PubMed Health⌕ Search

PubMed · 6507453

Drug interactions: theory versus practice.

Abstract

Cimetidine inhibition of P-450 oxidative metabolism results in interactions with many drugs, leading to clinically significant drug toxicity. A one-year survey of inpatient prescribing practices revealed a 32.6 percent incidence of concomitant cimetidine and interacting drug use. Retrospective chart review showed statistically significant increased toxic drug plasma levels in patients receiving theophylline and cimetidine, and a strong trend to increased rates of drug toxicity in phenytoin-cimetidine treated patients. Ranitidine appears to be a superior choice in patients receiving drugs metabolized by P-450 oxidation. When cimetidine and known interacting drugs are prescribed together, more frequent assessment of blood levels of the affected drug will be required, increasing substantially the cost to patients. Drug interactions of clinical significance occurring due to altered absorption because of effects of H2-receptor antagonists on gastric secretion are reviewed.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

J W Griffin, J R May, J T DiPiro. 1984-11-19. Drug interactions: theory versus practice.. https://pubmed.ncbi.nlm.nih.gov/6507453/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Prediction of the glomerular filtration rate using equations in kidney-pancreas transplant patients receiving cimetidine.

BACKGROUND: Current estimates of renal function in kidney transplant patients are frequently inaccurate compared to radionuclide GFR (rGFR) measurement. Cimetidine inhibits tubular secretion of creatinine and improves the accuracy of formulas to estimate GFR. METHODS: We studied the effect of a cimetidine-aided (800 mg tid for 24 hr) serum creatinine on the correlation of creatinine clearance and three prediction formulas (Cockroft-Gault, Levey, and Nankivell) compared to rGFR in 15 kidney-pancreas transplant patients. Results were adjusted for body surface area. RESULTS: Correlations with rGFR using cimetidine-aided creatinine were: Cockroft-Gault, r=0.710; Levey, r=0.752; Nankivell, r=0.676; creatinine clearance, r=0.643. By Bland and Altman analysis, agreement with rGFR was best with the Nankivell and Cockroft-Gault equations and worst with creatinine clearance. Cimetidine ($0.48 Canadian) costs substantially less than the rGFR test ($66.00 Canadian). CONCLUSION: Using cimetidine, prediction equations give a stronger correlation with GFR than creatinine clearance.

Cimetidine↗

In vitro availability of metformin in presence of h(2) receptor antagonists.

Metformin is a guanidine derivative used for the treatment of NIDDM. As it is used for a long-term therapy, it may be coadministered with other drugs. Present paper deals with the in vitro availability studies of metformin in presence of commonly used H(2) receptor antagonists. The later drugs compete with histamine for H(2) receptors and block gastric acid secretion and some cardiovascular effects of histamine. These studies were carried out in simulated gastric juices, simulating empty and full stomach, simulated intestinal juice and buffers of pH 7.4 simulating blood pH at 37 degrees C on a B.P. 2003 dissolution test apparatus. Commonly prescribed H(2) receptor antagonists like cimetidine, ranitidine and famotidine were used in these studies. The present study clearly indicated that availability of metformin can be altered in presence of most of the H(2) receptor antagonists studied except in presence of famotidine at pH 4 where the drug concentration remains unaltered. The availability of metformin was increased in simulated gastric juice, pH 7.4 and pH 9 (except ranitidine at pH 9) whereas the decrease in availability was observed in presence of cimetidine and ranitidine at pH 4 and ranitidine at pH 9. On the basis of these results, it is can be suggested that metformin should be coadministered with care along with H(2) receptor antagonists especially in case of ranitidine; although chances of adverse reactions are rare but decrease availability of metformin may result in delayed effect. On the other hand, increase in metformin concentration may result in hypoglycemic effects.

Cimetidine↗

[Can the survival of patients with recurrent disease after curative resection of colorectal cancer be prolonged by the administration of cimetidine?].

Administration of cimetidine after curative surgery can improve prognosis of patients with colorectal cancer. In this study, we analyzed whether cimetidine can influence the survival of patients with a recurrent disease after colorectal surgery. The subjects were 29 patients with recurrent disease: 14 patients were administered with cimetidine and 15 patients were not. In the cimetidine administered group, seven cases were recurrent in the liver, 5 cases in a local site and 1 case in the lymph node, whereas 7 cases were recurrent in the liver, 4 cases in a local site and 3 cases in the lung for the non-cimetidine administered group. There were no significant differences for both groups in terms of patient's survival after recurrence. Although it was not significant, the patient's survival after curative resection of recurrent disease for the cimetidine administered group was better than the non cimetidine administered group. Although the results did not show cimetidine could influence the overall survival of the patients after recurrence, it might be possible to improve the survival of the patients after resection of the recurrent disease.

Cimetidine↗