Is Cimetidine even dispense anymore?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

SHC1984

Membership Revoked
Removed
10+ Year Member
5+ Year Member
15+ Year Member
Joined
Feb 1, 2007
Messages
6,105
Reaction score
22
The insurance company I am doing my rotation at wants me to find data that supports the use of Cimetidine in children. Ranitidine is too expensive, so I need to find data to support the use of Cimetidine in children. All the data are old and from the 1980s. LOL... I hope that's okay. All the data seem to think cimetidine is okay, but has more side effects.


I know cimetidine has more drug drug interactions and side effects. Anyone here thinks it's a good idea to use cimetidine in children? Has anyone ever dispense this drug before?

Members don't see this ad.
 
It's good for warts!

Thank you there is actually articles on that too, but I think they are more worried about the GI area. LOL...

If you had a son would you put him on Rantidine or Cimetidine?

I think Rantidine is better, but the insurance company gotta save money, so whatever is the cheapest will have to work.
 
Members don't see this ad :)
If anyone can help me do my job and find articles (RECENT articles) to support the use of cimetidine in children please post it on here.

I prefer to go home before 5PM today.

Thanks.
 
If anyone can help me do my job and find articles (RECENT articles) to support the use of cimetidine in children please post it on here.

I prefer to go home before 5PM today.

Thanks.

Why is it our job to do your job? Suck it up buttercup.
 
If there were no DDI, I honestly wouldn't care as they are all BID and approximately equally effective

Okay thanks. I think that's what I am gonna tell them. I just didn't know if it will be a good idea to support the use of cimetidtine since it hasn't been used in many years and all the data on it is very old.


I'm pretty sure Ranitidine is cheap. Official formulary at the nursing home where I worked preferred Ranitidine and Famotidine.

http://scholar.google.com/scholar?hl=en&q=children+cimetidine&btnG=&as_sdt=1,33&as_sdtp=

Thanks! I think cimetidine is the cheapest so we wanna use that over anything else. The more money we save the more money in our pockets. ;)
 
Okay thanks. I think that's what I am gonna tell them. I just didn't know if it will be a good idea to support the use of cimetidtine since it hasn't been used in many years and all the data on it is very old.




Thanks! I think cimetidine is the cheapest so we wanna use that over anything else. The more money we save the more money in our pockets. ;)

Would it be worth it to save a few cents per day if you chose something that could have significant risk of DDI's? FWIW Famotidine is the primary H2Antagonist I have seen at hospitals I have worked/interned at for this reason.
 
maybe its a trick question?
 
Would it be worth it to save a few cents per day if you chose something that could have significant risk of DDI's? FWIW Famotidine is the primary H2Antagonist I have seen at hospitals I have worked/interned at for this reason.

It's Cimetidine VS Ranitidine for children. We need the liquid form. Cimetidine is much cheaper but you are right. The drug drug interaction could cause an increase in hospital visits. I will tell them that on Monday. I have no clue what to use...I prefer Rantidine to be honest since I have never seen Cimetidine dispensed before.

"Please do my work for me and oh yes, I want it within the next few hours."

SHC, I bet you are really impressing your preceptors on this rotation. They will probably offer you a job after you graduate.

I actually have an A in this rotation already pretty much (my preceptor told me while we were doing doctor's visits yesterday) and I got an awesome Midpoint evaluation already. :D I am a fast worker and get things done fast. ;) My preceptor saids to look in Tampa, FL for jobs though as thats where their main office is at.
 
It's Cimetidine VS Ranitidine for children. We need the liquid form. Cimetidine is much cheaper but you are right. The drug drug interaction could cause an increase in hospital visits. I will tell them that on Monday. I have no clue what to use...I prefer Rantidine to be honest since I have never seen Cimetidine dispensed before.

What sort of drugs does cimetidine interact with?

I actually have an A in this rotation already pretty much (my preceptor told me while we were doing doctor's visits yesterday) and I got an awesome Midpoint evaluation already. :D I am a fast worker and get things done fast. ;) My preceptor saids to look in Tampa, FL for jobs though as thats where their main office is at.

Good. I hope your preceptor doesn't see this thread, though. :eek:
 
Members don't see this ad :)
DOFETILIDE [Systemic] -- CIMETIDINE [Systemic]
Contraindicated
GoodConcurrent use of CIMETIDINE and DOFETILIDE may result in an increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest).METFORMIN [Systemic] -- CIMETIDINE [Systemic]
Major
ExcellentConcurrent use of METFORMIN and CIMETIDINE may result in an increase in metformin plasma concentrations.CITALOPRAM [Systemic] -- CIMETIDINE [Systemic]
Major
GoodConcurrent use of CIMETIDINE and CITALOPRAM may result in increased citalopram exposure and risk of QT interval prolongation.CIMETIDINE HYDROCHLORIDE [Systemic] -- OXTRIPHYLLINE [Systemic]
Major
GoodConcurrent use of CIMETIDINE and THEOPHYLLINE may result in theophylline toxicity (nausea, vomiting, palpitations, seizures).ZALCITABINE [Systemic] -- CIMETIDINE [Systemic]
Major
GoodConcurrent use of ZALCITABINE and CIMETIDINE may result in increased risk of zalcitabine toxicity (peripheral neuropathy, pancreatitis, lactic acidosis, hepatomegaly, hepatic failure).POSACONAZOLE [Systemic] -- CIMETIDINE [Systemic]
Major
GoodConcurrent use of CIMETIDINE and POSACONAZOLE may result in decreased posaconazole concentration.CHLOROQUINE [Systemic] -- CIMETIDINE [Systemic]
Major
GoodConcurrent use of CHLOROQUINE and CIMETIDINE may result in chloroquine toxicity (agitation, seizures, cardiac arrest).CIMETIDINE HYDROCHLORIDE [Systemic] -- MEPERIDINE [Systemic]
Major
GoodConcurrent use of MEPERIDINE and CIMETIDINE may result in meperidine toxicity (respiratory depression, CNS depression, hypotension).CIMETIDINE -- MORPHINE

interact(s) with: Interacting substances MORPHINE
MORPHINE SULFATE LIPOSOME


Major
GoodConcurrent use of CIMETIDINE and MORPHINE may result in morphine toxicity (CNS depression, respiratory depression).DELAVIRDINE [Systemic] -- CIMETIDINE [Systemic]
Major
FairConcurrent use of CIMETIDINE and DELAVIRDINE may result in reduced serum delavirdine levels.CIMETIDINE [Systemic] -- DOMPERIDONE [Systemic]
 
What sort of drugs does cimetidine interact with?



Good. I hope your preceptor doesn't see this thread, though. :eek:

Micromedex and Lexicomp are the best. It's all I use and Pubmed of course...but I don't like PubMed. Cimetidine has a MUCH longer list but SDN limits my post to this...I can't have more than 10 graphics.


Tell me about it...one time I worked for Target and got stuck with the laziest pharmacy manager...I was complaining about it on here and she found out it was me calling her a lazy ass. Man that was awkward. :eek: :oops: :eek: :oops:
 
Micromedex and Lexicomp are the best. It's all I use and Pubmed of course...but I don't like PubMed. Cimetidine has a MUCH longer list but SDN limits my post to this...I can't have more than 10 graphics.


Tell me about it...one time I worked for Target and got stuck with the laziest pharmacy manager...I was complaining about it on here and she found out it was me calling her a lazy ass. Man that was awkward. :eek: :oops: :eek: :oops:


Do you think all of those drug interactions are significant in pediatrics?

So your site is headquartered in Tampa Florida? I thought you said it was owned by the government. Not headquartered in Washington, DC?
 
Do you think all of those drug interactions are significant in pediatrics?

So your site is headquartered in Tampa Florida? I thought you said it was owned by the government. Not headquartered in Washington, DC?

Nah, most of them won't matter...except maybe morphine, celexa, paxil...but most won't b/c children aren't usually on those.

Which is good cuz I already told her I think it's okay to use cimetidine in children. LOL...

I am working for Wellcare. It's used by the state for medicaid and medicare. It's stationed in Tampa Florida. That's what my preceptor told me. She told me the jobs are competitve to get though, but possible...if I start this job I will most likely start with prior authorizations first.

I would LOVE this job, but I am sure it is very competitive like all other jobs.

I'll try my best, but I won't hold my breath either....
 
The job really is relaxing....my preceptor told me I can leave whenever I want to and she leaves whenever she wants to! lol....But I always get my work done first. I am not crazy enough to NOT listen to my preceptor. Of course I will do everything she saids. I can be very good and listen when I have to! LOL...;)
 
"Please do my work for me and oh yes, I want it within the next few hours."

SHC, I bet you are really impressing your preceptors on this rotation. They will probably offer you a job after you graduate.

C'mon, it's not like she actually EMPLOYED. Surely her preceptor doesn't actually expect her to do work, since she's not EMPLOYED. :laugh:
 
I've never written for cimetidine in my entire career (in both medicine or pediatrics)

I also would like to avoid something that inhibits p450 - because it makes it more difficult to add medications to the patient's current regiment (later on when they are hospitalized)

And I don't know about you, but gynecomastia or galactorrhea in children might freak some parents out. And what about teenagers on OCP?

But hey, if it saves a few pennies for the insurance companies, it's all good, because that is what matters most. I'm sure parents and physicians will understand.

(do pharmacies even stock cimetidine anymore? and is there a liquid formulation?)
 
The tablets smell pretty good...kind of like white chocolate.
 
C'mon, it's not like she actually EMPLOYED. Surely her preceptor doesn't actually expect her to do work, since she's not EMPLOYED. :laugh:

Actually this employment is an exception to the rule. My preceptor makes very good money and she works from home and comes to work whenever she feels like it and tells me I can leave whenever I want to. Can't blame you for hating though. :laugh: This is call employment without the stress something you can only wish you had. ;)


I've never written for cimetidine in my entire career (in both medicine or pediatrics)

I also would like to avoid something that inhibits p450 - because it makes it more difficult to add medications to the patient's current regiment (later on when they are hospitalized)

And I don't know about you, but gynecomastia or galactorrhea in children might freak some parents out. And what about teenagers on OCP?

But hey, if it saves a few pennies for the insurance companies, it's all good, because that is what matters most. I'm sure parents and physicians will understand.

(do pharmacies even stock cimetidine anymore? and is there a liquid formulation?)

That's a good point. I don't know much about cimetidine at all and I have NEVER filled it at all as a tech or intern. So I honestly don't know if it is stocked or not anymore.

My preceptor did NOT tell me to decide whether we should use it or not. LOL...that's not my choice.

She only ask me to look up information that supports the use of Cimetidine in children. See what the data saids. I noticed a few things.
1) all the data are from the 1980s.
2) all the data mention cimetidine having more side effects than rantidine and more DDI
3) However, most data said cimetidine is just as effective as rantidine and a few data said rantidine is only marginally more effective than cimetidine.

SO that's what I gathered.

Those are good points you mentioned. I'll make sure I let her know this. I want her to make the best decision. I'll tell her this monday. Thank you.
 
I've never written for cimetidine in my entire career (in both medicine or pediatrics)

I also would like to avoid something that inhibits p450 - because it makes it more difficult to add medications to the patient's current regiment (later on when they are hospitalized)

And I don't know about you, but gynecomastia or galactorrhea in children might freak some parents out. And what about teenagers on OCP?

But hey, if it saves a few pennies for the insurance companies, it's all good, because that is what matters most. I'm sure parents and physicians will understand.

(do pharmacies even stock cimetidine anymore? and is there a liquid formulation?)

Pretty much all this. Good input doc.
 
Sounds like typical government logic. Works+cheap = good. Nevermind the consequences. What's the difference in cost per member/year? What percentage of the pediatric population would we expect to need acid reduction using an H2RA? What are the potential reductions in Quality of life due to side effects? Are there any anticipated increases in overall costs due to medication changes necessitated by using one med over the other? Not really important as long as you can make it home by 5 I guess. We're only talking about thousands of little kids here.
 
Sounds like typical government logic. Works+cheap = good. Nevermind the consequences. What's the difference in cost per member/year? What percentage of the pediatric population would we expect to need acid reduction using an H2RA? What are the potential reductions in Quality of life due to side effects? Are there any anticipated increases in overall costs due to medication changes necessitated by using one med over the other? Not really important as long as you can make it home by 5 I guess. We're only talking about thousands of little kids here.

:laugh:
 
I think how bad of an idea Cimetidine is would become very obvious if SHC built a pharmacoeconomic decision tree. But again, who has time for that when you need to be home by 5 :laugh:
 
Two points. 1) ranitidine is about 25% cheaper than cimetidine and 2) drug drug interactions for cimetidine are, for the most part, irrelevant for peds.
 
Two points. 1) ranitidine is about 25% cheaper than cimetidine and 2) drug drug interactions for cimetidine are, for the most part, irrelevant for peds.

Clinical case scenerio:

You have a 13 year old male with childhood obesity (entire family is obese) with metabolic syndrome, childhood onset obesity related diabetes, as well as hyperlipidemia. Most likely this patient will also have reflux disease. Would cimetidine be a good option?

You have a 13 year old female with childhood obesity with associated metabolic syndrome, diabetes, hyperlipidemia, who already has reached menarche. In addition, she gets severe dysmenorrhea refractory to NSAIDS and is currently on OCP. She gets occasional reflux symptoms. Would cimetidine be a good option?

You have a 5 year old in the PICU for MRSA pneumonia secondary to influenza, currently intubated and sedated with fentanyl and versed with occasional propofol for sedation. Would cimetidine be appropriate in this setting? Would care be more complicated if the patient was already on cimetidine (for reflux) before the patient got sick?
 
I think how bad of an idea Cimetidine is would become very obvious if SHC built a pharmacoeconomic decision tree. But again, who has time for that when you need to be home by 5 :laugh:

Can you make one now for me? :D

Two points. 1) ranitidine is about 25% cheaper than cimetidine and 2) drug drug interactions for cimetidine are, for the most part, irrelevant for peds.

My preceptor told me liquid ranitidine is getting more expensive and cimetidine is cheaper. I don't know the pricing. I don't work retail, but according to my preceptor cimetidine is cheaper.
 
I have asked a lot of people and most of them are against cimetidine. I will bring this up monday morning.

Anyone here thinks I should use cimetidine please speak up now. thanks.
 
Can you make one now for me? :D
My preceptor told me liquid ranitidine is getting more expensive and cimetidine is cheaper. I don't know the pricing. I don't work retail, but according to my preceptor cimetidine is cheaper.

It is cheaper, but the reason why is because ranitadine is the superior product.

Cimetidine liquid is available, but the only time I've seen it used (in tablet or liquid form) is in the emergency room to combat an allergic reaction (they get epinephrine, diphenhydramine & cimetidine stat & an RX for the diphenhydramine & cimetidine.)

I have never seen cimetidine used to treat GERD in children. Ever. If nobody else is doing it, there is probably a good reason why.
 
Fill me in on your supplier because cimetidine isn't cheaper than ranitidine in my neck of the woods.
 
Can you make one now for me? :D



My preceptor told me liquid ranitidine is getting more expensive and cimetidine is cheaper. I don't know the pricing. I don't work retail, but according to my preceptor cimetidine is cheaper.

I'm not sure what she expects you to learn if she keeps spoonfeeding you searchable information. Surely a PBM has the resources to locate costs on generic drugs.
 
I have asked a lot of people and most of them are against cimetidine. I will bring this up monday morning.

Anyone here thinks I should use cimetidine please speak up now. thanks.

So are you going to present your information with the opening, "what they said on SDN"?

Does your school read this forum? You're really pushing the envelope with threads like this. ;)
 
Never seen anyone write for cimetidine, but it's still sold OTC...and people buy it.
 
Thank you there is actually articles on that too, but I think they are more worried about the GI area. LOL...

If you had a son would you put him on Rantidine or Cimetidine?

I think Rantidine is better, but the insurance company gotta save money, so whatever is the cheapest will have to work.

are you looking at famotidine as well? It can be compounded into a suspension.
 
I need information to support the use of Cimetidine in children. All the information I found are from the 1980s. I made this thread mainly to get some information on data that supports the use of cimetidine in children...I am having problems finding it.

I am NOT the one that choosse which drug is used on the prefer drug list, so it's actually not a discussion on what drug we should use. It's not my choice.
 
are you looking at famotidine as well? It can be compounded into a suspension.

I'll let my preceptor know that. She told me it only came in solid form.

Based on SHC's reports of making straight As except ID therapeutics, this thread has to be trolling

Or I just need people to help me find data. ;)
 
Don't see a PBM making compounded famotidine liquid their primary agent, since they don't even like to pay for compounds. And since most compounding pharmacies don't bill 3rd parties.

Good point. I had a patient not pick up their butt paste one time b/c medicaid didn't cover it.

Thanks for the info. :)
 
are you looking at famotidine as well? It can be compounded into a suspension.

It comes as a reconstitutable, but I think it might be more expensive than Zantac or Cimetidine.

I personally wouldn't use Cimetidine in children, or anyone for that matter. The risk of side effects and potential drug interactions, even if later on, just wouldn't be worth any minor cost savings.
 
It comes as a reconstitutable, but I think it might be more expensive than Zantac or Cimetidine.

I personally wouldn't use Cimetidine in children, or anyone for that matter. The risk of side effects and potential drug interactions, even if later on, just wouldn't be worth any minor cost savings.

I recommended against it on Monday. I told my preceptor my reasoning and she thank me. However, I don't know what her final decision is. She mentioned ranitadine liquid being very expensive now.
Ranitidine liquid is only covered for children under 5yo and the reason why she ask me to look this up was b/c a doctor wanted to use this liquid for a 7 yo and the insurance won't cover it....the doctor is asking for a to be covered and wouldn't use cimetidine.

Apparently ranitadine liquid is very expensive now....who knew. LOL
 
I recommended against it on Monday. I told my preceptor my reasoning and she thank me. However, I don't know what her final decision is. She mentioned ranitadine liquid being very expensive now.
Ranitidine liquid is only covered for children under 5yo and the reason why she ask me to look this up was b/c a doctor wanted to use this liquid for a 7 yo and the insurance won't cover it....the doctor is asking for a to be covered and wouldn't use cimetidine.

Apparently ranitadine liquid is very expensive now....who knew. LOL
I wonder what they consider "very expensive" considering the tabs aren't all that bad. If it truly is something really pricy, maybe you can do something similar to the po vanco trick everybody loves. Rather than IV powder replacing the expensive capsules, use cheap tablets to make a suspension. Of course I have no pricing info to figure out if that is actually feasible or not. Just an idea if somehow the liquid is an outrageous price.
 
I wonder what they consider "very expensive" considering the tabs aren't all that bad. If it truly is something really pricy, maybe you can do something similar to the po vanco trick everybody loves. Rather than IV powder replacing the expensive capsules, use cheap tablets to make a suspension. Of course I have no pricing info to figure out if that is actually feasible or not. Just an idea if somehow the liquid is an outrageous price.

Yeah I have no clue either. My preceptor said liquid ranitadine recently gone up and is expensive now...it use to be much cheaper. I have no idea since I don't work right now.

If it was very cheap I would imagine the patient would be willing to pay cash for it right? I mean if it's $10 to $20 then it would be much easier to just pay cash for it then to wait for insurance approval! Unless something is truely very expensive, I would imagine most people will not wait for insurance approval...sounds like a pain to me.
 
Pharmacy cost of ranitidine liquid is 50-70 bucks/473 mL depending on manufacturer. I would know. I'm using it in a prospective study so I have to get a grant to pay for it.
 
Pharmacy cost of ranitidine liquid is 50-70 bucks/473 mL depending on manufacturer. I would know. I'm using it in a prospective study so I have to get a grant to pay for it.

You guys got me curious. Just checked my wholesaler, ranitidine $18.62 per 16 oz, plenty in stock. There is another brand at $7.35 each, but out of stock. Mean while cimetidine is showing up as $8-$9 per 8 oz. Strangely famotidine suspension is running $65 per 50 ml, it's 7x cheaper to give it IV.
 
$18.62 versus $50 to $70 for 16 oz. :confused:

My preceptor did say it use to be pretty cheap but gone up a lot recently...is $18.62 an old price?
 
Top