The effect of oral cimetidine on total and unbound serum lidocaine concentrations in patients with suspected myocardial infarction

Berk, Steven I.; Gál, Péter; Bauman, Jerry L.; Douglas, Jean B.; McCue, Jack D.; Powell, J. Robert

doi:10.1016/0167-5273(87)90182-3

Cited by 8 publications

(2 citation statements)

References 7 publications

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“…This finding may have been influenced by the numerous concomitant drugs received by patients in the study. Berk et al (1987) reported that oral cimetidine increased the total and unbound lidocaine concentrations in 6 patients who were receiving continuous infusions oflidocaine. However, one major flaw of this study was the lack of a control patient population.…”

Section: Antiarrhythmicsmentioning

confidence: 98%

“…Cimetidine increased lidocaine concentrations in 6 healthy volunteers; 5 of these experienced symptoms of toxicity (Feely et al 1982). Berk et al (1987) reported that altered protein binding in patients with myocardial infarction reduced the clinical relevance of increased total lidocaine concentrations. In these patients, total lidocaine concentrations increased by 24% but unbound lidocaine increased by only 9% at 24h after cimetidine administration.…”

Section: Antiarrhythmicsmentioning

confidence: 99%

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Clinical Relevance of Cimetidine Drug Interactions

Shinn

1992

Drug Safety

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The excellent efficacy and tolerability profiles of H2-antagonists have established these agents as the leading class of antiulcer drugs. Attention has been focused on drug interactions with H2-antagonists as a means of product differentiation and because many patients are receiving multiple drug therapy. The main mechanism of most drug interactions involving cimetidine appears to be inhibition of the hepatic microsomal enzyme cytochrome P450, an effect which may be related to the different structures of H2-antagonists. Ranitidine appears to have less affinity than cimetidine for this system. There have been many published case reports and studies of drug interactions with cimetidine, but many of these have provided pharmacokinetic data only, with little information concerning the clinical significance of these findings. Nevertheless, the coadministration of cimetidine with drugs that have a narrow therapeutic margin (such as theophylline) may potentially result in clinically significant adverse effects. The monitoring of serum concentrations of drugs coadministered with cimetidine may reduce the risk of adverse events but does not abolish the problem. However, for most patients, concomitant administration of cimetidine with drugs possessing a wide therapeutic margin is unlikely to pose a significant problem.

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Section: Antiarrhythmicsmentioning

confidence: 98%

Section: Antiarrhythmicsmentioning

confidence: 99%