From the Guidelines
Cimetidine is primarily used to treat conditions related to excess stomach acid, including gastroesophageal reflux disease (GERD), peptic ulcers, heartburn, and acid indigestion. It belongs to a class of medications called H2 blockers (histamine-2 receptor antagonists) and works by reducing the amount of acid produced by the stomach. The typical dose for children is 30–40 mg/kg/d, divided in 4 doses, as syrup, and is indicated for ages ≥16 y 1. For adults, the dose ranges from 200 mg to 800 mg daily, often divided into multiple doses, with treatment duration varying from a few weeks for acute conditions to longer periods for chronic issues. Cimetidine can be taken with or without food, though taking it with meals may help maximize its effectiveness for certain conditions. The medication works by blocking histamine receptors in the stomach lining, preventing histamine from stimulating acid production. Some key points to consider when using cimetidine include:
- It is less effective than PPIs in symptom relief and healing rates of erosive esophagitis 1
- It has been linked to an increased risk of liver disease and gynecomastia 1
- It can interact with several medications by affecting liver enzymes, so it's essential to inform healthcare providers about all medications being taken 1
- Other H2RAs might be a better choice in patients treated with clopidogrel due to cimetidine's ability to competitively inhibit CYP2C19 1
- Cimetidine can be used as first-line therapy for gastrointestinal symptoms in mast cell activation syndrome (MCAS) and might help H1R antihistamines attenuate cardiovascular symptoms 1 Overall, cimetidine is a viable treatment option for conditions related to excess stomach acid, but its use should be carefully considered due to potential side effects and interactions.
From the FDA Drug Label
Cimetidine tablets are indicated in: (1) Short-term treatment of active duodenal ulcer. (2) Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of active ulcer. (3) Short-term treatment of active benign gastric ulcer. (4) Erosive gastroesophageal reflux (GERD). (5) The treatment of pathological hypersecretory conditions (i.e., Zollinger-Ellison Syndrome, systemic mastocytosis, multiple endocrine adenomas).
Cimetidine is used for:
- Short-term treatment of active duodenal ulcer and active benign gastric ulcer
- Maintenance therapy for duodenal ulcer patients
- Treatment of erosive gastroesophageal reflux (GERD)
- Treatment of pathological hypersecretory conditions, such as Zollinger-Ellison Syndrome, systemic mastocytosis, and multiple endocrine adenomas 2
From the Research
Uses of Cimetidine
- Cimetidine is used to treat gastroesophageal reflux disease (GERD) 3, 4, 5, 6
- It is effective in promoting the healing of esophageal ulcers and erosions 4, 5
- Cimetidine is also used to treat peptic ulcer disease, including duodenal and gastric ulcers 7
- It can be used to control gastric hypersecretion and peptic ulceration in Zollinger-Ellison syndrome 7
- Cimetidine has been used to treat reflux esophagitis in children 5
Dosage and Administration
- The typical dosage of cimetidine for GERD is 800 mg daily 3 or 800 mg twice daily 4
- For peptic ulcer disease, the dosage is typically 400 mg four times a day 7
- In children, the dosage is 30-40 mg/kg/day 5
Efficacy and Comparison to Other Treatments
- Cimetidine has been shown to be effective in healing esophageal ulcers and erosions, and in providing symptomatic relief in patients with GERD 4, 5
- However, omeprazole has been shown to be more effective than cimetidine in relieving heartburn symptoms in patients with GERD, regardless of the presence or absence of endoscopic oesophagitis 6