Cimetidine as adjunctive treatment for acetaminophen overdose.
The aim of this study was to determine if cimetidine in addition to N-acetylcysteine and standard supportive care provide additional hepatoprotection following acute acetaminophen poisoning. It was designed as a prospective study with alternate month treatment protocol, and the work was carried out at a regional certified poison information centre. For a 2-year period, consultations received by the Rocky Mountain Poison Center involving acute acetaminophen overdose patients with a serum level above the nomogram line, but who would not receive N-acetylcystine therapy until at least 8 h postingestion, were prospectively evaluated for adjunctive treatment with cimetidine. All patients received standard supportive therapy and N-acetylcysteine treatment. During odd numbered months, cimetidine 300 mg was administered intravenously every 6 h for the duration of N-acetylcysteine therapy. Forty-one cimetidine treated patients were compared to 66 patients in the control group. The peak measured AST levels (+/- s.e.) were 1259+/-330 and 1301+/-451 for the control and cimetidine treatment groups, respectively (P = 0.94). Fourteen of 64 patients (21%) in the control group and 8/41 patients (20%) in the cimetidine group developed an AST > 1000 IUL-1. There were no statistical differences between the cimetidine-treated and control groups when classified by AST < 100 IUL-1, 100-1000 IUL-1, or > 1000 IUL-1. The addition of cimetidine therapy to standard N-acetylcysteine treatment did not provide additional hepatoprotection in acutely acetaminophen poisoned patients when treatment was started later than 8 h post overdose.(ABSTRACT TRUNCATED AT 250 WORDS)
Burkhart
K K
KK
Rocky Mountain Poison and Drug Center, Denver General Hospital, University of Colorado Health Sciences Center 80204, USA.
Janco
N
N
Kulig
K W
KW
Rumack
B H
BH
D000082:Acetaminophen / Q000009:adverse effects* / Q000037:antagonists & inhibitors*; D000328:Adult; D002927:Cimetidine / Q000627:therapeutic use*; D062787:Drug Overdose / Q000188:drug therapy; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000517:prevention & control; D008297:Male
D000082:Acetaminophen; D002927:Cimetidine