Cimetidine

Approximately 33 million adults in the United States are overweight, and obesity is a major public health problem. The disappointing results of conventional weight-reduction treatments are often attributed to the inability of overweight individuals to control their craving for food. It is believed that since reduction of gastric acid secretion leads to reduced sensations of hunger, the use of histamine [H.sub.2] -blocking drugs could contribute to weight loss. Stoa-Birketvedt studied the effect of cimetidine on appetite and weight loss in overweight patients who attended a Norwegian family practice.

A total of 60 patients aged 18 to 59 years with body mass indexes ranging from 25 to 37 kg per [m.sup.2] received medical care, including a calorie-restricted diet, from the same clinic. These patients were randomly assigned to receive either 200 mg cimetidine or an identical placebo 30 minutes before meals three times daily. Compliance with diet was checked at each clinic visit. Patients were also given fiber supplements and were not permitted to drink alcoholic beverages during the eight-week trial. No advice was given about smoking.

The 30 patients receiving cimetidine lost an average of 9.5 kg (20 lb, 14 oz), while those taking placebo showed an average loss of 2.2 kg (4 lb, 13 oz). The cimetidine group showed continuing weight loss during the entire eight weeks, whereas that of the placebo group reached a plateau after the first two weeks of treatment. Reductions in body mass indexes were 3.33 for the cimetidine group and 0.77 for the placebo group. The patients taking cimetidine also showed greater reductions in abdominal and hip circumference and in both systolic and diastolic blood pressures.

All patients in the cimetidine group lost weight and reported reduction in appetite. The authors conclude that cimetidine may suppress hunger sensations resulting from low calorie intake, leading to better compliance with dietary restrictions. Although the mechanism of weight loss is not completely elucidated, they suggest that cimetidine may be a valuable adjunct to dietary treatment of obesity.

In contrast to the Norwegian study, a similar Danish study of cimetidine adjuvant treatment of obesity failed to demonstrate any effect on weight loss. Rasmussen and colleagues performed a randomized, double-blind study of 60 patients aged 18 to 60 with body mass indexes between 27 and 39 kg per [m.sup.2]. In this study, patients took 200 mg of cimetidine or an identical placebo 30 minutes before each meal three times daily for eight weeks. Compliance with therapy and dietary restrictions were checked at clinic visits. The mean weight loss was similar in both groups: 5.7 kg (12 lb, 9 oz) in the cimetidine group and 5.9 kg (12 lb, 15 oz) in the placebo group. Similar decreases in body mass index, waist and hip measurements, as well as blood pressure measurements, were observed in both groups.

An accompanying editorial by Garrow examines both papers as well as unpublished data made available by the investigators. The author concludes that the studies were well conducted and similar in design and size. No immediate explanation is apparent for the contrasting findings.

COPYRIGHT 1993 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group