Abstract
Both cimetidine therapy and cirrhosis individually interfere with normal elimination of various drugs. Cimetidine is often prescribed in patients with cirrhosis but there is incomplete data on its effect on drug elimination in cirrhotics. The purpose of this study was to address this issue. Eight stable cirrhotics were studied prior to and following 7 days of cimetidine administration, (300 mg orally q.i.d.). Chlordiazepoxide (Librium®), which is eliminated by the liver after demethylation, and indocyanine green, which is removed by the liver without biotransformation, were used as probes. Consistent with the concept that cimetidine interferes with drug metabolism by inhibiting microsomal oxidation, chlordiazepoxide clearance in the cirrhotics was inhibited by cimetidine (p < 0.05), but indocyanine green clearance was unaffected. As shown by us previously, untreated cirrhotics had substantially lower chlordiazepoxide clearance than did controls. The inhibitory effect of cimetidine on chlordiazepoxide clearance was less in cirrhotics than in controls (p < 0.05). In all subjects, there was excellent correlation between initial clearance and magnitude of depression in clearance after cimetidine, i.e., the larger the initial clearance, the larger the change (r = 0.97, p < 0.0001). Forty-eight hours after stopping cimetidine, chlordiazepoxide clearance returned to baseline in cirrhotics and controls. Our data demonstrate that cimetidine and cirrhosis may act additively to impair drug metabolism. This effect of cimetidine on chlordiazepoxide clearance is smaller in cirrhotics than in controls, but because of impaired initial drug elimination in cirrhosis, it may result in adverse clinical effects.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 305-309 |
| Number of pages | 5 |
| Journal | Hepatology |
| Volume | 5 |
| Issue number | 2 |
| DOIs | |
| State | Published - 1985 |
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ASJC Scopus subject areas
- Hepatology
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The effect of cimetidine on hepatic drug elimination in cirrhosis. / Nelson, D. C.; Avant, G. R.; Speeg, Kermit V; Hoyumpa, A. M.; Schenker, S.
In: Hepatology, Vol. 5, No. 2, 1985, p. 305-309.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The effect of cimetidine on hepatic drug elimination in cirrhosis
AU - Nelson, D. C.
AU - Avant, G. R.
AU - Speeg, Kermit V
AU - Hoyumpa, A. M.
AU - Schenker, S.
PY - 1985
Y1 - 1985
N2 - Both cimetidine therapy and cirrhosis individually interfere with normal elimination of various drugs. Cimetidine is often prescribed in patients with cirrhosis but there is incomplete data on its effect on drug elimination in cirrhotics. The purpose of this study was to address this issue. Eight stable cirrhotics were studied prior to and following 7 days of cimetidine administration, (300 mg orally q.i.d.). Chlordiazepoxide (Librium®), which is eliminated by the liver after demethylation, and indocyanine green, which is removed by the liver without biotransformation, were used as probes. Consistent with the concept that cimetidine interferes with drug metabolism by inhibiting microsomal oxidation, chlordiazepoxide clearance in the cirrhotics was inhibited by cimetidine (p < 0.05), but indocyanine green clearance was unaffected. As shown by us previously, untreated cirrhotics had substantially lower chlordiazepoxide clearance than did controls. The inhibitory effect of cimetidine on chlordiazepoxide clearance was less in cirrhotics than in controls (p < 0.05). In all subjects, there was excellent correlation between initial clearance and magnitude of depression in clearance after cimetidine, i.e., the larger the initial clearance, the larger the change (r = 0.97, p < 0.0001). Forty-eight hours after stopping cimetidine, chlordiazepoxide clearance returned to baseline in cirrhotics and controls. Our data demonstrate that cimetidine and cirrhosis may act additively to impair drug metabolism. This effect of cimetidine on chlordiazepoxide clearance is smaller in cirrhotics than in controls, but because of impaired initial drug elimination in cirrhosis, it may result in adverse clinical effects.
AB - Both cimetidine therapy and cirrhosis individually interfere with normal elimination of various drugs. Cimetidine is often prescribed in patients with cirrhosis but there is incomplete data on its effect on drug elimination in cirrhotics. The purpose of this study was to address this issue. Eight stable cirrhotics were studied prior to and following 7 days of cimetidine administration, (300 mg orally q.i.d.). Chlordiazepoxide (Librium®), which is eliminated by the liver after demethylation, and indocyanine green, which is removed by the liver without biotransformation, were used as probes. Consistent with the concept that cimetidine interferes with drug metabolism by inhibiting microsomal oxidation, chlordiazepoxide clearance in the cirrhotics was inhibited by cimetidine (p < 0.05), but indocyanine green clearance was unaffected. As shown by us previously, untreated cirrhotics had substantially lower chlordiazepoxide clearance than did controls. The inhibitory effect of cimetidine on chlordiazepoxide clearance was less in cirrhotics than in controls (p < 0.05). In all subjects, there was excellent correlation between initial clearance and magnitude of depression in clearance after cimetidine, i.e., the larger the initial clearance, the larger the change (r = 0.97, p < 0.0001). Forty-eight hours after stopping cimetidine, chlordiazepoxide clearance returned to baseline in cirrhotics and controls. Our data demonstrate that cimetidine and cirrhosis may act additively to impair drug metabolism. This effect of cimetidine on chlordiazepoxide clearance is smaller in cirrhotics than in controls, but because of impaired initial drug elimination in cirrhosis, it may result in adverse clinical effects.
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UR - http://www.scopus.com/inward/citedby.url?scp=0021955441&partnerID=8YFLogxK
U2 - 10.1002/hep.1840050226
DO - 10.1002/hep.1840050226
M3 - Article
C2 - 3979962
AN - SCOPUS:0021955441
VL - 5
SP - 305
EP - 309
JO - Hepatology
JF - Hepatology
SN - 0270-9139
IS - 2
ER -