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Cimetidine-Induced Coma in Cirrhosis of the Liver

Milton L. Levine, MD
JAMA. 1978;240(12):1238. doi:10.1001/jama.1978.03290120032011.
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To the Editor.—  Cimetidine, a potent H2-receptor antagonist, has been recently introduced for the suppression of gastric acid secretion.1,2 This medication has the ability to produce gynecomastia and breast swelling when used for a prolonged period (as in the Zollinger-Ellison syndrome)3 and apparently has a mild sedative effect when given orally.4 Although the usual route of administration is oral, the medication can be given intramuscularly and intravenously (IV). I recently observed a patient in whom profound coma developed while receiving cimetidine, which reversed when the therapy was discontinued. I believe this potential side effect of cimetidine should be brought to the attention of treating physicians.

Report of a Case.—  A 53-year-old bartender, who admits to a 25-year history of excessive alcohol use (which he claims he discontinued three months before hospitalization), was admitted to Franklin General Hospital,Valley Stream, NY, for massive upper gastrointestinal (GI) bleeding.

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