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Efficacy of cimetidine for gastric acid suppression in pediatric patients
J Lambert1, M Mobassaleh, R J Grand
1Department of Pediatrics, Boston Floating Hospital, New England Medical Center, Tufts University School of Medicine, Massachusetts.
Insights
Recommended cimetidine doses may be insufficient for adequate gastric acid suppression in pediatric patients. Higher doses showed improved efficacy in a double-blind study evaluating gastric pH.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Clinical Trials
Background:
- Gastroesophageal reflux and associated symptoms are common in pediatric patients.
- Cimetidine is used for gastric acid suppression, but optimal dosing in children is unclear.
Purpose of the Study:
- To evaluate the efficacy of oral cimetidine for gastric acid suppression in pediatric patients.
- To determine optimal dosing of cimetidine for achieving adequate gastric acid suppression in children.
Main Methods:
- Double-blind study involving 27 pediatric patients with gastrointestinal and/or pulmonary symptoms.
- Randomized administration of cimetidine at doses of 5, 7.5, 10, and 15 mg/kg.
- Continuous intragastric pH monitoring was used to assess gastric acid suppression.
Main Results:
- Higher cimetidine doses (10 and 15 mg/kg) demonstrated more effective and sustained gastric acid suppression compared to lower doses (5 and 7.5 mg/kg).
- At 10 mg/kg, 75% of patients achieved a gastric pH > 4 within 2 hours, with 75% experiencing suppression longer than 2 hours.
- Doses of 15 mg/kg showed sustained response for over 2 hours in 75% of patients, and over 3 hours in 50%.
Conclusions:
- Current recommended cimetidine doses for pediatric patients may not achieve adequate gastric acid suppression.
- Higher doses of cimetidine appear necessary for effective and sustained acid control in children.
- Further studies are warranted to establish optimal cimetidine dosing guidelines for pediatric use.
Abstract:
The efficacy of oral cimetidine for gastric acid suppression in pediatric patients was examined in a double-blind study. Twenty-seven patients with gastroesophageal reflux-related gastrointestinal symptoms, pulmonary symptoms, or both were given randomly determined doses of cimetidine. Response was evaluated by continuous intragastric monitoring with a pH probe. Twenty-three patients were given cimetidine doses of 5,7.5, and 10 mg/kg; eight of these patients were also given additional doses of 15 mg/kg. Four patients received only 10 and 15 mg/kg, because of previous poor clinical response to the lower dosages. The onset of gastric pH greater than 4 was delayed more than 2 hours in 50% of patients with responses to the 5 mg/kg dose. Of the patients with responses to the 10 mg/kg dose, 75% had showed a rise in gastric pH greater than 4 within 2 hours. With respect to the duration of gastric acid suppression, 70% of patients receiving 5 mg/kg doses and 52% of those receiving 7.5 mg/kg doses did not have a sustained a response for more than 2 hours, whereas 75% of patients receiving 10 mg/kg doses had gastric acid suppression for longer than 2 hours. Of the patients receiving 15 mg/kg doses, 75% had a response for more than 2 hours; 50% of these patients had a response for more than 3 hours. We conclude that recommended doses of cimetidine for children may not be optimal for adequate gastric acid suppression.