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Cimetidine is a drug with the indication of peptic ulcer disease, gastroesophageal reflux disease, and dermatological conditions including warts, urticaria, mastocytosis, and erythropoietic protoporphyria. This medication is an H2 receptor antagonist. This activity will describe cimetidine's indications, actions, and contraindications in these disorders. Cimetidine is available as an over-the-counter medication and by prescription. Therefore, this activity will further highlight the mechanisms of action, adverse effect profile, and other key factors pertinent to interprofessional team members in managing patients by using cimetidine. Objectives: Identify the mechanism of action of cimetidine. Describe the indications for using cimetidine. Review the drug-drug interactions associated with cimetidine use. Outline the interprofessional team strategies regarding healthcare, coordination, and communication to improve the therapeutic outcome of cimetidine in patients who would benefit therapeutically. Access free multiple choice questions on this topic.

Overdoses of cimetidine are rare. However, in the case of toxicity, maintaining the airway and cardiovascular status is critical. Decontamination of cimetidine includes gastric lavage and a reduction of drug absorption by the administration of activated charcoal.

As described by the Beers criteria, cimetidine should be avoided in geriatric patients with delirium or at high risk of delirium, as histamine H2 receptor antagonists may worsen their mental status or induce cognitive decline.[34] Healthcare professionals, including pharmacists, primary care providers, and nurse practitioners, should counsel patients to stop the drug promptly and report signs of an allergic reaction or worsening of gastrointestinal discomfort, especially blood in the stool, as a more thorough evaluation will be required. Clinicians, gastroenterologists, pharmacists, and nurses must review the patient's current medication history taking this H2-receptor antagonist to avoid decreased metabolism of the other drug by cimetidine via the inhibition cytochrome P450 isoenzymes. This interaction potential is especially true since cimetidine is available OTC, and patients may be taking it without first checking with the health care team. Adverse interaction potential is particularly problematic for patients on warfarin, so the interprofessional team must be aware of this combination. Nurses often collect medication information from patients, and pharmacists can verify non-prescription drug intake. The nurse or pharmacist should report to the entire interprofessional healthcare team if concerns are discovered. This type of collaboration is crucial to ensuring optimal outcomes with minimal adverse events. [Level 5] Patients suspected of having peptic ulcer disease should be investigated- upper gastrointestinal endoscopy and taking gastric mucosal biopsies. Those with an H. pylori infection should have treatment with a standard triple therapy regimen consisting of a proton pump inhibitor and two antibiotics (clarithromycin and amoxicillin/metronidazole) to eradicate the infection instead of only receiving symptomatic treatment with an H2-receptor antagonist. For obstetricians, patients with reflux esophagitis during pregnancy should have therapy with an H2-receptor antagonist (cimetidine, ranitidine, or famotidine); these drugs are all FDA category B and considered safe during pregnancy. There is no apparent increased risk for spontaneous abortion, preterm labor, or low birth weight after first-trimester exposure to H2-receptor antagonists.[35] However, ranitidine is better studied, making it the preferred H2-receptor antagonist in pregnancy.[33]

Patients suspected of having peptic ulcer disease should be investigated- upper gastrointestinal endoscopy and taking gastric mucosal biopsies. Those with an H. pylori infection should have treatment with a standard triple therapy regimen consisting of a proton pump inhibitor and two antibiotics (clarithromycin and amoxicillin/metronidazole) to eradicate the infection instead of only receiving symptomatic treatment with an H2-receptor antagonist. For obstetricians, patients with reflux esophagitis during pregnancy should have therapy with an H2-receptor antagonist (cimetidine, ranitidine, or famotidine); these drugs are all FDA category B and considered safe during pregnancy. There is no apparent increased risk for spontaneous abortion, preterm labor, or low birth weight after first-trimester exposure to H2-receptor antagonists.[35] However, ranitidine is better studied, making it the preferred H2-receptor antagonist in pregnancy.[33] Given the interaction and adverse event profile of cimetidine, and the improvement in newer agents in the H2-receptor antagonist class, cimetidine may not be the optimal initial therapeutic choice for many patients.