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    Anti-ulcer drug cimetidine (Tagamet) caused weight loss of 11 lbs in three months


    Posted by .(JavaScript must be enabled to view this email address)
    Monday, February 27, 2006 1:47 am Email this article
    Type II diabetics lost an average of 11 pounds in three months with the anti-ulcer medicine cimetidine (Tagamet) compared to 2.9 pounds in those given a placebo according to a study involving forty-three overweight type 2 diabetics (14 women and 29 men) who were given either 400 mg of cimetidine three times per day or a placebo thirty minutes before each meal. Fat Loss

    Body fat decreased from 30% to 25%

    The cimetidine group reduced body fat from 30 percent to 25 percent, had a 6 to 7 percent reduction in both diastolic and systolic blood pressure, and a reduction in waist, waist-to-hip ratio, a 14 percent reduction in blood sugar (162 mg per deciliter to 139), a 64 percent reduction in blood insulin (from 14.4 U per ml to 5.2), an 18 percent reduction in triglycerides (248 mg per deciliter to 204), and a 12 percent increase in HDL cholesterol (from 32 mg per deciliter to 36).

     

    Weight Loss

    Weight loss was 89% fat

    The weight loss was 89 percent fat in the cimetidine group and 85 percent in the placebo group.

    Weight loss: 11 lbs or 4.8%

    The weight loss of 11 pounds (reducing from 229 pounds to 218) in the cimetidine group represented 4.8 percent of body weight.

    Weight loss was steady throughout study

    Weight loss was fairly steady throughout the study at roughly 0.9 pounds per week and patients appeared to still be losing at the end of the study.

     

    Dose

    1200 mg per day is reasonable

    Twelve hundred mg per day is reasonable dose.

    Dose should not exceed 2400 mg per day

    Martindale: The Extra Pharmaceopoeia recommends the daily dose should not exceed 2,400 mg per day.

    However a smaller dose is recommended for patients with impaired renal function.

    A 40 percent reduction in dosage has been recommended for patients with hepatic failure, however patients with cirrhosis seem to have an increased resistance to H2 receptor blockers.

    The recommended dose for children over the age of one-year-old is 11 to 13 mg per pound of body weight.

     

    Previous study

    Previous study in non-diabetics found weight loss of 20.9 lbs or 12%

    A previous study from the same researchers published in 1993 found healthy non-diabetics lost an average of 20.9 pounds or 12 percent of body weight after two months using only half as much Cimetidine (150 mg three times per day) combined with a reduced-calorie diet.

    The dose was doubled for the present study because they found it had a stronger effect on satiety.

     

    Techincal Information

    Cimetadine blocks release of stomach acid, but this is not what causes weight loss

    Cimetidine is a histamine H2-receptor blocker, blocking the release of stomach acid and pepsin, however, its weight reducing effect is not related to an effect on stomach acids according to a study in rats.

    Cimetadine may increase CCK

    Some evidence suggests that it may increase satiety via cholecystokinin (CCK). CCK is a satiety hormone.

    It remains controversial whether obesity is the major contributor or an independent contributor to insulin resistance seen in type II diabetics the researcher noted.

     

    Subjects

    Subjects were 18- to 65-years-old

    Study subjects were 18- to 65-years-old and had a BMI greater than 25.

    Three patients in the cimetidine group and one in the placebo group dropped out due to diarrhea, while one patient in each group dropped out due to abdominal pain and vomiting.

    Adverse effects

    Minor adverse effects are generally infrequent and usually reversible, while serious reactions are rare according to Martindale: The Extra Pharmacopoeia.

    The most common side effects include diarrhea, dizziness, tiredness, headache, and rashes.

    A reversible state of confusion have occasionally occurred and are more common in patients who are elderly or seriously ill.

    Cimetidine has weak anti-androgenic effect.

    Gynecomastia (breast enlargement in men) and impotence have occasionally occurred in men taking relatively high doses.

    Adverse effects are dose-related

    Adverse effects are dose-related and decrease with the length of treatment.

     

    Association with cancer?

    Does cimetadine increase the risk of stomach cancer?

    It has been proposed that cimetidine and other H2 blockers may increase the risk of gastric cancer based on tumors found in animals given high doses on a long-term basis.

    However, any increased risk in human appears to decrease with time with no persistent effect long-term.

    Cimetadine may protect against stomach cancer

    In fact, H2 blockers may have a protective effect against gastric cancer as much as 10 years or more before any diagnosis of cancer according to one study.

    The association with gastric cancer may be explained by the initial symptoms being misdiagnosed and inappropriately treated with cimetidine.

    No fatal adverse effects

    No fatal adverse effects of cimetidine were found in a survey of 9928 patients taking cimetidine, and still appeared to be safe after 10 years of follow-up.

     

    Effects on the blood

    Effects on the blood

    Leucopenia, thrombocytopenia, and pancytopenia have been reported with cimetidine and other H2 blockers with neutopenia and agranulocytosis being the most common.

     

    Effects on nutrients

    Reduces iron and B12 absorption

    Cimetidine reduces the absorption of iron and vitamin B12.

     

    Effects on hormones

    Mild anti-testosterone effect

    Cimetidine has a dose-related mild anti-androgenic effect, that is, an anti-testosterone effect.

    Reduced sperm count and breast enlargement in men reported

    Reduced sperm counts, gynaecomastia (breast enlargement), breast tenderness, and impotence have been reported in men taking cimetidine.

    Symptoms resolved after withdrawal of the medication, a reduction in dose, or switching to ranitidine-another H2 receptor blocker.

     

    Cardiovascular

    Effects on cardiovascular system

    Bradycardia (slow heart rate), atrioventricular block, tachycardia (rapid heart beat), and hypotension (low blood pressure) have been reported in patients taking cimetidine.

    Caution is recommended for patients with cardiovascular disease.

     

    Kidneys

    Effects on the kidneys

    Reversible intestinal nephritis occurs in estimated 1 in 100,000 people taking cimetidine.

     

    Liver

    Effects on the liver

    Chronic active hepatitis with jaundice and abnormal liver function was reported in one patient taking 1,000 mg of cimetidine daily.

     

    Nervous System

    Effects on the nervous system

    Cimetidine use has been associated with a number of adverse neurological effects including confusion, bizarre behavior, reversible brain stem syndrome (with ataxia, dysarthria, visual impairment, deafness, and paresthesia), coma, convulsions, encephalopathy, visual hallucinations, paranoia, chorea, myopathy, and neuropathy.

    The reactions occur mostly in patient who are elderly, critically ill, or have impaired kidney or liver function.

     

    Lupus

    Report of lupus eruption

    Cimetidine induced a lupus eruption in a patient with lupus.

     

    Overdose

    Effects of taing too much cimetadine

    Cimetidine overdoses of 5,000 to 20,000 mg have not produced serious toxic reactions despite blood levels 57 times higher than normal in one patient.

    However, an overdose of 12,000 mg caused an elevated heart rate, dilated pupils, a disturbance in speech, agitation and disorientation in one patient, and respiratory distress in another who was taking other medicines for schizophrenia.

    Fatal bradycardia was reported after one person took an unknown amount of cimetidine and diazepam.

    Vomiting should be induced and the stomach pumped in cases of cimetidine overdose.

     

    Drug interactions

    Cimetadine can interact with many drugs

    Many drugs can be affected by cimetidine, however, few drugs affect the actions of cimetidine.

    Cimetidine may have a clinically significant interaction with cyclosporin, lingnocaine, nifedipine, phenytoin, suxamethonium, theophylline, and warfarin.

     

    Immune response

    May enhance immune response

    Cimetidine and other H2 receptor blockers may enhance immune response according to some reports.

     

    Comments

    Comment: Acid blockers are not the ideal weight loss drug

    Several years ago I heard a gastroenterologist on television say that the purpose of stomach acid is not for the digestion of food, but rather to kill pathogens, such as dangerous bacteria, that we consume.

    Several doctors have also noted that the amount of stomach acid decreases as we ago.

    Some doctors, such as Johnathan Wright, MD, even recommend that older people take a hydrocholoric acid supplement in order to increase replace lost stomach acid and improve the absorption of nutrients.

    (See the articles titled “The Digestive Theory of Aging: Part 1” and “The Digestive Theory of Aging: Part 2” by Dr. Wright.)

    He states that older people often experience indigestion because of too little stomach acid.

    Dr. Wright even wrote a book called “Why Stomach Acid is Good for You”. (Book cover shown below.)

    Therefore, it seems to me, that blocking stomach acid is not the ideal way to lose weight.

    REFERENCE

    Støa-Birketvedt G, Paus PN, Ganss R, Irgebetsen OC, Florholmen J. Cimetidine reduces weight and improves metabolic control in overweight patients with type 2 diabetes. International Journal of Obesity, Nov 1998, 22(11):1041-5.

    Støa-Birketvedt G, Vonen B, Waldum HL, Florholmen J. Effects of cimetidine suspension on appetite and weight in overweight subjects. BMJ, 1993, 306:1091-3.

    Reynolds JEF (editor). Martindale: The Extra Pharmaceopoeia 13th edition. The Pharmaceutical Press, London, 1993.

     


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