharmacological or herbal products patient may be taking for potential interactions. I.V.: Note administration specifics. Assess results of laboratory tests, therapeutic effectiveness (according to purpose for use), and adverse effects (eg, changes in CNS, agitation; gastric bleeding) regularly during therapy. Teach patient proper use, possible side effects/appropriate interventions, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Note: Strength is expressed as base
Infusion, as hydrochloride [premixed in NS]: 300 mg (50 mL)
Injection, solution, as hydrochloride: 150 mg/mL (2 mL, 8 mL)
Solution, oral, as hydrochloride: 300 mg/5 mL (240 mL, 480 mL)
Tablet: 200 mg [OTC], 300 mg, 400 mg, 800 mg
Tagamet® HB 200: 200 mg
Pricing: U.S. (www.drugstore.com)
Solution (Cimetidine HCl)
300 mg/5 mL (237): $35.55
Tablets (Cimetidine)
200 mg (30): $18.88
300 mg (180): $29.00
400 mg (90): $25.49
800 mg (30): $17.99
References
Burkhart KK, Janco N, Kulig KW, et al, “Cimetidine as Adjunctive Treatment for Acetaminophen Overdose,” Hum Exp Toxicol, 1995, 14(3):299-304.
Dellinger RP, Levy MM, Carlet JM, et al, “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008,” Intensive Care Med, 2008, 34(1):17-60. Available at http://www.survivingsepsis.org/system/files/images/2008_20International_20SSC_20Guidelines_1_.pdf
Fennerty MD and Higbee M, “Drug Therapy of Gastrointestinal Disease,” Geriatric Pharmacology, Bressler R and Katz MD, eds, New York, NY: McGraw-Hill, 1993, 585-608.
Fick DM, Cooper JW, Wade WE, et al “Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults,” Intern Med, 2003, 163(22):2716-24.
Garcia Rodriguez LA and Jick H, “Risk of Gynaecomastia Associated With Cimetidine, Omeprazole, and Other Antiulcer Drugs,” BMJ, 1994, 308(6927):503-6.
Inoue A, Teramae H, Hisa T, et al, “Fixed Drug Eruption Due to Cimetidine,” Acta Derm Venereol, 1995, 75(3):250.
Koren G and Zemlickis DM, “Outcome of Pregnancy After First Trimester Exposure to H2-Receptor Antagonists,” Am J Perinatol, 1991, 8(1):37-8.
Krenzelok EP, Litovitz T, Lippold KP, et al, “Cimetidine Toxicity: An Assessment of 881 Cases,” Ann Emerg Med, 1987, 16(11):1217-21.
Lambert J, Mobassaleh M, and Grand RJ, “Efficacy of Cimetidine for Gastric Acid Suppression in Pediatric Patients,” J Pediatr, 1992, 120(3):474-8.
Lloyd CW, Martin WJ, and Taylor BD, “The Pharmacokinetics of Cimetidine and Metabolites in a Neonate,” Drug Intell Clin Pharm, 1985, 19(3):203-5.
Lloyd CW, Martin WJ, Taylor BD, et al, “Pharmacokinetics and Pharmacodynamics of Cimetidine and Metabolites in Critically Ill Children,” J Pediatr, 1985, 107(2):295-300.
Penston J and Wormsley G, “Adverse Reactions and Interactions With H2-Receptor Antagonists,” Med Toxicol Adverse Drug Exp, 1986, 1(3):192-216.
Sawyer D, Conner CS, and Scalley, “Cimetidine: Adverse Reactions and Acute Toxicity,” Am J Hosp Pharm, 1981, 38(2):188-97.
Somogyi A and Gugler R, “Clinical Pharmacokinetics of Cimetidine,” Clin Pharmacokinet, 1983, 8(6):463-95.
Somogyi A and Muirhead M, “Pharmacokinetic Interactions of Cimetidine 1987,” Clin Pharmacokinet, 1987, 12(5):321-66.
International Brand Names
Lexi-Comp.com
Last full review/revision November 2009
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