LYCOS RETRIEVER 
Cimetidine: Patients
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Cimetidine has immunomodulatory effects that include blocking suppressor T cells and facilitating cell-mediated immunity (CMI). The histamine-induced upregulation of IL-6 and IL-8 production... may be completely abrogated by a combination of pyrilamine and cimetidine.[11] In patients with allergic rhinitis, cimetidine decreases the number of CD4+ and increases the number of CD8+ lymphocytes.[12] Cimetidine and famotidine slightly reduce the O2- or H2O2 production of neutrophils in a dose-dependent manner, although ranitidine fails to do so.[13] Cimetidine inhibits nitric-oxide-associated nitrate production in a horse soft-tissue inflammation model.[14] It decreases interleukin 6 production by human keratinocytes.[15] It can block cell proliferation and c-fox gene transcription.[16] It also might have a role in suppressing delayed hypersensitivity reactions.[17] The exact role that these immunological effects play in the treatment of clinical disease has yet to be defined.
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In the U.S. dose-ranging trial, over 80% of patients receiving Cimetidine 800 mg h.s. experienced nocturnal pain relief after 1 day. Relief from daytime pain was reported in approximately 70% of patients after 2 days. As with ulcer healing, the 800 mg h.s. dose was superior to 400 mg h.s. and not different from 1600 mg h.s.
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Kubota T, Fujiwara H, Ueda Y, Itoh T, Yamashita T, Yoshimura T, Okugawa K, Yamamoto Y, Yano Y, and Yamagishi H (2002) Cimetidine modulates the antigen presenting capacity of dendritic cells from colorectal cancer patients. Br J Cancer 86: 1257-1261.[Medline]
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In numerous placebo-controlled studies conducted worldwide, the percent of patients with observed ulcers at the end of 1 year's therapy with Cimetidine 400 mg h.s. was significantly lower (10% to 45%) than in patients receiving placebo (44% to 70%). Thus, from 55% to 90% of patients were maintained free of observed ulcers at the end of 1 year with Cimetidine 400 mg h.s.
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Cimetidine should be used cautiously in geriatric patients and in patients with significantly impaired hepatic or renal function. In humans meeting these criteria, increased risk of CNS (confusion) effects may occur; dosage reductions may be necessary.
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One of the most important uses of cimetidine in dermatological therapy is to reduce the dapsone induction of methemoglobinemia.[53] Cimetidine reduces the hepatic oxidation of dapsone to the hydroxylamine, thereby limiting methemoglobinemia formation. This strategy allows maintenance of higher daily dosages of dapsone, sometimes even in excess of 200 mg.[54] In one study, co-administration of cimetidine with dapsone kept methemoglobin levels at 30% below the control values for nearly three months. Eight patients with dermatitis herpetiformis, linear IgA disease, or folliculitis decalvans, who were on long term dapsone therapy (50-100 mg daily), added cimetidine, 1.6 g daily, for three months.[55] Their mean methemoglobin level fell from a baseline of 5.5 g/dl to 3.9 g/dl in the third week. The values remained low until week 12 when there was a return to baseline. There was no alteration in hemoglobin level from baseline (mean 12.7 g/dl) during the cimetidine therapy. However, there was a significant fall in the visual analogue score for headache.
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