1.3.1 H2-receptor antagonists

General guidance

• Histamine H2 receptor (H2RA) antagonists remain useful agents for some patients with mild to moderate GORD.
• Cimetidine has several important drug interactions.
• Significant numbers of patients remain on treatment doses of these agents without any apparent attempt to step down their therapy.
• Planned step-down should be discussed with the patient upon initiation of treatment and should be carried out.
• Gynaecomastia with cimetidine appears to be dose dependent. At the lower dose commonly used it is very rare.
• Intravenous histamine H2-receptor antagonists are ineffective in acute ulceration and have been reported to increase infective complications. Therefore they should not be used in general hospital practice.

Recommended drugs:

1st line Ranitidine

2nd line  Cimetidine

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low