Biomedical subjects
Publications and source records attributed to J H Bauman.
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The association between thyroid disease and asthma is complex. Treatment of asthma in patients with thyroid disease is further complicated by the effects of thyroid dysfunction on drug metabolism. We report a patient with asthma whose calculated theophylline clearance was 0.156 L/kg/h during active Graves' disease which decreased to 0.042 L/kg/h after a euthyroid state was achieved. The potential mechanisms of this interaction are discussed and the effects of thyroid dysfunction on asthma and drug metabolism are reviewed.
Ranitidine is a selective, competitive histamine H2-receptor antagonist recently approved by the Food and Drug Administration for use in the short-term treatment of active duodenal ulcers and gastric hypersecretory conditions. Ranitidine is four to ten times more potent than cimetidine on a molar basis in inhibiting stimulated gastric acid secretion. Clinical studies have demonstrated that ranitidine is as effective as cimetidine and is similarly well tolerated. Based on available literature (approximately 700 publications), this article reviews the pharmacology, safety profile, and clinical efficacy of ranitidine in duodenal ulcers and gastric hypersecretory conditions.
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Cimetidine has been reported to decrease the biotransformation of drugs metabolized by the MFOE system. Additionally, cimetidine decreases liver blood flow and increases the bioavailability of drugs with high hepatic extraction ratios. Patients receiving cimetidine in conjunction with drugs known to interact with cimetidine in conjunction with drugs known to interact with cimetidine are at risk of experiencing toxicity. When appropriate, reducing the dosage of these agents or switching to an alternative drug will minimize the incidence of side effects. Clinicians should be suspicious if patients experience exaggerated drug effects when cimetidine therapy is begun.
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Four patients who had experienced a cimetidine-theophylline interaction are reported. All patients displayed decreases in theophylline elimination after the introduction of cimetidine. Clearances approached baseline values when cimetidine was discontinued. Patients on this drug combination should be monitored closely for signs of theophylline toxicity. When indicated, a beta agonist may be a better choice of a bronchodilator for peptic ulcer patients.
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