Cimetidine, Cimetidine Hydrochloride (Monograph)

Drug class: Histamine H2-Antagonists

Medically reviewed by Drugs.com on Oct 10, 2024. Written by ASHP.

Introduction

Histamine H₂ receptor antagonist.^b

Uses for Cimetidine, Cimetidine Hydrochloride

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^{† [off-label]}.¹⁰⁵ ¹⁰⁶ ¹²³ ²⁸⁸

Self-medication as initial therapy to achieve acid suppression, control symptoms, and prevent complications of less severe symptomatic GERD^{† [off-label]}.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^{† [off-label]} 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

Cimetidine, Cimetidine Hydrochloride 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.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.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.^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

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† [off-label]

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† [off-label]

Oral

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 Cimetidine, Cimetidine Hydrochloride

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

Hepatic Impairment

Further dosage adjustments may be necessary in presence of severe renal impairment.¹¹⁸

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

Drug Interactions

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
Antacids^b	Decreased cimetidine absorption^b	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 needed^b
Myelosuppressive drugs (e.g., alkylating agents [e.g., carmustine], antimetabolites) and/or therapies (radiation)^b	May potentiate myelosuppression^b
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 needed^b
Warfarin¹¹⁸	Potential for delayed elimination, increased blood concentrations of warfarin¹¹⁸	Monitor PT, adjust dosage if needed^b

Cimetidine, Cimetidine Hydrochloride 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 patients^a	Food-stimulated secretion decreased by 50% for 1 hour, then 75% for 2 hours.^a
Oral: 300-mg dose at breakfast in duodenal ulcer patients^a	Continued suppression for 4 hours, with partial suppression after lunch^a	Effect enhanced and maintained by additional 300-mg dose with lunch^a
Oral: 300-mg dose with food^b	Mean gastric pH 3.5–4 at 1 hour, 5.5–6.1 at 4 hours^b
Oral: Single dose 300 mg with food^a	Mean gastric pH: 3.5, 3.1, 3.8, 6.1 at hour 1, 2, 3, 4, respectively^a	Placebo mean gastric pH: 2.6, 1.6, 1.9, 2.2 at hour 1, 2, 3, 4, respectively^a
Oral: 300–400 mg in fasting state in duodenal ulcer patients^b	Anacidity for up to 8 hours^b
Oral: 300 mg in duodenal ulcer patients^b	Basal gastric acid output decreased by 90% for 4 hours^b	Meal-stimulated acid secretion by 66% for 3 hours^b
IV continuous infusion: mean dosage of 160 mg/hour (range:40-600 mg/hour) in pathologic hypersecretory conditions^b	Maintained secretion at ≤10 mEq/hour^b
IV continuous infusion (37.5 mg/hour or 900 mg daily) in patients with active or healed duodenal or gastric ulcer^b	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 ulcer^b	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 Cl_cr 20–50 mL/minute.^b 3.7 hours in patients with Cl_cr <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

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.

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

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

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* 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
			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
	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

† Off-label: 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.

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

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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. https://pubmed.ncbi.nlm.nih.gov/3757403

109. Parenti CM, Hoffman JE. Hyperpyrexia associated with intravenous cimetidine therapy: report of a case. Arch Intern Med. 1986; 146:1821-2. https://pubmed.ncbi.nlm.nih.gov/3753124

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