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The cimetidine-lidocaine interaction.

A B Knapp, W Maguire, G Keren

    Annals of Internal Medicine
    |February 1, 1983
    PubMed
    Summary
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    Cimetidine, an H2-receptor antagonist, significantly increases serum lidocaine concentration, potentially leading to toxic levels. This drug interaction highlights the importance of monitoring lidocaine levels when co-administered with cimetidine.

    Area of Science:

    • Pharmacology
    • Clinical Medicine

    Background:

    • Lidocaine is a crucial antiarrhythmic drug, but its efficacy is influenced by hepatic blood flow.
    • Cimetidine, an H2-receptor antagonist, is known to reduce hepatic blood flow.

    Purpose of the Study:

    • To investigate the potential interaction between cimetidine and lidocaine.
    • To determine if cimetidine affects serum lidocaine concentrations.

    Main Methods:

    • A study involving 21 patients receiving continuous lidocaine infusions.
    • Patients were divided into two groups: one receiving cimetidine (300 mg every 6 hours) with lidocaine, and a control group receiving only lidocaine.
    • Serum lidocaine levels were monitored.

    Main Results:

    • 14 out of 15 patients receiving both lidocaine and cimetidine showed an increase in serum lidocaine levels.

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  • Six patients in the combined group developed toxic lidocaine levels, with two experiencing symptoms.
  • No significant change in lidocaine levels was observed in the control group.
  • Concomitant administration of diphenhydramine (an H1-receptor antagonist) with lidocaine did not result in elevated lidocaine levels.

    • Conclusions:

    • A significant drug interaction exists between lidocaine and cimetidine.
    • Cimetidine's inhibition of H2 receptors likely mediates the observed increase in serum lidocaine levels.
    • Careful monitoring of lidocaine levels is recommended when co-administered with cimetidine to prevent toxicity.