Are H2 receptor antagonists safe over the counter drugs?

Andersen, Morten; Schou, Jens

doi:10.1136/bmj.309.6953.493

Cited by 18 publications

(14 citation statements)

References 7 publications

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“…However, the Danish experience of 5 years with OTC H 2 ‐antagonists does not support this hypothesis. They did not notice any change in hospital admission pattern for complications of ulcer disease 3 . Similarly, Feldman 4 also found no evidence that availability of prescription H 2 ‐antagonists had resulted in a delay in diagnosis or therapy of patients with ulcerated gastric cancer or an alteration in the prognosis.…”

Section: Discussionmentioning

confidence: 96%

“…Similarly, Feldman 4 also found no evidence that availability of prescription H 2 ‐antagonists had resulted in a delay in diagnosis or therapy of patients with ulcerated gastric cancer or an alteration in the prognosis. Nevertheless, it is imperative that consumers are warned not to take OTC H 2 ‐antagonists if they are aged over 65 or if certain symptoms are present, especially the so‐called alarm symptoms 3 , . 4 In addition, recurrent nocturnal heartburn symptoms are often associated with reflux oesophagatis, which should not be treated by either antacids or H 2 ‐antagonists in OTC dosage 18 , .…”

Section: Discussionmentioning

confidence: 99%

“… 2 Until recently, for lack of an alternative over‐the‐counter (OTC) medication, antacid self‐medication was largely uncontested 2 . The range of available drugs is now increasing, however, because an OTC status has been given to H 2 ‐antagonists 3 …”

Section: Introductionmentioning

confidence: 99%

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Comparison of the effect of the antacid Rennie versus low‐dose H₂‐receptor antagonists (ranitidine, famotidine) on intragastric acidity

Netzer

Brabetz-Höfliger

Bründler

et al. 1998

Aliment Pharmacol Ther

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The onset of action in fasting volunteers was significantly faster with the antacid than with the two H2-antagonists. The duration of action was significantly longer with an H2-antagonist than with the antacid. This suggests that the two products should be used for different indications: antacids are superior for rapid pain relief, whereas H2-antagonists might be better for symptom prophylaxis--for example for nocturnal dyspepsia.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Comparison of the effect of the antacid Rennie versus low‐dose H₂‐receptor antagonists (ranitidine, famotidine) on intragastric acidity

Netzer

Brabetz-Höfliger

Bründler

et al. 1998

Aliment Pharmacol Ther

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“…Clearly, clinical The three major limitations in epidemiological studies are selection bias, information bias and confounding. The acute liver injury is fairly rare in patients treated with antiulcer drugs, and more data are required to confirm whether identification of the cohort population through the computer files of the GPRD database with a sampling method cimetidine carries a greater risk than that of other acidsuppressing drugs [19]. unrelated to the outcome renders selection bias an improbable explanation for the observed estimates of risk.…”

Section: Case Validation Study Cohort Definitionmentioning

confidence: 99%

The risk of acute liver injury associated with cimetidine and other acid‐suppressing anti‐ulcer drugs

Rodríguez

Wallander

Stricker

1997

Brit J Clinical Pharma

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Aims The objective of this study was to estimate the risk of acute liver injury associated with individual acid‐suppressing drugs and assess the role of dose and duration of treatment. Methods We used a nested case‐control study design within a cohort of over 100 000 users of cimetidine, famotidine, omeprazole and ranitidine. The primary source of information was the General Practitioners Research Database. We identified 108 981 persons aged 20–74 years who received at least one prescription for cimetidine, famotidine, omeprazole, or ranitidine during 1990–93, and we ascertained the first occurrence of clinically acute liver injury referred to a specialist or admitted to a hospital. Results After review of medical records, 33 patients were considered eligible cases of idiopathic acute liver injury with no fatal cases. The type of liver injury was hepatocellular in almost half of the cases, and 80% of all cases presented with jaundice. Twelve cases occurred among current users of cimetidine, five among ranitidine users and one in an omeprazole user. The absolute risk of acute liver injury associated with cimetidine was estimated to be slightly greater than one per 5000 users of cimetidine. The adjusted relative risk (RRs) and 95% CI of developing acute liver injury associated with current use of cimetidine compared to non‐use was 5.5 (1.9–15.9), with omeprazole 2.1 (0.2–19.2) and with ranitidine 1.7 (0.5–5.8). In the absence of concomitant use of other hepatotoxic drugs, the RR with cimetidine was 14.4 (2.8–73.7). Among users of cimetidine, the risk was especially high in the first 2 months of starting therapy (RR: 11.3, 3.7–35.1) and at daily doses of 800 mg or greater (RR: 8.8, 3.0–26.0). Conclusions Cimetidine was the individual anti‐ulcer drug with the highest risk of developing symptomatic acute liver disease. Further data are required to confirm this finding. Our study indicates that there is a dose relationship and a short latent period between cimetidine treatment and acute liver injury.

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“…The study relied on using computerised prescribing records from general practices as the main source of prescribing data. This neglects the confounding influence of over the counter drugs which have an important influence on the prevalence of gastrointestinal disease 4 5…”

mentioning

confidence: 99%

Risk of gastrointestinal effects with COX-2 inhibitors and NSAIDs: COX-2 inhibitors were thought of as a safe option

Lewis¹,

Kay

2005

BMJ

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Editor-News that pressing financial problems have caused NHS trusts in Suffolk to set new "thresholds" to treatments such as joint replacements reinforces concerns raised by a recent BMA survey of medical directors of trusts in which over a third of respondents anticipated reductions of key services in response to funding shortfalls. What has hitherto escaped comment is how cuts in services are far more likely to be felt in some parts of the country than others.Deficits in the NHS are invariably presented as a problem of financial mismanagement, but the pattern of deficits shows that the current resource allocation model discriminates against particular communities. According to the recently published accounts for 3 89 out of 303 (30%) English primary care trusts ended the year in deficit. The table shows how 301 of these trusts are distributed accorded to fifths of deprivation and rurality.Primary care trusts serving populations that are in both the most rural and the least deprived fifth were most likely to be in financial difficulties. Seventeen of the 25 (68%) in this category were in deficit. These trusts received the lowest funding allocation per head (£995). By contrast, only 3% (one of 34) of the primary care trusts serving populations that are in both the most urban and the most deprived fifths failed to break even in 2004-5. These trusts received the highest funding allocations per head (£1405).This shows that poor financial management can at best only partly explain why some trusts are in deficit. The pattern of deficits implies that NHS funding provides insufficient resources for rural areas, for comparatively affluent areas, and, most particularly, for areas that are both rural and affluent. The risk is that such measures will result in NHS services being subject to a new postcode lottery, in which rural residents are more likely to lose out. Sheena Asthana professor of health policy

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Are H2 receptor antagonists safe over the counter drugs?

Cited by 18 publications

References 7 publications

Comparison of the effect of the antacid Rennie versus low‐dose H₂‐receptor antagonists (ranitidine, famotidine) on intragastric acidity

Comparison of the effect of the antacid Rennie versus low‐dose H₂‐receptor antagonists (ranitidine, famotidine) on intragastric acidity

The risk of acute liver injury associated with cimetidine and other acid‐suppressing anti‐ulcer drugs

Risk of gastrointestinal effects with COX-2 inhibitors and NSAIDs: COX-2 inhibitors were thought of as a safe option

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Are H2 receptor antagonists safe over the counter drugs?

Cited by 18 publications

References 7 publications

Comparison of the effect of the antacid Rennie versus low‐dose H2‐receptor antagonists (ranitidine, famotidine) on intragastric acidity

Comparison of the effect of the antacid Rennie versus low‐dose H2‐receptor antagonists (ranitidine, famotidine) on intragastric acidity

The risk of acute liver injury associated with cimetidine and other acid‐suppressing anti‐ulcer drugs

Risk of gastrointestinal effects with COX-2 inhibitors and NSAIDs: COX-2 inhibitors were thought of as a safe option

Contact Info

Product

Resources

About

Comparison of the effect of the antacid Rennie versus low‐dose H₂‐receptor antagonists (ranitidine, famotidine) on intragastric acidity

Comparison of the effect of the antacid Rennie versus low‐dose H₂‐receptor antagonists (ranitidine, famotidine) on intragastric acidity