Doxepin and cimetidine in the treatment of duodenal ulcer: a double-blind comparative study

Twenty-one patients with endoscopically proven active duodenal ulcers were studied in a double-blind randomized trial comparing doxepin hydrochloride (50 mg during the first week, and 100 mg thereafter, at bedtime) and cimetidine (1,200 mg/day in four divided doses). After two weeks, the average size of the ulcers had decreased 94% in the doxepin group (n = 8) versus 66% in the cimetidine group (n = 13) (P less than 0.01). After six weeks, the average size of the ulcers had decreased 97% in both the doxepin group (n = 5) and the cimetidine group (n = 10). Doxepin was significantly (P less than 0.01) more effective than cimetidine in women. Although cimetidine was less effective than doxepin, it was more effective in men than in women. Neither drug significantly altered ratings of the patients' anxiety or depression, most of which were within the normal range before and throughout treatment. Possible mechanisms of action of this tricyclic antidepressant and suggestions for its use in ulcer therapy are discussed.