Cimetidine

Indications & Dose:

INDICATIONS AND DOSE

Short term treatment of duodenal and benign gastric ulcers; maintenance therapy for duodenal ulcer; erosive gastroesophageal reflux disease (GERD); prevention of upper gastrointestinal bleeding in critically ill patients; treatment of pathological hypersecretory

• BY MOUTH

Adults: By mouth, 400 mg twice daily (with break fast and at night) or 800 mg at night

Benign gastric and duodenal ulceration:

• BY MOUTH

Adults:for at least 4 weeks (6 weeks in gastric ulceration, 8 weeks in NSAID associated ulceration); when necessary the dose may be increased to 400 mg 4 times daily or 800mg morning and evening or rarely (e.g. as in stress ulceration) to a max, of 2.4 g daily in divided doses.

Reflux oesophagitis:

• BY MOUTH

 Adults:400 mg 4 times daily for 4-8 weeks.

Zollinger Ellison syndrome:

• BY MOUTH

Adults:400 mg 4 times daily or occassionally more

Gastric acid reduction :

BY MOUTH

Adults:(prophylaxis of acid aspiration; do not use syrup), obstetrics 400 mg at start of labour, then up to 400 mg every 4 hours if required (max. of 2.4 g daily); surgical procedures 400 mg 90-120 minutes before induction of general anaesthesia

Short bowel syndrome:

BY MOUTH

Adults:400 mg twice daily (with breakfast and at bedtime) adjusted according to response. To reduce degradation of pancreatic enzyme supple-ment 0.8-1.6 g daily in 4 divided doses according to response 1-1/2 hours before meals.

BY INJECTABLE

Adults:

By intramuscular injection, 200 mg every 4-6 hours, max. 2.4 g daily. 

By slow intravenous injection, 200 mg given over at least 2 minutes; may be repeated every 4-6 hours; if a larger dose is needed or there is cardiovascular impairment; the dose should be diluted and given over at least 10 minutes (infusion is preferable); max. 2.4 g daily.

Children over 1 year :Usually 20-30 mg/kg daily in divided doses.

Maintenance: 400 mg at night or 200 mg morning and night.

By intramuscular injection: or slow intravenous injection or infusion 20-30 mg/kg daily in divided doses.

By intravenous infusion: 400 mg in 100 ml of sodium chloride 0.9% intravenous infusion infused over 1/2 -1 hour (may be repeated every 4-6 hours) or by conti-nuous infusion at an average rate of 50- 100 mg/hour over 24 hours, max 2.4 g daily.

Contraindications:

Hypersensitivity.Pregnacy and lactation.

Side Effects:

CNS: Anxiety, confusion, depression, dizziness, headache, psychosis, seizures, tremors, weakness

CV: Bradycardia, tachycardia

GI: Abdominal cramps, diarrhea, jaundice, paralytic ileus

GU: Galactorrhea, gynecomastia, impotence; increase in BUN, creatinine

HEME: Agranulocytosis, aplastic anemia, neutropenia, thrombocytopenia

SKIN: Alopecia, exfoliative dermatitis, flushing, rash, sweating, urticaria

Cautions:

Precautions:

Organic brain syndrome, hepatic disease, renal disease, elderly.

Pregnancy: Safety not established.

Breast-feeding: Use with caution.

Old age: May be used in low dose

Interaction:

Drugs

Amiodarone, benzodiazepines; calcium channel blockers; amiodarone; cyclic antidepressants; carbamazepine; carmustine; chloramphenicol; cisapride; citalopram; clozapine; diltiazem; femoxidine; flecanide; glyburile; glipizide; labetolol; lidocaine; lomustine; melphalan; metoprolol; narcotic analgesics; moricizine; Nacetylprocainamide; nicotine; phenytoin; peridolol; praziquantel; procainamide; propafinone; propranolol; quinidine; tacrine; theophylline; tolbutamide: Increased concentrations of interacting drugs with potential for toxicity

Ketoconazole, cefpodoxime, cefuroxime: Reduced concentrations of interacting drugs

Warfarin: Increased concentrations of interacting drugs with potential for toxicity

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: