PubMed · 55937
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R F Logan, J A Forrest. 1976-03-20. Letter: Cimetidine, metiamide and gastric ulcer.. https://doi.org/10.1016/s0140-6736(76)90469-4
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Routine determination of the blood serum concentration of most of the usual anticonvulsants is possible by means of an immunoenzymatic method (EMIT). Determination of the total concentration permits conclusions as to the amount of available, unbound and, thus, effective amount of the substance. Regular determination of serum values provides insight into the relevant pharmacokinetics. Metabolism of anticonvulsants differs greatly among individuals and therefore considerable individual variation exists in the relation between the applied dose and the attained serum level. The metabolic rate of the various substances is unequal and, accordingly, the time necessary to reach a steady state and the half life is very variable. Metabolism may be altered by various biological adaptations, diseases or other drugs, causing alterations in the serum level of the anticonvulsant. Results obtained to date indicate a therapeutic threshold concentration range. In a certain percentage of patients seizures are abolished or diminish in frequency only on attaining such a serum level. In more benign cases an adequate therapeutic effect may be obtained with lower ("subtherapeutic") concentrations, while on the other hand, in malignant cases, no efficient control of seizure activity can be attained even at a high serum concentration. The method should be used in all problematic patients. Up to 50% of patients with insufficient control of seizures show improvement or, even, absence of seizures if this method is included in the therapeutic concept.
Twenty-two adult patients with active endoscopically proven reflux oesophagitis entered a double-blind trial of treatment with either cimetidine (1 g/day) or placebo. A repeat endoscopy was carried out at eight weeks after the beginning of treatment on 19 of the patients. The mucosa appeared macroscopically normal at eight weeks in 81.8% of the cimetidine-treated patients, while 90% of patients were described histologically as having a normal or unremarkable mucosa. The results in placebo-treated patients were 55.6% and 44.4% respectively. The cimetidine-treated patients consumed significantly less antacids than the placebo-treated patients, and the over all assessment of their well-being was significantly better (90.9% patient satisfaction with treatment in the cimetidine group compared to 18.2% in the placebo group). Two patients in the placebo group did not complete the trial due to continuing severity of their symptoms, while none in the cimetidine group felt that their condition had remained static or was worse.
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