Histamine H2 receptors antagonist. The histamine H receptor blocker cimetidine (Tagament) markedly inhibits gastric secretion stimulated by food, gastrin, histamine, and caffeine. The dosage'is 300mg 4 times daily before meals and at
bedtime. The dose must be reduced by one-half in patients with renal insufficiency.

The drug has been reported to be of value in benign gastric ulcer, peptic esophagitis, Zollinger-Ellison's syndrome and stress ulcerations. Studies comparing cimentidine and potent antacids have shown them to be equally effective. The drugis approved in the USA for short-term treatment of duodenal ulcer (6-8 weeks), Zollinger-Ellison's syndrome and hypersecretory states such as systemic mastocytosis. Rare side-effects have included gynecomastia, galactorrhea, impotence, skin rashes, leukopenia, agranulocytosis, hepatitis, elevated serum creatinine, and decreased IgA and IgM. Of more concern are interactions between cimetidine and warfarin, theophylline, lidocaine, and other drugs, which occur via the p-450 cytochrome system of the liver. Other H2 receptor blockers are currently under investigation (e.g. ranitidine) and should be available soon.

Sedatives. Tense and apprehensive patients will usually benefit greatly from sedation. Hypnotic doses of the drugs may be necessary to ensure sleep. Parasympatholytic (anticholinergic) drugs. Although the parasympatholytic drugs have been widely used over a long period of time for treatment of peptic ulcer, their effectiveness is questionable. Their usefulness is limited largely to the relief of refractory pain. The dosage necessary to produce significant gastric antisecretoryeffect may cause blurring of vision, constipation, urinary retention, and tachycardia. If patients have gastric retention, these drugs are contraindicated.

Belladonna extract, 8 to 24mg, or atropine, 0.25 to 0.5mg, 20 to 30 minutes before meals and at bedtime with or without sedatives. Synthetic parasympatholytics. Numerous proprietary tertiary and quaternary amines are available as belladonna or atropine substitutes. Although they do not have central nervous system side-effects, it is difficult to substantiate other therapeutic advantages. They are also more expensive.

For more information, visit http://www.tcmadvisory.com/