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Indications

Cimetidine is a gastric acid reducer used in the short-term treatment of duodenal and gastric ulcers.[1] Therefore, the drug effectively manages gastric hypersecretion and is used to manage reflux esophagitis disease and prevent stress-related gastric ulcers. With the development of proton pump inhibitors, such as omeprazole, approved for the same indications, cimetidine is available as an over-the-counter formulation to prevent heartburn or acid indigestion, along with the other H2-receptor antagonists.

In the past, before the approval of proton pump inhibitors, intravenous cimetidine offered a treatment option to seriously ill patients in the intensive care unit who required prophylaxis against stress-induced ulcers through its H2-receptor antagonist.[2]

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Recently, several studies have assessed the use of cimetidine in dermatology, including warts, ulceration, and mastocytosis. For example, treatment of multiple warts in pediatric heart transplant recipients.[3] In adults, cimetidine therapy appears to be beneficial with low toxicity in treating recalcitrant warts.[4] This effect may be due to reports of the immunomodulatory properties of this drug, attributed to cimetidine’s ability to reduce regulatory/suppressor T cell-mediated immunosuppression.[5]

There are also reports that cimetidine can inhibit heme biosynthesis and results in symptomatic improvement in children with acute intermittent porphyria and porphyria cutanea tarda. Both conditions are related to erythropoietic protoporphyria, a rare hereditary disease of heme biosynthesis that manifests with severe photosensitivity and hepatotoxicity. The rapid reduction in photosensitivity was observable within weeks of initiating cimetidine systemic therapy, and skin photosensitivity also improved. Also, there was a reduction in serum erythrocyte protoporphyrin levels, and liver function tests improved with no adverse effects from cimetidine for over two years of treatment.[6] Similar results were reported with the use of cimetidine and lactulose.[7] However, other researchers reported that there is not enough evidence for the benefit of cimetidine in protoporphyria.[8][9]

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Other dermatological indications include (i) condylomata acuminate and papillomatosis in young children, (ii) chronic idiopathic urticaria and other types of urticaria, (iii) pruritus after a burn injury, and (iv) in treating “periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome.” [10][11][12][13]

Cimetidine has shown beneficial effects on cell-mediated immunity following burn injury and alleviated damages induced by long-term low-dose neutron and gamma combined irradiation in animals via antioxidation and immunomodulation.[14][15]

Other studies support cimetidine as a treatment for bladder pain resulting from interstitial cystitis. There is no conclusion yet whether the mechanism involves a peptidergic pathway in the human bladder as cimetidine has on the parietal cells of the gastrointestinal tract.[16]

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