Considerations for selection of parenteral histamine (H2)-receptor antagonists

Parenteral histamine (H2)-receptor antagonists are safe and effective therapy for the prophylaxis of stress-related erosive syndrome. Of the three agents available, parenteral cimetidine is the most widely studied; parenteral formulations of ranitidine and famotidine have not been investigated as extensively. Parenteral cimetidine appears to be effective in reducing incidence and complications associated with gastrointestinal hemorrhage caused by stress-related erosive syndrome, although its effects on bleeding that has already begun are not clear. Antacids are also effective in decreasing the incidence of stress-related gastrointestinal hemorrhage, but they are inconvenient and expensive to administer. Primed continuous of stress-related erosive syndrome in critically ill patients; the evidence available on the efficacy of continuous infusions of ranitidine is inconsistent, and very few data are available on the value of famotidine. Direct comparative clinical trials are needed to assess definitively the efficacy of primed continuous infusions of cimetidine or other H2-receptor antagonists versus that of antacid therapy.