Abstract
Cimetidine markedly inhibits gastric acid secretion, but from the therapeutic point of view it is important to know whether concurrent treatment with an anticholinergic increases its effect. This possibility has been investigated by measuring the 24 h intragastric acidity and nocturnal output of acid in four duodenal ulcer patients, each receiving on separate occasions cimetidine 1 g/day and placebo, atropine 2-4 mg/day and placebo, cimetidine and atropine, or two placebos. Cimetidine alone decreased mean hourly hydrogen ion activity by 63% of control values, decreased mean hourly hydrogen ion concentration (total acid) by 41%, inhibited nocturnal acid secretion by 83% and resulted in half the nocturnal samples being anacidic. Atropine alone had no effect when compared with control and combined treatment with both drugs was not superior to cimetidine alone. Atropine did not affect the absorption or urinary excretion of cimetidine. Fasting serum gastrin concentrations were not changed by any of the treatments. At the doses studied, the combination of cimetidine with an anticholinergic appears to offer no advantages over treatment with the H2-antagonist alone. Cimetidine is the only potent anti-secretory drug that does not cause acute side-effects and this important advantage would be lost if it were given with a maximal dose of an anticholinergic.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Beermann B., Hellström K., Rosèn A. On the metabolism of propantheline in man. Clin Pharmacol Ther. 1972 Mar-Apr;13(2):212–220. doi: 10.1002/cpt1972132212. [DOI] [PubMed] [Google Scholar]
- Beermann B., Hellström K., Rosén A. The gastrointestinal absorption of atropine in man. Clin Sci. 1971 Jan;40(1):95–106. doi: 10.1042/cs0400095. [DOI] [PubMed] [Google Scholar]
- Brömster D., Carlberger G., Lundh G., Möller J., Rosén A. The effect of some oral anticholinergics on gastric emptying, pH and osmolarity in man. Scand J Gastroenterol. 1969;4(2):185–192. doi: 10.3109/00365526909179927. [DOI] [PubMed] [Google Scholar]
- Burland W. L., Duncan W. A., Hesselbo T., Mills J. G., Sharpe P. C., Haggie S. J., Wyllie J. H. Pharmacological evaluation of cimetidine, a new histamine H2-receptor antagonist, in healthy man. Br J Clin Pharmacol. 1975 Dec;2(6):481–486. doi: 10.1111/j.1365-2125.1975.tb00564.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- GROISSER V. W., FARRAR J. T. Effect of intestinal motility on the absorption of sodium in man. Am J Dig Dis. 1962 Jan;7:57–68. doi: 10.1007/BF02231931. [DOI] [PubMed] [Google Scholar]
- Gibbons D. O., Lant A. F. Effects of intravenous and oral propantheline and metoclopramide on ethanol absorption. Clin Pharmacol Ther. 1975 May;17(5):578–584. doi: 10.1002/cpt1975175578. [DOI] [PubMed] [Google Scholar]
- Ivey K. J. Anticholinergics: do they work in peptic ulcer? Gastroenterology. 1975 Jan;68(1):154–166. [PubMed] [Google Scholar]
- Jaffe J. M. Effect of propantheline on nitrofurantoin absorption. J Pharm Sci. 1975 Oct;64(10):1729–1730. doi: 10.1002/jps.2600641039. [DOI] [PubMed] [Google Scholar]
- Konturek S. J., Biernat J., Oleksy J., Rehfeld J. F., Stadil F. Effect of atropine on gastrin and gastric acid response to peptone meal. J Clin Invest. 1974 Sep;54(3):593–597. doi: 10.1172/JCI107796. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Levy G., Gibaldi M., Procknal J. A. Effect of an anticholinergic agent on riboflavin absorption in man. J Pharm Sci. 1972 May;61(5):798–799. doi: 10.1002/jps.2600610529. [DOI] [PubMed] [Google Scholar]
- Longstreth G. F., Go V. L., Malagelada J. R. Cimetidine suppression of nocturnal gastric secretion in active duodenal ulcer. N Engl J Med. 1976 Apr 8;294(15):801–804. doi: 10.1056/NEJM197604082941502. [DOI] [PubMed] [Google Scholar]
- Manninen V., Apajalahti A., Melin J., Karesoja M. Altered absorption of digoxin in patients given propantheline and metoclopramide. Lancet. 1973 Feb 24;1(7800):398–400. doi: 10.1016/s0140-6736(73)90252-3. [DOI] [PubMed] [Google Scholar]
- Milton-Thompson G. J., Williams J. G., Jenkins D. J., Misiewicz J. J. Inhibition of nocturnal acid secretion in duodenal ulcer by one oral dose of metiamide. Lancet. 1974 Apr 20;1(7860):693–694. doi: 10.1016/s0140-6736(74)92901-8. [DOI] [PubMed] [Google Scholar]
- Nimmo J., Heading R. C., Tothill P., Prescott L. F. Pharmacological modification of gastric emptying: effects of propantheline and metoclopromide on paracetamol absorption. Br Med J. 1973 Mar 10;1(5853):587–589. doi: 10.1136/bmj.1.5853.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pounder R. E., Williams J. G., Milton-Thompson G. J., Misiewicz J. J. 24-hour control of intragastric acidity by cimetidine in duodenal-ulcer patients. Lancet. 1975 Nov 29;2(7944):1069–1072. doi: 10.1016/s0140-6736(75)90434-1. [DOI] [PubMed] [Google Scholar]
- Pounder R. E., Williams J. G., Milton-Thompson G. J., Misiewicz J. J. Effect of cimetidine on 24-hour intragastric acidity in normal subjects. Gut. 1976 Feb;17(2):133–138. doi: 10.1136/gut.17.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Richardson C. T., Walsh J. H. The value of a histamine H2-receptor antagonist in the management of patients with the Zollinger-Ellison syndrome. N Engl J Med. 1976 Jan 15;294(3):133–135. doi: 10.1056/NEJM197601152940304. [DOI] [PubMed] [Google Scholar]
- Thjodleifsson B., Wormsley K. G. Gastric response to metiamide. Br Med J. 1974 May 11;2(5914):304–306. doi: 10.1136/bmj.2.5914.304. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thompson M. H., Albinus M., Blair E. L., Reed J. D., Venables C. W. Proceedings: The interaction of cholinergic and histaminic blockades on the partieta cell: therapeutic possibilities. Br J Surg. 1975 Feb;62(2):158–158. [PubMed] [Google Scholar]