USE OF IV CIMETIDINE, RANITIDINE, AND FAMOTIDINE IN 40 HOSPITALS

The drug experiences of 1200 patients receiving i.v. histamine H-2-rec eptor antagonists were studied. Forty hospitals in five southeastern s tates participated in a drug-use evaluation (DUE). In addition to supp lying background information, a pharmacist at each hospital used a sta ndardized form to perform a concurrent review of 30 consecutive adult patients who had been started on i.v. cimetidine, ranitidine, or famot idine. In addition to the patient's age and the prescriber's medical s pecialty, specific DUE criteria included the reason given in the medic al record for use; dosage regimen and adjustments made on the basis of the patient's renal function; other GI drugs taken concurrently; phar macist intervention; simultaneous use of oral medications; occurrence of adverse events; H-2-antagonist use with specified drug products kno wn to affect serum drug concentrations of one or both medications; and use of gastric pH monitoring. Therapy with i.v. H-2 antagonists was u sually started by internal medicine specialists or surgeons, and most of the evaluated patients received such therapy for prevention of stre ss-related mucosal damage. According to estimated creatinine clearance , 34% of patients were in need of dosage adjustments, but such adjustm ents were made in only 49% of these. Forty percent of patients began t herapy while taking at least one medication orally, and almost one fou rth of patients were receiving an additional drug for the treatment of an acid-peptic or related indication. The occurrence of adverse event s was similar for the three H-2 antagonists studied. The findings iden tify several problematic areas in the way H-2 antagonists are used in clinical practice.