Central nervous system reactions to histamine-2 receptor blockers

Article Abstract:

One of the most widely prescribed classes of drugs in the US at the present time is the group called histamine-2 (H2) receptor blockers, which includes cimetidine, ranitidine, famotidine, and nizatidine. These agents are used to treat and prevent ulcers, but they also have a wide array of side effects. Some of the more serious of these affect the central nervous system (CNS), causing delusions, psychosis, delirium, hallucinations, and other changes in mental status. A review is presented of the medical literature concerning the CNS side effects of H2-blockers. Of particular interest was whether any one of the four drugs is more often associated with such side effects and whether certain patients are at greater risk of side effects. In 97 percent of the cases of CNS side effects associated with H2-blockers, symptoms were noted within 2 weeks of starting therapy and stopped within 3 days of stopping the drug. The main side effects were confusion or disorientation (45 percent), or agitation, hostility, or delirium (22 percent). Hospitalized patients were far more likely to experience these adverse effects than outpatients, with those in intensive care units at greatest risk. Most studies seem to suggest that the elderly are at increased risk, although these data are not conclusive. Presence of a psychiatric illness or the use of psychotropic drugs did not increase the likelihood of side effects, nor were patients with abnormal liver and kidney function at greater risk. All four drugs have been associated with adverse effects on the central nervous system, but cimetidine has been associated with these reactions most often. However, this may be the result of biases (affected by the drugs' relative market shares or physicians' unintentional biases in reporting side effects), and no one drug can be said to be associated with these effects more than the others. Accurate determination of the incidence of and risk factors for CNS side effects from H2-blockers will require further, carefully controlled research. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Ranitidine, Cimetidine, Famotidine, Nizatidine

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The association between mortality rates and decreased concentrations of interleukin-10 and interleukin-1 receptor antagonist in the lung fluids of patients with the adult respiratory distress syndrome

Article Abstract:

Patients in the early stages of adult respiratory distress syndrome (ARDS) who produce low levels of immune system proteins called cytokines appear to have a lower chance for survival. Researchers evaluated trends in survival rates among 28 patients with ARDS and with varying lung fluid cytokine levels. They also compared these study patients' cytokine levels with 9 patients on ventilators without ARDS (the control group). Surviving patients with ARDS had significantly higher median levels of the cytokines interleukin-1 and interleukin-10 than nonsurvivors. Study patients' median cytokine levels were significantly higher than the control group.

Patient outcomes, Mortality, Measurement, Interleukins, Acute respiratory distress syndrome, Adult respiratory distress syndrome

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