A second look at cimetidine.

Two-well conducted double blind studies have shown that cimetidine is not better than placebo in healing of duodenal ulcers at the end of the 6 weeks. I was surprised when the F.D.A. released the use of cimetidine on August 17, 1977, even when they knew the results of a large multicentered American study. However, considering the results of many European studies, one has to be fair in saying that cimetidine is useful for duodenal ulcers if used according to F.D.A. guidelines. The problem of cimetidine therapy starts when it is used for almost any gastrointestinal condition in a knee jerk fashion. Cimetidine is not any better than antacids. It gained rapid acceptance in the treatment of ulcer disease only because of its ease of administration and lack of side effects, like diarrhea. My purpose of writing this article is to highlight that cimetidine is not a cure-all and is over utilized. It has been estimated that approximately 11 million patients were treated with cimetidine between November 1976 to February 1979. The number has reached a staggering level now. I will be heartbroken if some serious side effect comes into light after 15-20 years of its use. I am sure everyone is familiar with the INH story. INH toxicity is just becoming known after more than 20 years of clinical use. One should also not forget the uterine cancer in daughters of mothers on DES. The purpose of this article is just to underline the need for a proper indication in the use of cimetidine.