cimetidine

(sye met' i deen)

Apo-Cimetidine (CAN), Gen-Cimetidine (CAN), Novo-Cimetine (CAN), Nu-
Cimet (CAN), Peptol (CAN), Tagamet, Tagamet HB, Tagamet HB Suspension

Pregnancy Category B

Drug class
Histamine2 (H2) antagonist

Therapeutic actions
Inhibits the action of histamine at the histamine2 (H2) receptors of the stomach, inhibiting
gastric acid secretion and reducing total pepsin output.

Indications
• Short-term treatment of active duodenal ulcer
• Short-term treatment of benign gastric ulcer
• Treatment of pathologic hypersecretory conditions (Zollinger-Ellison syndrome)
• Prophylaxis of stress-induced ulcers and acute upper GI bleeding in critical
patients
• Treatment of erosive gastroesophageal reflux
• OTC use: Relief of symptoms of heartburn, acid indigestion, sour stomach

Contraindications and cautions

• Contraindicated with allergy to cimetidine.
• Use cautiously with impaired renal or hepatic function, lactation.

Available forms
Tablets—100, 200, 300, 400, 800 mg; liquid—300 mg/5 mL; injection—150 mg/mL,
300 mg/2 mL

Dosages
ADULTS
• Active duodenal ulcer: 800 mg PO hs or 300 mg PO qid at meals and hs or
400 mg PO bid; continue for 4–6 wk. For intractable ulcers, 300 mg IM or IV q
6–8 hr.
• Maintenance therapy for duodenal ulcer: 400 mg PO hs.
• Active gastric ulcer: 300 mg PO qid at meals and hs or 800 mg hs.
• Pathologic hypersecretory syndrome: 300 mg PO qid at meals and hs, or 300 mg
IV or IM q 6 hr. Individualize doses as needed; do not exceed 2,400 mg/day.
• Erosive gastroesophageal reflux disease: 1,600 mg PO in divided doses bid–qid
for 12 wk.
• Prevention of upper GI bleeding: Continuous IV infusion of 50 mg/hr. Do not
treat beyond 7 days (if creatinine clearance < 30 mg/min, give 25 mg/hr).
• Heartburn, acid indigestion: 200 mg as symptoms occur, up to 4 tablets/24 hr.
PEDIATRIC PATIENTS
Not recommended for children < 12 yr.
GERIATRIC PATIENTS OR PATIENTS WITH IMPAIRED RENAL FUNCTION
Accumulation may occur. Use lowest dose possible, 300 mg PO or IV q 12 hr; may be
increased to q 8 hr if patient tolerates it and levels are monitored.

Pharmacokinetics
Route Onset Peak
Oral Varies 1–1.5 hr
IV, IM Rapid 1–1.5 hr

Metabolism: Hepatic; T1/2: 2 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts
Preparation: For IV injections, dilute in 0.9% sodium chloride injection, 5% or 10%
dextrose injection, lactated Ringer's solution, 5% sodium bicarbonate injection to a
volume of 20 mL. Solution is stable for 48 hr at room temperature. For IV infusions,
dilute 300 mg in at least 50 mL of 5% dextrose injection or one of above listed solutions.
Infusion: Inject by direct injection over not less than 2 min; by infusion, slowly over 15–
20 min.
Incompatibilities: Incompatible with aminophylline, barbiturate in IV solutions;
pentobarbital sodium and pentobarbital sodium and atropine in the same syringe.

Adverse effects
• CNS: Dizziness, somnolence, headache, confusion, hallucinations, peripheral
neuropathy; symptoms of brain stem dysfunction (dysarthria, ataxia, diplopia)
• CV: Cardiac arrhythmias, cardiac arrest, hypotension (IV use)
• GI: Diarrhea
• Hematologic: Increases in plasma creatinine, serum transaminase
• Other: Impotence (reversible), gynecomastia (in long-term treatment), rash,
vasculitis, pain at IM injection site

Interactions
Drug-drug
• Increased risk of decreased white blood cell counts with antimetabolites,
alkylating agents, other drugs known to cause neutropenia
• Increased serum levels and risk of toxicity of warfarin-type anticoagulants,
phenytoin, beta-adrenergic blocking agents, alcohol, quinidine, lidocaine,
theophylline, chloroquine, certain benzodiazepines (alprazolam,
chlordiazepoxide, diazepam, flurazepam, triazolam), nifedipine, pentoxifylline,
tricyclic antidepressants, procainamide, carbamazepine when taken with
cimetidine

Nursing considerations
Assessment
 • History: Allergy to cimetidine, impaired renal or hepatic function, lactation
• Physical: Skin lesions; orientation, affect; pulse, baseline ECG (continuous with
IV use); liver evaluation, abdominal exam, normal output; CBC, liver and renal
function tests

Interventions
• Give drug with meals and at hs.
• Decrease doses in renal and liver dysfunction.
• Administer IM dose undiluted deep into large muscle group.
• Arrange for regular followup, including blood tests to evaluate effects.

Teaching points
• Take drug with meals and at bedtime; therapy may continue for 4–6 wk or longer.
• Take antacids as prescribed, and at recommended times.
• Inform your health care provider about your cigarette smoking habits. Cigarette
smoking decreases the drug's effectiveness.
• Have regular medical followups to evaluate your response to drug.
• Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion,
hallucinations, dizziness, muscle or joint pain.

Adverse effects in Italic are most common; those in Bold are life-threatening.