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Increased cimetidine clearance in burn patients.
JAMA
|March 1, 1985
Summary
Burned patients clear cimetidine faster, reducing its effectiveness. Increased drug clearance in burn patients may necessitate adjusted dosing schedules for optimal therapeutic outcomes.
Area of Science:
- Pharmacokinetics
- Critical Care Medicine
- Burn Injury
Background:
- Cimetidine efficacy is often reduced in burned and critically ill surgical patients.
- The underlying pharmacokinetic changes are not fully understood.
Purpose of the Study:
- To investigate the pharmacokinetics and dynamics of cimetidine in burned patients.
- To identify the reasons for decreased cimetidine efficacy in this population.
Main Methods:
- Studied cimetidine kinetics in eight burned patients and compared them to nine healthy controls.
- Measured drug elimination half-life, total clearance, and correlated clearance with burn size.
- Monitored gastric pH in relation to plasma cimetidine levels.
Main Results:
- Burned patients exhibited a significantly reduced elimination half-life (1.5 vs. 2.2 hours) and increased total clearance (13.3 vs. 8.2 mL/min/kg) of cimetidine.
- Cimetidine clearance strongly correlated with the size of the burn.
- Higher drug excretion was observed in burned patients within eight hours compared to controls over 24 hours.
Conclusions:
- Increased cimetidine clearance in burned patients likely explains its diminished effectiveness.
- Altered dosing regimens may be required to maintain therapeutic plasma levels in critically ill surgical and burn patients.