title: One week treatment with cimetidine does not attenuate the cortisol response to a short corticotropin test in stable intensive care patients: a prospective, randomized, and controlled study.
abstract: Cimetidine is commonly used for stress ulcer prophylaxis in intensive care patients. Cimetidine contains an imidazole structure. Similar drugs have been shown to inhibit steroid synthesis by blocking cytochrome P450-dependent reactions in the adrenal cortex. It is suggested that bolus injections of cimetidine suppress the normal corticosteroid production. This might be deleterious since a decreased cortisol response seems to be associated with increased mortality during chronic severe stress. We therefore performed a prospective, randomized, and controlled study to assess the effect of a short-term continuous infusion of either cimetidine or ranitidine, a non-imidazole H2-pantagonist, upon cortisol secretion in a cohort of hemodynamically stable intensive care patients. Twenty patients were consecutively enrolled following determined inclusion criteria and divided in three treatment groups: 6 controls, 7 cimetidine- and 7 ranitidinetreated subjects. Both cimetidine (1200 mg) and ranitidine (200 mg) were administered by infusion pump over 24 hrs. A short corticotropin test was done within 24 hrs after admission (d0) and repeated 7 days thereafter (d7). On both occasions, plasma cortisol was measured immediately before the test and 30 min afterwards. The three treatment groups presented a normal cortisol response at d0 and d7. Peak cortisol levels after stimulation did not show any significant difference for both the cimetidine and the ranitidine group, either at d0 or at d7. Moreover, this response at d0 and d7 was also not significantly different from the one observed in the controls. From this study we can conclude that one week treatment with conventional intravenous doses of cimetidine does not induce significant alterations of the cortisol response in hemodynamically stable ICU patients.
authors.affiliation: Intensive Care Department, Academic Hospital, Vrije Universiteit Brussel, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Spapen
authors.forename: M
authors.initials: M
authors.lastname: Diltoer
authors.forename: D N
authors.initials: DN
authors.lastname: Nguyen
authors.forename: G
authors.initials: G
authors.lastname: Ingels
authors.forename: J
authors.initials: J
authors.lastname: Ramet
authors.forename: L
authors.initials: L
authors.lastname: Huyghens
mesh_terms: D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D002927:Cimetidine / Q000494:pharmacology*; D005260:Female; D006635:Histamine H2 Antagonists / Q000494:pharmacology*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011899:Ranitidine / Q000494:pharmacology*
chemical_list: D006635:Histamine H2 Antagonists; D002927:Cimetidine; D011899:Ranitidine; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone