Indication: Acid-reflux disorders (GERD), Peptic Ulcer Disease
Approximately 33 million adults in the United States are overweight, and more than a third of these are obese. Obesity carries a number or risks, ranging from hypertension and diabetes mellitus to gallstones. Treatment by restricted diet alone is often unsuccessful because of the inability of obese people to control the craving for food. Moreover, dieters often report ulcer-like pain and heartburn that are relieved by food, which further compromises compliance.
Recently Stoa-Birketvedt reported the results of a randomized double-blind trial evaluating the efficacy of the histamine-2 receptor blocker cimetidine for reducing hunger and improving compliance with dietary restriction. Study participants were 60 obese Norwegian adults (55 women and 5 men) aged 25 – 37, half of whom received cimetidine suspension 200 mg/10 mL, and half identical placebo, 30 minutes before breakfast, lunch, and dinner. The suspension was chosen because a viscous tasty “treat” may contribute to reducing food craving. Fiber supplements dissolved in a glass of water were taken immediately before the three main meals. Subjects were instructed to follow a 1200-kcal daily diet based on sample menus.
During the 8-week study all subjects lost weight, but the cimetidine group lost significantly more weight. Motivated obese dieters will usually lose 4.5 kg during 8 weeks. In this study there was no motivational support, so the placebo-treated dieters lost only 2.2 kg. By contrast, the cimetidine-treated dieters lost 9.5 kg. During the first week (and throughout the trial) the cimetidine group reported less hunger than subjects in the placebo group. Cimetidine (Tagamen) may have aided weight loss by reducing acid secretion and hunger sensation, or it may interact with certain gastrointestinal peptide hormones (i.e., cholecystokinin) involved in regulating food intake.
A Danish team tried to reproduce this study with a randomized, placebo-controlled trial of their own. They studied 60 subjects (51 women, 9 men) aged 18 – 60 who received cimetidine 200 mg/10 mL or identical placebo in an 8-week parallel phase followed by an 8-week crossover phase. They found no difference in weight loss between cimetidine-treated subjects and placebo-treated subjects (mean weight loss, 5.7 kg and 5.9 kg, respectively). The Danish investigators suggested that the results of the Norwegian trial were due to subjects correctly guessing which treatment group they were assigned to (cimetidine or placebo). In other words, the study was not really double blind.
Commenting on both studies, editorialist John Garrow wrote, “A mean loss of 9.5 kg in 8 weeks is a remarkably good result, and if such weight loss could be achieved by simply telling patients they were on cimetidine, that would be a therapeutic triumph … It remains baffling that cimetidine and placebo should have such different effects in Norway and Denmark.”
Question and Answer
Question from Eric of San Francisco:
I am taking 3 tablets of Tagamet after dinner and have two questions: Are three tablets at once the best way to take the medication (this is how the pharmacist recommended it). ALSO, and more importantly, my skin has felt hot and sunburned (though I have not been in the sun) while taking the medication. Is that a possible side-effect (sun sensitivity or extremely dry skin?).
Dear Eric,
The dosage and timing of using Tagamet (Cimetidine) (and other such H-2 Antagonists) depends on the reason that you are taking this med. As you may be aware, Tagamet is used for many purposes. If used for heartburn of reflux-the best way to take the medication would generally be about 1/2 hour before eating. The other important point is the strength of the tables you are using-Tagamet now comes in many strengths-varying from 75mg to 800mg. The strength of the tablets will determine how many you can take at one time.
Heartburn may also be treated by patients taking these meds twice a day; early in the morning and just before bedtime. For many patients a single dose before the evening meal is adequate-others may need more frequent dosing-keeping in mind the strength of the tablets you are using.
In patients with Ulcer Disease who are being treated with H-2 Antagonist-it has been found that a single dose at bedtime often works best; some patients may even require very high dosages. The treatment of Ulcer Disease today has been expanded to include the use of Antibiotics in those in whom the ulcer is due to a bacterial infection know as H. Pylori.
Your best bet is to ask both your pharmacist and physician about the best way to take the medication for your particular situation; if in fact you are using this medication on a regular basis over the counter for heartburn-without consulting your physician-you are playing with fire. While these meds are adequate for occasional relief of heartburn, if needed on a chronic or continuous basis-a physician should be consulted. Many patients with chronic heartburn have significant abnormalities related to their esophagus-and only after careful evaluation can the problem be correctly treated.
As for the skin symptoms, the Physician’s Desk Reference (PDR) does not list photosensitivity or excessively dry skin as a side effect (although other skin-related side effects are note); it may be best to also discuss this with your physician and perhaps consider discontinuing the med and observing if there is any difference.
Jennifer is a clinical pharmacologist. She helps doctors of all medical specialties choose medications. Jennifer consults about drug dosage, interactions, and side effects.