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Drug Name cimetidine (sye met' i deen) Apo-Cimetidine (CAN), GenCimetidine (CAN), NovoCimetine (CAN), NuCimet (CAN), Tagamet, Tagamet HB, Tagamet HB Suspension Pregnancy Category B Drug class Histamin e2 (H2) antagoni st Adults

Dosages

Active duodenal ulcer: 800 mg PO hs or 300 mg PO qid with meals and at bedtime or 400 mg PO bid; continue for 46 wk unless healing is demonstrated by endoscopy. For intractable ulcers, 300 mg IM or IV q 6 8 hr. Maintenance therapy for duodenal ulcer: 400 mg PO at bedtime. Active benign gastric ulcer: 300 mg PO qid with meals and at bedtime or 800 mg at bedtime. Pathologic hypersecretory syndrome: 300 mg PO qid with meals and at bedtime, or 300 mg IV or IM q 6 hr. Individualize doses as needed; do not exceed 2,400 mg/day. Erosive GERD: 1,600 mg PO in divided doses bid qid for 12 wk. Prevention of upper GI bleeding: Continuous IV

Therapeutic Actions Cimetidine competitively inhibits histamine at H2-receptors of the gastric parietal cells resulting in decreased gastric acid secretion, gastric volume and hydrogen ion concentration. It is a potent inhibitor of metabolism in the hepatic mixedfunction oxidase systems. It is also used in patients with pancreatic insufficiency to reduce the breakdown of pancreatic enzyme supplements.

Indications Short-term treatment and maintenance 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 GERD OTC use: Relief of symptoms of heartburn, acid indigestion, sour stomach

Adverse effects Diarrhea, dizziness, tiredness, rash, headache, CNS disturbances, arthralgia, myalgia, gynecomastia, alopecia, blood dyscrasias, nephritis, hepatitis, pancreatitis, granulocytopeni a, hypersensitivity reactions.

Contraindications Hypersensitivity, lactation.

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 examination, normal output; CBC, LFTs, renal function tests Interventions Give drug with meals and at bedtime. Decrease doses in renal and hepatic impairment. Administer IM dose undiluted deep into large muscle group. Arrange for regular follow-up, including blood tests to evaluate effects. Teaching points Take drug with meals and at bedtime; therapy may continue for 46 weeks or longer. Take antacids as prescribed and at

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infusion of 50 mg/hr. Do not treat beyond 7 days. Heartburn, acid indigestion: 200 mg as symptoms occur; up to 4 tablets/24 hr. Do not take maximum dose for > 2 wk. 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; if creatinine clearance < 30 mL/min, give 25 mg/hr IV for prevention of upper GI bleed.

recommended times. Inform your health care provider about your cigarette smoking habits. Cigarette smoking decreases the drug's effectiveness. Have regular medical follow-up care to evaluate your response to drug. Tell your health care providers about all medications, over-thecounter drugs, or herbs you take; this drug may interact with many of these. Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, hallucinations, dizziness, muscle or joint pain.

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