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Generic Name: Cimetidine
Class: Histamine H2-Antagonists
VA Class: GA301
CAS Number: 51481-61-9

Introduction

Histamine H2 receptor antagonist.b

Uses for Tagamet

Duodenal Ulcer

Short-term treatment of active duodenal ulcer (endoscopically or radiographically confirmed).a b

Maintainence of healing and reduction in recurrence of duodenal ulcer.a b

Pathologic GI Hypersecretory Conditions

Long-term treatment of Zollinger-Ellison syndrome, multiple endocrine adenomas, systemic mastocytosis.a b

Gastric Ulcer

Short-term treatment of active benign gastric ulcer.a b

Gastroesophageal Reflux (GERD)

Short-term treatment of erosive esophagitis (endoscopically diagnosed) in patients with GERD.118

Treatment of symptomatic GERD.105 106 123 288

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Always get your pet's drug and dose recommendation from the veterinarian.

Self-medication as initial therapy to achieve acid suppression, control symptoms, and prevent complications of less severe symptomatic GERD.288

Upper GI Bleeding

Prevention of upper GI bleeding resulting from stress-related mucosal damage (erosive esophagitis, stress ulcers) in critically ill patients.118 142 143 144 145 146 147 152 153 154 155 156 157 161 162 163 164 165 166 170 171 172 173 174 175 176 177 179 188 191

Treatment of upper GI bleeding secondary to hepatic failure, esophagitis, duodenal or gastric ulcers when hemorrhage is not caused by major blood vessel erosion.b

Heartburn (pyrosis), Acid Indigestion (hyperchlorhydria), or Sour Stomach

Short-term self-medication for relief of heartburn symptoms in adults and adolescents≥12 years of age.c

Short-term self-medication for prevention of heartburn symptoms associated with acid indigestion (hyperchlorhydria) and sour stomach brought on by ingestion of certain foods and beverages in adults and children ≥12 years of age.c

Allergic Conditions and Urticarias124 125 126 127 128 129 130 131 132 133 134 135 136 137

Tagamet Dosage and Administration

Administration

Administer orally, IV, or IM.118

Administer by IM or slow IV injection, or by intermittent or continuous IV infusion in hospitalized patients with pathological GI hypersecretory conditions or intractable duodenal ulcer, or when oral therapy is not feasible.118

Oral Administration

Administer with or without food; administration with food may delay and slightly decrease absorption, but achieves maximum antisecretory effect when stomach is no longer protected by food buffering effect. Administer oral tablets with water.b

Antacids may be given as necessary for pain relief, but not at the same time.a b

For duodenal ulcer treatment, administration once daily at bedtime is the regimen of choice because of a high healing rate, maximal pain relief, decreased drug interaction potential, and maximal compliance.117 118 119

For gastric ulcer treatment, administration once daily at bedtime is the regimen of choice because of convenience and decreased drug interaction potential.118

For gastroesophageal reflux, once-daily dosing is not considered appropriate.288

IM Administration

May be administered undiluted.a b

Intermittent Direct IV Injection

Dilution

Dilute 300 mg to 20 mL with 0.9% sodium chloride injection or other compatible IV solution before direct IV injection (see Compatibility under Stability).118

Rate of Administration

Inject over ≥5 minutes.118

Intermittent IV infusion

Reconstitution

Reconstitute ADD-Vantage vials according to manufacturer’s directions.118

Dilution

Dilute 300 mg in at least 50 mL of 0.9% sodium chloride injection or 5% dextrose injection or other compatible IV solution (see Compatibility under Stability).118

No additional dilution required for commercially available infusion solution (300 mg cimetidine in 50 mL of 0.9% sodium chloride injection).a

Rate of Administration

Over 15–20 minutes.118

Continuous IV Infusion

Dilution

Dilute 900 mg in 100–1000 mL of a compatible IV solution (see Compatibility under Stability).a b

Rate of Administration

Over 24 hours.a b

Adjust rate to individual patient requirements.a b

Volume <250 mL: use controlled-infusion device (e.g., pump).a b

Dosage

Dosage of cimetidine hydrochloride expressed in terms of cimetidine.118

Pediatric Patients

20–40 mg/kg daily in divided doses has been used in a limited number of children when potential benefits are thought to outweigh the possible risks.118

Heartburn, Acid Indigestion, or Sour Stomach
Heartburn Relief (Self-medication)
Oral

Adolescents ≥12 years of age: 200 mg once or twice daily, or as directed by a clinician.268

Prevention of Heartburn (Self-medication)
Oral

Adolescents ≥12 years of age: 200 mg once or twice daily or as directed by a clinician; administer immediately (or up to 30 minutes) before ingestion of causative food or beverage.c

Adults

General Parenteral Dosage

Parenteral dosage regimens for GERD have not been established.a

General parenteral dosage (in hospitalized patients with pathologic hypersecretory conditions or intractable ulcer, or for short-term use when oral therapy is not feasible):a

IM

300 mg every 6–8 hours.118

Intermittent Direct IV Injection

300 mg every 6–8 hours.118

300 mg more frequently if increased daily dosage is necessary (i.e., single doses not >300 mg), up to 2400 mg daily.118

Intermittent IV Infusion

300 mg every 6–8 hours.118

300 mg more frequently if increased daily dosage is necessary (i.e., single doses not >300 mg), up to 2400 mg daily.118

Continuous IV infusion

900 mg over 24 hours (37.5 mg/hour).a b See Pathologic GI Hypersecretory Conditions under Dosage: Adults.

For more rapid increase in gastric pH, a loading dose of 150 mg may be given as an intermittent infusion before continuous infusion.a b

Duodenal Ulcer
Treatment of Active Duodenal Ulcer
Oral

Dosage of choice: 800 mg once daily at bedtime.117 118 119

Patients with ulcer >1 cm in diameter who are heavy smokers (i.e., ≥1 pack daily) when rapid healing (e.g., within 4 weeks) is considered important:118 1.6 g daily at bedtime.117 118 119

Administer for 4–6 weeks unless healing is confirmed earlier.117 118 If not healed or symptoms continue after 4 weeks, additional 2–4 weeks of full dosage therapy may be beneficial.118 More than 6–8 weeks at full dosage is rarely needed.118

Healing of active duodenal ulcers may occur in 2 weeks in some, and occurs within 4 weeks in most patients.117 118 119 120 121 122

Other regimens (no apparent rationale for these other than familiarity of use) that have been used:117 118 300 mg 4 times daily with meals and at bedtime; 200 mg 3 times daily and 400 mg at bedtime; 400 mg twice daily in the morning and at bedtime.b

Maintenance of Healing of Duodenal Ulcer
Oral

400 mg daily at bedtime.118 Efficacy not increased by higher dosages or more frequent administration.b

Pathologic GI Hypersecretory Conditions
Zollinger-Ellison Syndrome
Oral

300 mg 4 times daily with meals and at bedtime.118

Higher doses administered more frequently may be necessary;a b adjust dosage according to response and tolerance but in general, do not exceed 2400 mg daily.a

Continue as long as necessary.118

Continuous IV Infusion

Mean infused dose of 160 mg/hour (range: 40-600 mg/hour) in one study.a

Gastric Ulcer
Oral

Preferred regimen: 800 mg once daily at bedtime.118

Alternative regimen: 300 mg 4 times daily, with meals and at bedtime.118

Monitor to ensure rapid progress to complete healing.a b

Studies limited to 6 weeks, efficacy for >8 weeks not established.118

GERD

Once daily (at bedtime) not considered appropriate therapy.288

Treatment of Symptomatic GERD
Oral

300 mg 4 times daily has been used.105 106 123

Treatment of Erosive Esophagitis
Oral

800 mg twice daily or 400 mg 4 times daily (e.g., before meals and at bedtime) for up to 12 weeks.118

Upper GI Bleeding
Prevention of Upper GI Bleeding
Continuous IV Infusion

50 mg/hour; loading dose not required.118

Safety and efficacy of therapy beyond 7 days has not been established.118

Alternative dosage: Some clinicians recommend 300-mg IV loading dose over 5–20 minutes, then continuous IV infusion at 37.5–50 mg/hour; titrate with 25-mg/hour increments up to 100 mg/hour based on gastric pH (e.g., to maintain a pH of at least 3.5–4).118 143 144 173 174 176 188

Intermittent IV doses may be less effective in preventing upper GI bleeding than continuous IV infusion.155 172 173 174 175 176 177 178 188 189 191

Treatment of Upper GI Bleeding
Oral

1–2 g daily in 4 divided doses has been used.b

IV

1–2 g daily in 4 divided doses has been used.b

Heartburn, Acid Indigestion, or Sour Stomach
Heartburn (Self-medication)
Oral

200 mg once or twice daily, or as directed by clinician.268

Maximum 400 mg in 24 hours, but not continuously for >2 weeks except under clinician supervision.c

Prevention of Heartburn (Self-medication)
Oral

200 mg once or twice daily or as directed by a clinician; administer immediately (or up to 30 minutes) before ingestion of causative food or beverage.c

Maximum 400 mg in 24 hours, but not continuously for >2 weeks except under clinician supervision.c

Prescribing Limits

Pediatric Patients

Heartburn, Acid Indigestion, or Sour Stomach
Heartburn (Self-Medication)
Oral

Adolescents ≥12 years of age: Maximum 400 mg in 24 hours, but not continuously for >2 weeks except under clinician supervision.c

Prevention of Heartburn (Self-medication)
Oral

Adolescents ≥12 years of age: Maximum 400 mg in 24 hours, but not continuously for >2 weeks except under clinician supervision.c

Adults

General Parenteral Dosage

General parenteral dosage (hospitalized patients with pathologic hypersecretory conditions or intractable duodenal ulcer, or short-term use when oral therapy is not feasible):

Direct IV injection

Maximum 2.4 g daily.a

Maximum 300 mg per dose.a

Maximum concentration 300 mg/20 mL.a

Maximum injection rate: 20 mL over not less than 5 minutes (4 mL per minute).a

Intermittent IV Infusion

Maximum 2.4 g daily.a

Maximum 300 mg per dose.a

Maximum concentration 300 mg/50 mL.a

Maximum infusion rate: 15–20 minutes.a

GERD
Short-term Treatment of Erosive Esophagitis
Oral

Safety and efficacy beyond 12 weeks of administration have not been established.a

Heartburn, Acid Indigestion, or Sour Stomach
Heartburn Relief (Self-medication)
Oral

Maximum 400 mg in 24 hours, but not continuously for >2 weeks except under clinician supervision.c

Prevention of Heartburn (Self-medication)
Oral

Maximum 400 mg in 24 hours, but not continuously for >2 weeks except under clinician supervision.c

Duodenal Ulcer
Intermittent Direct IV Injecton

Maximum 2.4 g daily.a

Intermittent IV Infusion

Maximum 2.4 g daily.a

Gastric Ulcer
Short-term treatment of Active Benign Gastric Ulcer
Oral

Safety and efficacy beyond 8 weeks have not been established.118

Intermittent Direct IV Injection

Maximum 2.4 g daily.a

Intermittent IV Infusion

Maximum 2.4 g daily.a

Pathologic GI Hypersecretory Conditions (e.g., Zollinger-Ellison Syndrome)
Oral

Maximum usually 2.4 g daily.118

Intermittent Direct IV Injection

Maximum 2.4 g daily.a

Intermittent IV Infusion

Maximum 2.4 g daily.a

Upper GI Bleeding
Prevention of Upper GI Bleeding
Continuous IV Infusion

Safety and efficacy beyond 7 days have not been established.a

Special Populations

Renal Impairment

Severe (Clcr< 30 mL/minute)
Oral

300 mg every 12 hours.118

Accumulation may occur; use lowest frequency of dosing compatible with adequate response.118

Increase frequency to every 8 hours or more frequently (with caution) if required.118

Presence of hepatic impairment may require further dosage reduction.118

Direct IV Injection

300 mg every 12 hours.118

Accumulation may occur; use lowest frequency compatible with adequate response.118

Increase frequency to every 8 hours or more frequently (with caution) if required118

Presence of hepatic impairment may require further dosage reduction.118

Continuous IV Infusion

Prevention of Upper GI Bleeding: One-half recommended dosage (i.e., 25 mg/hour).118

Hemodialysis

Decreases blood levels; administer at the end of hemodialysis and every 12 hours during interdialysis.b

Hepatic Impairment

May require further dosage reduction in the presence of severe renal impairment.118

Cautions for Tagamet

Contraindications

  • Known hypersensitivity to cimetidine or any ingredient in the formulation.118

Warnings/Precautions

General Precautions

Cardiovascular Effects

Rapid IV administration associated rarely with hypotension, cardiac arrhythmias; avoid.a b

Gastric Malignancy

Response to cimetidine does not preclude presence of gastric malignancy.118

CNS Effects

Reversible confusional states reported, especially in geriatric (i.e., ≥50 years) and severely ill (e.g., hepatic or renal disease, organic brain syndrome) patients.118 b Usually occurs within 2–3 days after initiating cimetidine and resolves within 3–4 days after discontinuance.118 b

Respiratory Effects

Administration of H2-receptor antagonists has been associated with an increased risk for developing certain infections (e.g., community-acquired pneumonia).302 303

Specific Populations

Pregnancy

Category B.a

Pregnant women should consult a clinician before using for self-medication.268

Lactation

Distributed into milk.118 Generally, do not nurse during therapy with cimetidine.118

Nursing women should consult a clinician before using for self-medication.268

Pediatric Use

Safety and efficacy not established in children <16 years of age; do not use unless potential benefits outweigh risks.118

Safety and efficacy for self-medication not established in children <12 years of age; do not use unless directed by a clinician.c

Renal Impairment

Dosage adjustments necessary in patients with severe renal impairment.118 (See Renal Impairment under Dosage and Administration.)

Hepatic Impairment

Further dosage adjustments may be necessary in presence of severe renal impairment.118 (See Hepatic Impairment under Dosage and Administration.)

Immunocompromised Patients

Increased possibility of Strongyloides stercoralis hyperinfection with decreased gastric acidity.118 269 270

Common Adverse Effects

Headache,118 144 dizziness, somnolence, diarrhea.118

With ≥1 month of therapy: gynecomastia.118 b

With IM therapy: transient pain at injection site.118

Interactions for Tagamet

Inhibits hepatic microsomal enzyme systems, decreases hepatic metabolism of some drugs.118 If necessary, adjust dosage of hepatically metabolized drugs when cimetidine therapy is initiated or discontinued.b

Specific Drugs

Drug

Interaction

Comments

Alcohol

Possible increased blood alcohol concentrations,256 257 258 259 260 261 263 264 265 psychomotor impairment256 257 258 259 260 261 267

Potential for psychomotor impairment controversial, 256 257 258 259 260 261 267 but use caution during performance of hazardous tasks requiring mental alertness, physical coordination257 258 261

Antacidsb

Decreased cimetidine absorptionb

Administer 1 hour before or after cimetidine in the fasting state, or 1 hour after cimetidine is taken with food.a b

Benzodiazepines118

Potential for delayed elimination, increased blood concentrations of certain benzodiazepines (e.g., diazepam, chlordiazepoxide, triazolam)118

Adjust dosage if needed b

Calcium-channel blockers (e.g., nifedipine)a

Potential for delayed elimination, increased blood concentrations of nifedipine118

Adjust dosage if needed b

Ketoconazole118

Absorption of ketoconazole may be affected by altered gastric pH118

Administer ≥2 hours before cimetidine118

Lidocaine118

Potential for delayed elimination, increased blood concentrations of lidocaine118

Adverse effects reported, adjust dosage if needed b

Metronidazole118

Potential for delayed elimination, increased blood concentrations of metronidazole118

Adjust dosage if neededb

Myelosuppressive drugs (e.g., alkylating agents [e.g., carmustine], antimetabolites) and/or therapies (radiation)b

May potentiate myelosuppressionb

 

Phenytoin118

Potential for delayed elimination, increased blood concentrations of phenytoin118

Adverse effects reported, adjust dosage if needed b

Propranolol118

Potential for delayed elimination, increased blood concentrations of propranolol118

Adjust dosage if needed b

Theophylline118

Potential for delayed elimination, increased blood concentrations of theophylline118

Adverse effects reported, adjust dosage if needed b

Triamterene108

Potential for delayed elimination, increased blood concentrations of triamterene118

Consider potential of clinically important interaction108

Tricyclic Antidepressants118

Potential for delayed elimination, increased blood concentrations of certain tricyclic antidepressants118

Adjust dosage if neededb

Warfarin118

Potential for delayed elimination, increased blood concentrations of warfarin118

Monitor PT, adjust dosage if neededb

Tagamet Pharmacokinetics

Absorption

Bioavailability

Oral: 60–70%.b

Onset

≥70% decrease in basal acid secretion within 45 minutes after single 300- or 400-mg IV dose in healthy males.100

Duration

Dosage Regimen

Effect On Acid Secretion

Comments

Oral: 800 mg at bedtime in duodenal ulcer patients118

Mean hourly nocturnal secretion decreased by 85% over 8 hours.118

No effect on daytime acid secretion118

Oral: 1600 mg at bedtime in duodenal ulcer patients 118

Mean hourly nocturnal secretion decreased by 100% over 8 hours, 35% decrease for additional 5 hours.118

Moderate (<60%) 24-hour suppression118

Oral: 400 mg twice daily in duodenal ulcer pateints118

Nocturnal secretion decreased by 47–83% over 6–8 hours 118

Moderate (<60%) 24-hour suppression118

Oral: 300 mg 4 times daily in duodenal ulcer patients118

Nocturnal secretion decreased by 54% over 9 hours118

Moderate (<60%) 24-hour suppression118

Oral: Single 300-mg dose within 1 hour after meal in duodenal ulcer patientsa

Food-stimulated secretion decreased by 50% for 1 hour, then 75% for 2 hours.a

 

Oral: 300-mg dose at breakfast in duodenal ulcer patientsa

Continued suppression for 4 hours, with partial suppression after luncha

Effect enhanced and maintained by additional 300-mg dose with luncha

Oral: 300-mg dose with foodb

Mean gastric pH 3.5–4 at 1 hour, 5.5–6.1 at 4 hoursb

 

Oral: Single dose 300 mg with fooda

Mean gastric pH: 3.5, 3.1, 3.8, 6.1 at hour 1, 2, 3, 4, respectivelya

Placebo mean gastric pH: 2.6, 1.6, 1.9, 2.2 at hour 1, 2, 3, 4, respectivelya

Oral: 300–400 mg in fasting state in duodenal ulcer patientsb

Anacidity for up to 8 hoursb

 

Oral: 300 mg in duodenal ulcer patientsb

Basal gastric acid output decreased by 90% for 4 hoursb

Meal-stimulated acid secretion by 66% for 3 hoursb

IV continuous infusion: mean dosage of 160 mg/hour (range:40-600 mg/hour) in pathologic hypersecretory conditionsb

Maintained secretion at ≤10 mEq/hourb

 

IV continuous infusion (37.5 mg/hour or 900 mg daily) in patients with active or healed duodenal or gastric ulcerb

Maintained gastric pH at >4 for >50% of the time at steady-state.b

 

Intermittent injection: (300 mg every 6 hours or 1200 mg daily) in patients with active or healed duodenal or gastric ulcerb

Maintained gastric pH at >4 for >50% of the time at steady-state.b

 

IV: Single 300- or 400-mg dose in healthy males

≥70% decrease in basal acid secretion maintained for 4–4.5 hours100

 

Food

Delays, slightly decreases absorption.b However, administration with meals achieves maximum blood concentrations and antisecretory effect when stomach is no longer protected by food buffering effect.b

Distribution

Extent

Widely distributed throughout the body.b

Distributed into human milk.b

Crosses the placenta in animals.b

Plasma Protein Binding

15–20%.b

Elimination

Metabolism

Metabolized to sulfoxide (major metabolite) and 5-hydroxymethyl derivatives in liver.a b More extensively metabolized after oral than parenteral administration.a

Elimination Route

Excreted principally in urine.a b Single oral dose: 48% (unchanged) excreted in urine over 24 hours.a IV or IM: about 75% (unchanged) excreted in urine within 24 hours.a Single IV dose of radiolabeled cimetidine: 80–90% (50–73% unchanged, remainder as metabolites) excreted in urine over 24 hours.b About 10% excreted in feces.b

Half-life

2 hours.a

After IV administration in children 4.1–15 years of age: Apparent biphasic decline of plasma cimetidine and cimetidine sulfoxide concentrations with half-lives of 1.4 and 2.6 hours, respectively.102

Special Populations

2.9 hours in patients with Clcr 20–50 mL/minute.b 3.7 hours in patients with Clcr <20 mL/minute.b 5 hours in anephric patients.b

Stability

Storage

Oral

Liquid and Tablets

Tight, light-resistant containers at 15–30°C.b

Parenteral

Injection

15–30°C.b Protect from light.b Do not refrigerate.b Stable in most IV solutions for at least 3 days at room temperature in concentrations of 1.2–5 mg/mL,b but use within 48 hours when diluted as directed.118 b

Injection for IV infusion only

15–30°C.b Protect from excessive heat; brief exposure up to 40°C does not adversely affect stability.b Stable through the labeled expiration date when stored as recommended.118

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Amino acids 3.5, 5.5, or 8.5% with electrolytes

Amino acids 5.5 or 8.5%

Dextrose 5% with Ascor-B-Sol

Dextrose 5% and Electrolyte #48

Dextrose 5% and Electrolyte #75

Dextrose 5% in Ringer’s injection, lactated

Dextrose 5% in sodium chloride 0.2, 0.45, or 0.9%

Dextrose 10% in sodium chloride 0.9%

Dextrose 5% in water

Dextrose 10% in water

Dextrose 5% in water with vitamins

Fructose 5% and Electrolyte #48

Fructose 5% and Electrolyte #75

Invert sugar 5% in water

Invert sugar 10% in water

Ionosol B in dextrose 5% in water

Ionosol MB in dextrose 5% in water

Ionosol T in dextrose 5% in water

Mannitol 10% in water

Normosol M, 900 cal

Normosol M in dextrose 5% in water

Normosol M and Surbex T in dextrose 5% in water

Normosol R

Normosol R, pH 7.4

Normosol R in dextrose 5% in water

Plasma-Lyte 56 in dextrose 5% in water

Plasma-Lyte M in dextrose 5% in water

Ringer’s injection

Ringer’s injection, lactated

Sodium bicarbonate 5%

Sodium chloride 0.9%

Drug Compatibility
Admixture CompatibilityHID

Compatible

Acetazolamide sodium

Amikacin sulfate

Aminophylline

Atracurium besylate

Cefoxitin sodium

Chlorothiazide sodium

Ciprofloxacin

Clindamycin phosphate

Colistimethate sodium

Dexamethasone sodium phosphate

Digoxin

Epinephrine HCl

Erythromycin lactobionate

Ethacrynate sodium

Flumazenil

Furosemide

Gentamicin sulfate

Insulin, regular

Isoproterenol HCl

Lidocaine HCl

Lincomycin HCl

Meropenem

Metaraminol bitartrate

Methylprednisolone sodium succinate

Midazolam HCl

Norepinephrine bitartrate

Penicillin G potassium

Phytonadione

Polymyxin B sulfate

Potassium chloride

Protamine sulfate

Quinidine gluconate

Sodium nitroprusside

Tacrolimus

Vancomycin HCl

Verapamil HCl

Vitamin B complex

Vitamin B complex with C

Incompatible

Amphotericin B

Variable

Ampicillin sodium

Cefazolin sodium

Metoclopramide HCl

Y-Site CompatibilityHID

Compatible

Acyclovir sodium

Amifostine

Aminophylline

Anakinra

Anidulafungin

Atracurium besylate

Aztreonam

Bivalirudin

Cisplatin

Cladribine

Clarithromycin

Cyclophosphamide

Cytarabine

Dexmedetomidine HCl

Diltiazem HCl

Docetaxel

Doxorubicin HCl

Doxorubicin HCl liposome injection

Enalaprilat

Esmolol HCl

Etoposide phosphate

Fenoldopam mesylate

Filgrastim

Fluconazole

Fludarabine phosphate

Foscarnet sodium

Gallium nitrate

Gemcitabine HCl

Granisetron HCl

Haloperidol lactate

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hetastarch in sodium chloride 0.9%

Idarubicin HCl

Inamrinone lactate

Labetalol HCl

Levofloxacin

Linezolid

Melphalan HCl

Meropenem

Methotrexate sodium

Midazolam HCl

Milrinone lactate

Nicardipine HCl

Ondansetron HCl

Oxaliplatin

Paclitaxel

Pancuronium bromide

Pemetrexed disodium

Piperacillin sodium–tazobactam sodium

Propofol

Remifentanil HCl

Sargramostim

Tacrolimus

Teniposide

Theophylline

Thiotepa

Topotecan HCl

Vecuronium bromide

Vinorelbine tartrate

Zidovudine

Incompatible

Allopurinol sodium

Amphotericin B cholesteryl sulfate complex

Amsacrine

Cefepime HCl

Indomethacin sodium trihydrate

Lansoprazole

Warfarin sodium

Actions

  • Inhibits basal and stimulated gastric acid secretion.b

  • Competitively inhibits histamine at parietal cell H2 receptors.b

  • Weak antiandrogenic effect.b

Advice to Patients

  • Importance of patients informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs.289

  • Importance of taking antacids on an empty stomach 1 hour before or 1 hour after oral administration of cimetidine, or 1 hour after the drug is taken with food,b but not at same time as oral cimetidine.a b

  • Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.289

  • Before self-medication, importance of consulting clinician if taking warfarin, theophylline, or phenytoin.268

  • Importance of following dosage instructions when cimetidine is administered for self-medication, unless otherwise directed by a clinician.c

  • Importance of promptly informing clinician of persistent abdominal pain or difficulty swallowing.268

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Cimetidine

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Solution

300 mg/mL*

Cimetidine Hydrochloride Oral Solution

Actavis, Duramed, Endo, Hi-Tech, Morton Grove, Pharmaceutical Associates, Teva

Tagamet (with parabens, povidone, and propylene glycol)

GlaxoSmithKline

Tablets, film-coated

200 mg*

Tagamet HB 200

GlaxoSmithKline

Tagamet HB (with povidone)

GlaxoSmithKline

300 mg*

Tagamet (with povidone and propylene glycol)

GlaxoSmithKline

400 mg*

Tagamet Tiltab (with povidone and propylene glycol)

GlaxoSmithKline

800 mg*

Tagamet Tiltab (with povidone and propylene glycol; scored)

GlaxoSmithKline

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Cimetidine Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Solution

300 mg (of cimetidine) per 5 mL*

Tagamet HCl (with alcohol 2.8% parabens and propylene glycol)

GlaxoSmithKline

Parenteral

Injection

150 mg (of cimetidine) per mL

Cimetidine Hydrochloride Injection

Endo, Hospira, Sicor

Injection, for IV infusion only

150 mg (of cimetidine) per mL

Cimetidine Hydrochloride ADD-Vantage

Hospira

Cimetidine Hydrochloride in Sodium Chloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion only

6 mg (of cimetidine) per mL (300, 900, or 1200 mg) in 0.9% Sodium Chloride

Cimetidine HCl in 0.9% Sodium Chloride Injection (available in flexible plastic container)

Hospira

6 mg (of cimetidine) per mL (300 mg) in 0.9% Sodium Chloride

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Cimetidine 200MG Tablets (MYLAN): 30/$18.99 or 90/$29.97

Cimetidine 300MG Tablets (TEVA PHARMACEUTICALS USA): 180/$29.99 or 360/$59.98

Cimetidine 400MG Tablets (TEVA PHARMACEUTICALS USA): 90/$31.99 or 180/$47.97

Cimetidine HCl 300MG/5ML Solution (MORTON GROVE PHARMACEUTICALS): 237/$35.99 or 711/$105.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions December 1, 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Frank WO, Peace KE, Watson M et al. The effect of single intravenous doses of cimetidine or ranitidine on gastric secretion. Clin Pharmacol Ther. 1986; 40:665-72. [IDIS 224634] [PubMed 3780128]

101. Peterson WL, Richardson CT. Intravenous cimetidine or two regimens of ranitidine to reduce fasting gastric acidity. Ann Intern Med. 1986; 104:505-7. [IDIS 213856] [PubMed 3954278]

102. Lloyd CW, Martin WJ, Taylor BD et al. Pharmacokinetics and pharmacodynamics of cimetidine and metabolites in critically ill children. J Pediatr. 1985; 107:295-300. [IDIS 202955] [PubMed 4020559]

103. Richter JE. Treatment of severe reflux esophagitis. Ann Intern Med. 1986; 104:588-9. [PubMed 2869728]

104. Glaxo Inc. Zantac tablets prescribing information. Research Triangle Park, NC; 1986 Jun.

105. Lieberman DA, Keeffe EB. Treatment of severe reflux esophagitis with cimetidine and metoclopramide. Ann Intern Med. 1986; 104:21-6. [IDIS 209099] [PubMed 3940501]

106. Castell DO. Medical therapy for reflux esophagitis: 1986 and beyond. Ann Intern Med. 1986; 104:112-4. [PubMed 2866742]

107. Temple JG, Bradby GV, O’Connor FO et al. Cimetidine and metoclopramide in oesophageal reflux disease. BMJ. 1983; 286:1863-4. [IDIS 172185] [PubMed 6407606]

108. Muirhead MR, Somogyi AA, Rolan PE et al. Effect of cimetidine on renal and hepatic drug elimination: studies with triamterene. Clin Pharmacol Ther. 1986; 40:400-7. [IDIS 222124] [PubMed 3757403]

109. Parenti CM, Hoffman JE. Hyperpyrexia associated with intravenous cimetidine therapy: report of a case. Arch Intern Med. 1986; 146:1821-2. [IDIS 220820] [PubMed 3753124]

110. Landolfo K, Low DE, Rogers AG. Cimetidine-induced fever. Can Med Assoc J. 1984; 130:1580. [PubMed 6733633]

111. Potter HP Jr, Byrne EB, Lebovitz S. Fever after cimetidine and ranitidine. J Clin Gastroenterol. 1986; 8(3 Part 1):275-6. [PubMed 3734359]

112. Ramboer C. Drug fever with cimetidine. Lancet. 1978; 1:330-1. [IDIS 78223] [PubMed 75368]

113. McLoughlin JC, Callender ME, Love AHG. Cimetidine fever. Lancet. 1978; 1:499-500.

114. Corbett CL, Holdsworth CD. Fever, abdominal pain and leucopenia. Br Med J. 1978; 1:753-4. [IDIS 79314] [PubMed 630330]

115. Nistico G, Rotiroti D, de Sarro A et al. Mechanism of cimetidine-induced fever. Lancet. 1978; 2:265-6. [PubMed 79060]

116. Randolph WC, Peace KE, Seaman JJ et al. Bioequivalence of a new 800-mg cimetidine tablet with commercially available 400-mg tablets. Curr Ther Res. 1986; 39:767-72.

117. Lewis JH. Summary of the 30th meeting of the Food and Drug Administration Gastrointestinal Drugs Advisory Committee: January 16–17, 1986. Am J Gastroenterol. 1986; 81:495-8. [IDIS 217071] [PubMed 3518411]

118. SmithKline Beecham. Tagamet (cimetidine tablets, cimetidine hydrochloride liquid, and cimetidine hydrochloride injection) prescribing information. Philadelphia, PA; 1994 Jul.

119. Seaman JJ (Smith Kline French Laboratories, Philadelphia, PA): Personal communication; 1985 Oct.

120. Delattre M, Dickson B. Cimetidine once daily. Lancet. 1984; 1:625. [IDIS 183275] [PubMed 6142325]

121. Howden CW, Jones DB, Hunt RH. Nocturnal doses of H2 receptor antagonists for duodenal ulcer. Lancet. 1985; 1:647-8. [IDIS 198508] [PubMed 2857992]

122. Capurso L, Dal Monte PR, Mazzeo F et al. Comparison of cimetidine 800 mg once daily and 400 mg twice daily in acute duodenal ulceration. BMJ. 1984; 289:1418-20. [IDIS 193800] [PubMed 6437579]

123. Behar J, Brand DL, Browr FC et al. Cimetidine in the treatment of symptomatic gastroesophageal reflux: a double blind controlled trial. Gastroenterology. 1978; 74(2 Part 2):441-8. [PubMed 340333]

124. Carpenter GB, Bunker-Soler AL, Nelson HS. Evaluation of combined H1- and H2-receptor blocking agents in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. 1983; 71:412-7. [IDIS 168755] [PubMed 6131914]

125. Smith Laboratories, Inc. Chymodiactin (chymopapain for injection) prescribing information. Northbrook, IL; 1985 Jun.

126. Deutsch PH. Dermatographism treated with hydroxyzine and cimetidine and ranitidine. Ann Intern Med. 1984; 101:569. [IDIS 191756] [PubMed 6089638]

127. Cook J, Shuster S. The effect of H1 and H2 receptor antagonists on the dermographic response. Acta Derm Venereol. 1983; 63:260-2. [PubMed 6192650]

128. Mansfield LE, Smith JA, Nelson HS. Greater inhibition of dermographia with a combination of H1 and H2 antagonists. Ann Allergy. 1983; 50:264-5. [IDIS 169170] [PubMed 6132569]

129. Irwin RB, Lieberman P, Friedman MM et al. Mediator release in local heat urticaria: protection with combined H1 and H2 antagonists. J Allergy Clin Immunol. 1985; 76:35-9. [IDIS 202459] [PubMed 2861221]

130. Farnam J, Grant JA, Lett-Brown MA et al. Combined cold- and heat-induced cholinergic urticaria. J Allergy Clin Immunol. 1986; 78:353-7. [IDIS 220782] [PubMed 3734288]

131. Duc J, Pecoud A. Successful treatment of idiopathic cold urticaria. Ann Allergy. 1986; 56:355-7. [IDIS 214294] [PubMed 2870670]

132. Singh G. H2 blockers in chronic urticaria. Int J Dermatol. 1984; 23:627-8. [PubMed 6151554]

133. Harvey RP, Wegs J, Schocket AL. A controlled trial of therapy in chronic urticaria. J Allergy Clin Immunol. 1981; 68:262-6. [IDIS 164241] [PubMed 6116728]

134. Harvey RP, Schocket AL. The effect of H1 and H2 blockade on cutaneous histamine response in man. J Allergy Clin Immunol. 1980; 65:136-9. [IDIS 113986] [PubMed 6101337]

135. Monroe EW, Cohen SH, Kalbfleisch J et al. Combined H1 and H2 antihistamine therapy in chronic urticaria. Arch Dermatol. 1981; 117:404-7. [IDIS 136345] [PubMed 6114712]

136. Farnam J, Grant JA, Guernsey BG et al. Successful treatment of chronic idiopathic urticaria and angioedema with cimetidine alone. J Allergy Clin Immunol. 1984; 73:842-5. [IDIS 186576] [PubMed 6725793]

137. Kulczycki A Jr. Aspartame-induced urticaria. Ann Intern Med. 1986; 104:207-8. [IDIS 213657] [PubMed 3946947]

138. Travenol Laboratories, Inc. Descriptive information on premixed Mini-Bag container frozen products. Travenol Laboratories, Inc.: Deerfield, IL; 1987 Jun.

139. Lesser IM, Miller BL, Boone K et al. Delusions in a patient treated with histamine H2 receptor antagonists. Psychosomatics. 1987; 28:501-2. [PubMed 3432552]

140. Romisher S, Felter R, Dougherty J. Tagamet-induced acute dystonia. Ann Emerg Med. 1987; 16:1162-4. [PubMed 3662164]

141. Cantú TG, Korek JS. Central nervous system reactions to histamine-2 receptor blockers. Ann Intern Med. 1991; 114:1027-34. [IDIS 281752] [PubMed 1674198]

142. SmithKline Beecham, Philadelphia, PA: Personal communication.

143. Karlstadt RG, Iberti TJ, Silverstein J et al. Comparison of cimetidine and placebo for the prophylaxis of upper gastrointestinal bleeding due to stress-related gastric mucosal damage in the intensive care unit. Intensive Care Med. 1990; 5:26-32.

144. Karlstadt R, D’Ambrosio C, McCafferty J et al. Cimetidine is effective prophylaxis against upper gastrointestinal bleeding in the intensive care unit. Paper presented at the 9th World Congress of Gastroenterology. Sydney, Australia: 1990 Aug 26-31.

145. Basso N, Bagarani M, Materia A et al. Cimetidine and antacid prophylaxis of acute upper gastrointestinal bleeding in high risk patients. Am J Surg. 1981; 141:339-41. [IDIS 168162] [PubMed 7011078]

146. Moscona R, Kaufman T, Jacobs R et al. Prevention of gastrointestinal bleeding in burns: the effects of cimetidine or antacids combined with early enteral feeding. Burns. 1985; 12:65-7.

147. Nagasue N, Yukaya H, Ogawa Y et al. Prophylaxis of upper gastrointestinal bleeding with cimetidine in patients undergoing partial hepatectomy. Ann Chirurg Gyn. 1984; 73:6-10.

148. Groll A, Simon JB, Wigle RD et al. Cimetidine prophylaxis for gastrointestinal bleeding in an intensive care unit. Gut. 1986; 27:135-40. [IDIS 214564] [PubMed 3485068]

149. Priebe HJ, Skillman JJ, Bushnell LS et al. Antacid versus cimetidine in preventing acute gastrointestinal bleeding: a randomized trial in 75 critically ill patients. N Engl J Med. 1980; 302:426-30. [IDIS 110682] [PubMed 6986027]

150. Chan KH, Mann KS. Failure of cimetidine prophylaxis in neurosurgery. Aust NZ J Surg. 1989; 59:133-6.

151. Karlstadt R, Palmer RH. Gastric pH control and pneumonia in the critically ill. Intensive Care Med. 1990; 16:346. [PubMed 2212268]

152. Halloran LG, Zfass AM, Gayle MW et al. Prevention of acute gastrointestinal complications after severe head injury: a controlled trial of cimetidine prophylaxis. Am J Surg. 1980; 139:44-8. [IDIS 109074] [PubMed 6985776]

153. Lacroix J, Infante-Rivard C, Jenicek M et al. Prophylaxis of upper gastrointestinal bleeding in intensive care units: a meta-analysis. Crit Care Med. 1989; 17:862-9. [PubMed 2670450]

154. Lacroix J, Infante-Rivard C, Gauthier M. Prophylaxis of upper gastrointestinal bleeding in intensive care units: a meta-analysis. Crit Care Med. 1991; 18:1492-3.

155. Cook DJ, Witt LG, Cook RJ et al. Stress ulcer prophylaxis in the critically ill: a meta-analysis. Am J Med. 1991; 91:519-27. [IDIS 293635] [PubMed 1835294]

156. Shuman RB, Schuster DP, Zuckerman GR. Prophylactic therapy for stress ulcer bleeding: a reappraisal. Ann Intern Med. 1987; 106:562-7. [IDIS 227981] [PubMed 3548524]

157. Reusser P, Gyr K, Scheidegger D et al. Prospective endoscopic study of stress erosions and ulcers in critically ill neurosurgical patients: current incidence and effect of acid-reducing prophylaxis. Crit Care Med. 1990; 18:2704.

158. Reines HD. Do we need stress ulcer prophylaxis? Crit Care Med. 1990; 18:344. Editorial.

159. Goetting MG. Stress ulcers in the neurosurgical critical care patient. Crit Care Med. 1991; 19:446. [PubMed 1999114]

160. Goetting MG. Stress ulcers in the neurosurgical critical care patient. Crit Care Med. 1991; 19:446-7. [PubMed 1999114]

161. Zuckerman GR, Shuman R. Therapeutic goals and treatment options for prevention of stress ulcer syndrome. Am J Med. 1987; 83(Suppl 6A):29-35. [IDIS 241984] [PubMed 3321975]

162. Miller TA. Mechanisms of stress-related mucosal damage. Am J Med. 1987; 83(Suppl 6A):8-14. [PubMed 3321980]

163. Friedman CJ, Oblinger MJ, Suratt PM et al. Prophylaxis of upper gastrointestinal hemorrhage in patients requiring mechanical ventilation. Crit Care Med. 1982; 10:316-9. [PubMed 7042201]

164. Stothert JC Jr, Simonowitz DA, Dellinger EP et al. Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill. Ann Surg. 1980; 192:169-74. [IDIS 121210] [PubMed 7406571]

165. Halloran LG, Zfass AM, Gayle WE et al. Prevention of acute gastrointestinal complications after severe head injury: a controlled trial of cimetidine prophylaxis. Am J Surg. 1980; 139:44-8. [IDIS 109074] [PubMed 6985776]

166. Zinner MJ, Zuidema GD, Smith PL et al. The prevention of upper gastrointestinal tract bleeding in patients in an intensive care unit. Surg Gynecol Obstet. 1981; 153:214-20. [IDIS 164505] [PubMed 7017982]

167. Hastings PR, Skillman JJ, Bushnell LS et al. Antacid titration in the prevention of acute gastrointestinal bleeding: a controlled, randomized trial in 100 critically ill patients. N Engl J Med. 1978; 298:1041-5. [PubMed 25384]

168. McAlhany JC Jr, Colmic L, Czaja AJ et al. Antacid control of complications from acute gastroduodenal disease after burns. J Trauma. 1976; 16:645-8. [PubMed 785019]

169. Adeyemi SD, Ein SH, Simpson JS. Perforated stress ulcer in infants: a silent threat. Ann Surg. 1979; 190:706-8. [PubMed 518170]

170. Peura DA, Johnson LF. Cimetidine for prevention and treatment of gastroduodenal mucosal lesions in patients in an intensive care unit. Ann Intern Med. 1985; 103:173-7. [IDIS 202747] [PubMed 3874573]

171. Lacroix J, Infante-Rivard C, Gauthier M et al. Clinical and laboratory observations: upper gastrointestinal tract bleeding acquired in a pediatric intensive care unit: prophylaxis trial with cimetidine. J Pediatr. 1986; 108:1015-8. [IDIS 217558] [PubMed 3519913]

172. Martin LF, Booth FV, Reines HD et al. Stress ulcers and organ failure in intubated patients in surgical intensive care units. Ann Surg. 1992; 215:332-7. [PubMed 1558413]

173. Siepler JK, Trudeau W, Petty DE. Use of continuous infusion of histamine2-receptor antagonists in critically ill patients. DICP Ann Pharmacother. 1989; 23(Suppl)S40-3. (IDIS 260919)

174. Ostro MJ, Russel JA, Soldin SJ et al. Control of gastric pH with cimetidine: boluses versus primed infusions. Gastroenterology. 1985; 89:532-7. [IDIS 203780] [PubMed 4018499]

175. Tryba M, Zevounou F, Torok M et al. Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine: a controlled study with pirenzepine as a basic medication. Am J Med. 1985; 79(Suppl 2C):55-61. [IDIS 207863] [PubMed 3876031]

176. Siepler JK. A dosage alternative for H2-receptor antagonists—constant infusion. Clin Ther. 1986; 8(Suppl A):24-33. [PubMed 2878728]

177. Cannon LA, Heiselman D, Gardner W et al. Prophylaxis of upper gastrointestinal tract bleeding in mechanically ventilated patients: a randomized study comparing the efficacy of sucralfate, cimetidine, and antacids. Arch Intern Med. 1987; 147:2101-6. [IDIS 236198] [PubMed 3500684]

178. Levinson MJ. Gastric stress ulcers. Hosp Pract. (Office Ed). 1989; (March 30):59-68.

179. Strembo MA, Karlstadt RG. H2 blockers in stress ulcer prophylaxis. Hosp Pract. (Office Ed). 1989; (October 30):17,20.

180. Karlstadt RG, Palmer RH. Risk factors in nosocomial pneumonia in intensive care. Arch Intern Med. 1990; 150:919. [PubMed 2360954]

181. Maki DG. Risk factors for nosocomial infection in intensive care: “devices vs nature” and goals for the next decade. Arch Intern Med. 1989; 149:30-5. [PubMed 2643417]

182. Craven DE, Kunches LM, Kilinshky V et al. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis. 1986; 133:792-6. [PubMed 3706887]

183. Craven DE, Kunches LM, Lichtenberg DA et al. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med. 1988; 148:1161-8. [PubMed 3365084]

184. Driks MR, Craven DE, Celli BR et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers: the role of gastric colonization. N Engl J Med. 1987; 317:1376-82. [IDIS 235514] [PubMed 2891032]

185. Reusser P, Zimmerli W, Scheidegger D et al. Role of gastric colonization in nosocomial infections and endotoxemia: a prospective study in neurosurgical patients on mechanical ventilation. J Infect Dis. 1989; 160:414-20. [PubMed 2760497]

186. Tryba M. Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care unit patients: sucralfate versus antacids. Am J Med. 1987; 83(Suppl 3B):117-24. [IDIS 240155] [PubMed 3310626]

187. Cook DJ, Laine LA, Guyatt GH et al. Nosocomial pneumonia and the role of gastric pH: a meta-analysis. Chest. 1991; 100:7-13. [PubMed 1676361]

188. Wilcox CM. Stress ulcer prophylaxis in medical patients: who, what, and how much? Am J Gastroenterol. 1988; 83:1199-1211.

189. Peura DA. Controversies, dilemmas, and dialogues. Prophylactic therapy of stress-related mucosal damage: why, which, who, and so what? Am J Gastroenterol. 1990; 85:935-6. Editorial. (IDIS 288383)

190. Koretz RL. Controversies, dilemmas, and dialogues. Prophylactic therapy of stress-related mucosal damage: why, which, who, and so what? Am J Gastroenterol. 1990; 85:936-7. Editorial.

191. Kingsley AN. Prophylaxis for acute stress ulcers: antacids or cimetidine. Am Surg. 1985; 51:545-7. [PubMed 3898949]

192. Martin LF, Max MH, Polk HC Jr. Failure of gastric pH control by antacids or cimetidine in the critically ill: a valid sign of sepsis. Surgery. 1980; 88:59-68. [PubMed 6966835]

193. Reviewers’ comments (personal observations).

194. SmithKline Beecham. Philadelphia, PA: Personal communication.

195. Peura DA, Koretz RL. Should patients in the intensive care unit be provided routinely with antacids, sucralfate, or H2 blocker prophylaxis to prevent stress bleeding? In: Gitnick G, Barnes HV, Duffy TP et al eds. Debates in Medicine. Chicago, IL: Mosby—Year Book, Inc; 1991; 4:230-55.

196. Martin LF, McBooth FV, Karlstadt RG et al. Continuous intravenous cimetidine decreased stress-related upper gastrointestinal hemorrhage without promoting pneumonia. Crit Care Med. 1991 (in press).

197. Baxter Healthcare Corporation. Descriptive information on premixed liquid products. Deerfield, IL; 1992 Sep.

198. Anon. Safety of terfenadine and astemizole. Med Lett Drugs Ther. 1992; 34:9-10. [PubMed 1732711]

199. Ateshkadi A, Lam NP, Johnson CA. Helicobacter pylori and peptic ulcer disease. Clin Pharm. 1993; 12:34-48. [IDIS 307044] [PubMed 8428432]

200. Blaser MJ. Helicobacter pylori: its role in disease Clin Infect Dis. 1992; 15:386-91.

201. Murray DM, DuPont HL, Cooperstock M et al. Evaluation of new anti-infective drugs for the treatment of gastritis and peptic ulcer disease associated with infection by Helicobacter pylori. Clin Infect Dis. 1992; 15(Suppl 1):S268-73.

202. Peterson WL. Helicobacter pylori and peptic ulcer disease. N Engl J Med. 1991; 324:1043-8. [IDIS 279263] [PubMed 2005942]

203. Graham DY, Go MF. Evaluation of new antiinfective drugs for Helicobacter pylori infection: revisited and updated. Clin Infect Dis. 1993; 17:293-4. [PubMed 8399892]

204. Murray DM, DuPont HL. Reply. (Evaluation of new antiinfective drugs for Helicobacter pylori infection: revisited and updated.) Clin Infect Dis. 1993; 17:294-5.

205. George LL, Borody TJ, Andrews P et al. Cure of duodenal ulcer after eradication of H. pylori. Med J Aust. 1990; 153:145-9. [IDIS 273364] [PubMed 1974027]

206. Farrell MK. Dr. Apley meets Helicobacter pylori. J Pediatr Gastroenterol Nutr. 1993; 16:118-9. [PubMed 8450375]

207. Fiocca R, Solcia E, Santoro B. Duodenal ulcer relapse after eradication of Helicobacter pylori. Lancet. 1991; 337:1614. [PubMed 1675746]

208. Marshall BJ. Campylobacter pylori: Its link to gastritis and peptic ulcer disease. Clin Infect Dis. 1990; 12(Suppl 1):S87-93.

209. Graham DY, Lew GM, Evans DG et al. Effect of triple therapy (antibiotics plus bismuth) on duodenal ulcer healing. A randomized controlled trial. Ann Intern Med. 1991; 115:266-9. [IDIS 284354] [PubMed 1854110]

210. Reviewers’ comments (personal observations) on Helicobacter pylori.

211. Glassman MS. Helicobacter pylori infection in children. A clinical overview. Clin Pediatr (Phila). 1992; 31:481-7. [IDIS 300639] [PubMed 1643767]

212. Marshall BJ. Treatment strategies for Helicobacter pylori infection. Gastroenterol Clin North Am. 1993; 22:183-98. [PubMed 8449566]

213. Chiba N, Rao BV, Rademaker JW et al. Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori. Am J Gastroenterol. 1992; 87:1716-27. [IDIS 307322] [PubMed 1449132]

214. Bianchi Porro G, Parente F, Lazzaroni M. Short and long term outcome of Helicobacter pylori positive resistant duodenal ulcers treated with colloidal bismuth subcitrate plus antibiotics or sucralfate alone. Gut. 1993; 34:466-9. [IDIS 312865] [PubMed 8491391]

215. Borody T, Andrews P, Mancuso N et al. Helicobacter pylori reinfection 4 years post-eradication. Lancet. 1992; 339:1295. [PubMed 1349686]

216. Hixson LJ, Kelley CL, Jones WN et al. Current trends in the pharmacotherapy for peptic ulcer disease. Arch Intern Med. 1992; 152:726-32. [IDIS 295736] [PubMed 1558429]

217. Rauws EAJ, Tytgat GNJ. Cure of duodenal ulcer with eradication of Helicobacter pylori. Lancet. 1990; 335:1233-5. [IDIS 267578] [PubMed 1971318]

218. Hentschel E, Brandstätter G, Dragosics B et al. Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med. 1993; 328:308-12. [IDIS 308862] [PubMed 8419816]

219. Sloane R, Cohen H. Commonsense management of Helicobacter pylori-associated gastroduodenal disease. Personal views. Gastroenterol Clin North Am. 1993; 22:199-206. [PubMed 8449567]

220. Katelaris P. Eradicating Helicobacter pylori. Lancet. 1992; 339:54. [IDIS 290645] [PubMed 1345965]

221. Burette A, Glupczynski Y. On: The who’s and when’s of therapy for Helicobacter pylori. Am J Gastroenterol. 1991; 86:924-5. [IDIS 284893] [PubMed 2058644]

222. Bell GD, Powell K, Burridge SM et al. Experience with ″triple’ anti-Helicobacter pylori eradication therapy: side effects and the importance of testing the pretreatment bacterial isolate for metronidazole resistance. Ailment Pharmacol Ther. 1992; 6:427-35.

223. Ateshkadi A, Lam NP, Johnson CA. Helicobacter pylori and peptic ulcer disease. Clin Pharm. 1993; 12:34-48. [IDIS 307044] [PubMed 8428432]

224. Blaser MJ. Helicobacter pylori: its role in disease. Clin Infect. 1992; 15:386-91.

225. Marshall BJ. Treatment strategies for Helicobacter pylori infection. Gastroenterol Clin North Am. 1993; 22:183-98. [PubMed 8449566]

226. Bayerdorffer E, Mannes GA, Sommer A et al. Long-term follow-up after eradication of Helicobacter pylori with a combination of omeprazole and amoxycillin. Scand J Gastroenterol Suppl. 1993; 196:19-25. [PubMed 8341987]

227. Unge P, Ekstrom P. Effects of combination therapy with omeprazole and an antibiotic on H. pylori and duodenal ulcer disease. Scand J Gastroenterol Suppl. 1993; 196:17-8.

228. Hunt RH. Hp and pH: implications for the eradication of Helicobacter pylori. Scand J Gastroenterol Suppl. 1993; 196:12-6. [PubMed 8341986]

229. Malfertheiner P. Compliance, adverse events and antibiotic resistance in Helicobacter pylori treatment. Scand J Gastroenterol Suppl. 1993; 196:34-7. [PubMed 8341989]

230. Bell GD, Powell U. Eradication of Helicobacter pylori and its effect in peptic ulcer disease. Scand J Gastroenterol Suppl. 1993; 196:7-11. [PubMed 8341990]

231. Farrell MK. Dr. Apley meets Helicobacter pylori. J Pediatr Gastroenterol Nutr. 1993; 16:118-9. [PubMed 8450375]

232. Nomura A, Stemmermann GN, Chyou PH et al. Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med. 1991; 325:1132-6. [PubMed 1891021]

233. Parsonnet J, Friedman GD, Vandersteen DP et al. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991; 325:1127-31. [PubMed 1891020]

234. An international association between Helicobacter pylori infection and gastric cancer. The EUROGAST Study Group. Lancet. 1993; 341:1359-62. [PubMed 8098787]

235. Talley NJ, Zinsmeister AR, Weaver A et al. Gastric adenocarcinoma and Helicobacter pylori infection. J Natl Cancer Inst. 1991; 83:1734-9. [PubMed 1770552]

236. Forman D, Newell DG, Fullerton F et al. Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ. 1991; 302:1302-5. [PubMed 2059685]

237. Forman D. Helicobacter pylori infection: a novel risk factor in the etiology of gastric cancer. J Natl Cancer Inst. 1991; 83:1702-3. [PubMed 1770545]

238. Parsonnet J. Helicobacter pylori and gastric cancer. Gastroenterol Clin North Am. 1993; 22:89-104. [PubMed 8449573]

239. Correa P. Is gastric carcinoma an infectious disease? N Engl J Med. 1991; 325:1170-1.

240. Isaacson PG, Spencer J. Is gastric lymphoma an infectious disease? Hum Pathol. 1993; 24:569-70.

241. Rauws EAJ, Tytgat GNJ. Cure of duodenal ulcer with eradication of Helicobacter pylori. Lancet. 1990; 335:1233-5. [IDIS 267578] [PubMed 1971318]

242. Hunt RH. pH and Hp—gastric acid secretion and Helicobacter pylori: implications for ulcer healing and eradication of the organism. Am J Gastroenterol. 1993; 88:481-3. [IDIS 313340] [PubMed 8470623]

243. Reviewers’ comments (personal observations) on Helicobacter pylori; 1993 Oct 26.

244. Marshall BJ. Helicobacter pylori. Am J Gastroenterol. 1994; 89(Suppl):S116-28.

245. Labenz J, Gyenes E, Rühl GH et al. Amoxicillin plus omeprazole versus triple therapy for eradication of Helicobacter pylori in duodenal ulcer disease: a prospective, randomized, and controlled study. Gut. 1993; 34:1167-70. [IDIS 320468] [PubMed 8406147]

246. Anon. Drugs for treatment of peptic ulcers. Med Lett Drugs Ther. 1994; 36:65-7. [PubMed 7912812]

247. Freston JW. Emerging strategies for managing peptic ulcer disease. Scand J Gastroenterol Suppl. 1994; 201:49-54. [PubMed 8047824]

248. Axon ATR. The role of acid inhibition in the treatment of Helicobacter pylori infection. Scand J Gastroenterol Suppl. 1994; 201:16-23. [PubMed 8047818]

249. Labenz J, Rühl GH, Bertrams J et al. Medium- or high-dose omeprazole plus amoxicillin eradicates Helicobacter pylori in gastric ulcer disease. Am J Gastroenterol. 1994; 89:726-30. [IDIS 329264] [PubMed 8172146]

250. Labenz J, Borsch G. Evidence for the essential role of Helicobacter pylori in gastric ulcer disease. Gut. 1994; 35:19-22. [IDIS 324883] [PubMed 8307443]

251. NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease. Helicobacter pylori in peptic ulcer disease. JAMA. 1994; 272:65-9. [IDIS 332306] [PubMed 8007082]

252. Fennerty MB. Helicobacter pylori. Ann Intern Med. 1994; 154:721-7.

253. Adamek RJ, Wegener M, Labenz J et al. Medium-term results of oral and intravenous omeprazole/amoxicillin Helicobacter pylori eradication therapy. Am J Gastroenterol. 1994; 89:39-42. [IDIS 324011] [PubMed 8273795]

254. Cotton P. NIH consensus panel urges antimicrobials for ulcer patients, skeptics concur with caveats. JAMA. 1994; 271:808-9. [PubMed 8114221]

255. Feldman M. The acid test. Making clinical sense of the consensus conference on Helicobacter pylori. JAMA. 1994; 272:70-1. [PubMed 8007084]

256. Raufman JP, Notar-Francesco V, Raffaniello RD et al. Histamine-2 receptor antagonists do not alter serum ethanol levels in fed, nonalcoholic men. Ann Intern Med. 1993; 118:488-94. [IDIS 311490] [PubMed 8095127]

257. Lewis JH, McIsaac RL. H2 antagonists and blood alcohol levels. Dig Dis Sci. 1993; 38:569-71. [IDIS 311762] [PubMed 8095199]

258. Roine R, Hernández-Mu˜noz R, Baraona E et al. H2 antagonists and blood alcohol levels. Dig Dis Sci. 1993; 38:572-3.

259. Anon. H2 blocker interaction with alcohol is not clinically significant, FDA advisory committee concludes March 12; issue may be revisited, agency indicates. FDC Rep Drugs Cosmet. 1993 Mar 22:10.

260. Levitt MD. Do histamine-2 receptor antagonists influence the metabolism of ethanol? Ann Intern Med. 1993; 118:564-5. Editorial.

261. Marshall JM. Interaction of histamine2-receptor antagonists and ethanol. Ann Pharmacother. 1994; 28:55-6. [IDIS 324482] [PubMed 7907240]

262. Fraser AG, Prewett EJ, Hudson M et al. The effect of ranitidine, cimetidine or famotidine on low-dose post-prandial alcohol absorption. Aliment Pharmacol Ther. 1991; 5:263-72. [PubMed 1888825]

263. Fraser AG, Hudson M, Sawyer AM et al. Short report: the effect of ranitidine on the post-prandial absorption of a low dose of alcohol. Aliment Pharmacol Ther. 1992; 6:267-71. [PubMed 1600045]

264. Palmer RH, Frank WO, Nambi P et al. Effects of various concomitant medications on gastric alcohol dehydrogenase and the first-pass metabolism of ethanol. Am J Gastroenterol. 1991; 86:1749-55. [PubMed 1683743]

265. Gugler R. H2-antagonists and alcohol: do they interact? Drug Saf. 1994; 10:271-80.

266. Peura DA, Graham DY. Helicobacter pylori: consensus reached: peptic ulcer is on the way to becoming an historic disease. Am J Gastroenterol. 1994; 89:1137-9. [PubMed 8053422]

267. Levine LR, Cloud ML, Enas NH. Nizatidine prevents peptic ulceration in high-risk patients taking nonsteroidal anti-inflammatory drugs. Arch Intern Med. 1993; 153:2449-54. [IDIS 321821] [PubMed 8215749]

268. SmithKline Beecham Consumer Healthcare. Tagamet HB (cimetidine) tablets product information. Pittsburgh, PA; 1995.

269. Cadranel JF, Eugene C. Another example of Strongyloides stercoralis infection associated with cimetidine in an immunosuppressed patient. Gut. 1986; 27:1229. [PubMed 3781340]

270. Ainley CC, Clarke DG, Timothy AR et al. Strongyloides stercoralis hyperinfection associated with cimetidine in an immunosuppressed patient: diagnosis by endoscopic biopsy. Gut. 1986; 27:337-8. [PubMed 3699555]

271. Markham A, McTavish D. Clarithromycin and omeprazole: as Helicobacter pylori eradication therapy in patients with H. pylori-associated gastric disorders. Drugs. 1996; 51:161-78. [PubMed 8741237]

272. Soll AH. Medical treatment of peptic ulcer disease. JAMA. 1996; 275:622-9. [IDIS 361115] [PubMed 8594244]

273. Labenz J, Börsch G. Highly significant change of the clinical course of relapsing and complicated peptic ulcer disease after cure of Helicobacter pylori infection. Am J Gastroenterol. 1994; 89:1785-8. [IDIS 336721] [PubMed 7942667]

274. Wang WM, Chen CY, Jan CM et al. Long-term follow-up and serological study after triple therapy of Helicobacter pylori-associated duodenal ulcer. Am J Gastroenterol. 1994; 89:1793-6. [IDIS 336723] [PubMed 7942669]

275. Walsh JH, Peterson WL. The treatment of Helicobacter pylori infection in the management of peptic ulcer disease. N Engl J Med. 1995; 333:984-91. [IDIS 354448] [PubMed 7666920]

276. Hackelsberger A, Malfertheiner P. A risk-benefit assessment of drugs used in the eradication of Helicobacter pylori infection. Drug Saf. 1996; 15:30-52. [PubMed 8862962]

277. Rauws EAJ, van der Hulst RWM. Current guidelines for the eradication of Helicobacter pylori in peptic ulcer disease. Drugs. 1995; 6:984-90.

278. van der Hulst RWM, Keller JJ, Rauws EAJ et al. Treatment of Helicobacter pylori infection: a review of the world literature. Helicobacter. 1996; 1:6-19. [PubMed 9398908]

279. Lind T, Veldhuyzen van Zanten S, Unge P et al. Eradication of Helicobacter pylori using one-week triple therapies combining omeprazole with two antimicrobials: the MACH I study. Helicobacter. 1996; 1:138-44. [PubMed 9398894]

280. Anon. The choice of antibacterial drugs. Med Lett Drugs Ther. 1996; 38:25-34. [PubMed 8598824]

281. Fennerty MB. Practice guidelines for treatment of peptic ulcer disease. JAMA. 1996; 276:1135. [IDIS 373209] [PubMed 8827957]

282. Soll AH. Practice guidelines for treatment of peptic ulcer disease. JAMA. 1996; 276:1136-7.

283. TAP Pharmaceuticals, Inc. Prevacid (lansoprazole) delayed-release capsules prescribing information. Deerfield, IL; 1997 Aug.

284. Langtry HD, Wilde MI. Lansoprazole: an update of its pharmacological properties and clinical efficacy in the management of acid-related disorders. Drugs. 1997; 54:473-500. [PubMed 9279507]

285. Garnett RG. Lansoprazole: a proton pump inhibitor. Ann Pharmacother. 1996; 30:1425. [IDIS 376983] [PubMed 8968456]

286. Zimmerman AE, Katona BG. Lansoprazole: a comprehensive review. Pharmacotherapy. 1997; 17:308-26. [IDIS 383782] [PubMed 9085323]

287. Hatlebakk JG, Nesje LB, Hausken T et al. Lansoprazole capsules and amoxicillin oral suspension in the treatment of peptic ulcer disease. Scand J Gastroenterol. 1995; 11:1053-7.

288. DeVault KR, Castell DO, Practice Parameters Committee of the American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 1999; 94:1434-42. [IDIS 429620] [PubMed 10364004]

289. Behar J, Brand DL, Brown FC et al. Cimetidine in the treatment of symptomatic gastroesophageal reflux. Gastroenterol. 1978; 74:441-8.

290. Sontag S, Robinson M, McCallum RW et al. Ranitidine therapy for gastroesophageal reflux disease. Results of a large double-blind trial. Arch Intern Med. 1987; 1485-91.

291. Euler AR, Murdock RH, Wilson TH et al. Ranitidine is effective therapy for erosive esophagitis. Am J Gastroenterol. 1993; 88:520-4. [IDIS 313345] [PubMed 8470632]

292. Galmiche JP, Fraitag B, Filoche B et al. Double-blind comparison of cisapride and cimetidine in treatment of reflux esophagitis. Dig Dis Sci. 1990; 35:649-55. [IDIS 267862] [PubMed 2331957]

293. Lepoutre L, Vander Speck P. Vanderlinden I et al. Healing of greade-II and III oesophagitis through motility stimulation with cisapride. Digestion. 1990; 45:109-14. [PubMed 2190850]

294. Richter JE, Long JF. Cisapride for gastroesophageal reflux disease: A placebo-controlled, double-blind study. Am J Gastroenterol. 1995; 90:423-30. [IDIS 343455] [PubMed 7872282]

295. Galmiche JP, Brandstatter G, Evreux M et al. Combined therapy with cisapride and cimetidine in severe reflux esophagitis: A double-blind placebo-controlled trial. Gut. 1988; 29:675-81. [IDIS 243368] [PubMed 3294124]

296. Ganzini L, Casey DE, Hofman WF et al. The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders. Arch Intern Med. 1993; 153:1469-75. [IDIS 316182] [PubMed 8512437]

297. Rex DK. Gastroesophageal reflux disease in adults: pathophysiology, diagnosis, and management. J Fam Pract. 1992; 35:673-81. [PubMed 1453152]

298. Hixson LJ, Kelley CL, Jones WN et al. Current trends in the pharmacotherapy for gastroesophageal reflux disease. Arch Intern Med. 1992; 152:717-23. [IDIS 295735] [PubMed 1558428]

299. Sontag SJ. The medical management of reflux eophagitis: role of antacids and acid inhibition. Gastroenterol Clin North Am. 1990; 19:683-712. [PubMed 1977703]

300. Richter JE. A critical review of current medical therapy for gastroesophageal reflux disease. J Clin Gastroenterol. 1986; 8(Suppl 1):72-80. [PubMed 2874168]

301. Antonson CW, Robinson MG, Hawkins TM et al. High doses of histamine antagonists do not prevent relapses of peptic esophagitis following therapy with a proton pump inhibitor. Gastroenterology. 1990; 98:A16.

302. Laheij RJF, Sturkenboom MCJM, Hassing RJ et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004;292:1955-60.

303. Gregor JC. Acid suppression and pneumonia.; a clinical indication for rational prescibing. JAMA. 2004;292:2012-3. Editorial.

304. Fine MJ, Smith MA, Carson MA. Prognosis and outcomes of patients with community-acquired pneumonia: a meta-analysis. JAMA. 1996; 275:134-41. [PubMed 8531309]

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:372-86.

a. GlaxoSmithKline. Tagamet (cimetidine tablets, cimetidine hydrochloride liquid, and cimetidine hydrochloride injection) prescribing information. Research Triangle Park, NC; 2002 June.

b. AHFS drug information 2003. McEvoy GK, ed. Cimetidine. Bethesda, MD: American Society of Health-System Pharmacists; 2003:2775-81.

c. GlaxoSmithKline. Tagamet HB 200 (cimetidine) tablets, product information. In: 2003 PDR for Nonprescription Drugs and Dietary Supplements. Thomson, Montavel NJ; 2003: 659.

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