Re: dependence on Tagamet?

Posted By Amei on March 01, 1999 at 20:12:21:

In Reply to: Re: dependence on Tagamet? posted by HFHSM.D.-ym on February 28, 1999 at 00:19:42:






: : Is it possible to get physically dependent on Tagamet or have 'backlash' when you stop taking it?
I have been taking about 4 300mg tablets per week for a condition I discussed in previous posts last year.  I don't really feel it is acid related but it helps stop the symptoms and I don't seem to be having side effects.  Before I started taking it I only had an acid problem or heartburn very rarely and had only taken anti-acids a couple of times in my life.  
I am having some tests done and they told me not to take Tagamet (and Axcid, Pepcid, etc.) for a week beforehand.  Yesterday I had the worst acid problem I have ever had.  My throat was burning, my bowels were acting up and the stool was thin and burned.  
Is it possible that it is related to my not taking Tagamet for a few days or is it just a coincidence?  
Also, there is a small chance that I am pregnant (only a couple of weeks if I am).  Could this be related?  Is it OK to take Tagamet while pregnant?  
Thanks for your help.  
Dear JAL,
It is difficult to state with certainty whether or not your symptoms are related to discontinuation of Tagamet, pregnancy, foods you might have eaten during this period of time, food poisoning or a viral illness. If your symptoms return upon discontinuation of the drug and resolve with restarting the drug, it would suggest that cimetidine (Tagamet) seems to be controlling your symptoms. Cimetidine (Tagamet) is generally considered a very safe drug with few side effects. It can be prescribed for long periods of time without adverse reactions and is often used for maintenance therapy in gastroesophageal reflux disease and in select patients with ulcers. Some patients with allergic conditions respond to histamine receptor blockers such as cimetidine. Since the drug has been around for quite some time there is a lot of experience with the use and side effect profile of this medication.
Cimetidine (Tagamet) is classified as a Category B drug. Studies performed in animals at doses up to 40 times the normal human dose have revealed no evidence of impaired fertility or harm to the fetus due to the Tagamet. On the other hand, no adequate and well controlled studies have been performed in pregnant women. There are a few published studies that suggest that ranitidine (Zantac) is safe during pregnancy. Ranitidine (Zantac)like cimetidine (Tagamet) is also a histamine receptor blocker.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you wish to be seen at our institution please call 1-800-653-6568, our Referring Physician's Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
: *Keywords: cimetidine, Tagamet




Thank you for the the quick and thorough response.  
Since I will be having another test next week I will be unable to take the Tagamet and see if my symptoms are related to stopping the medication until after that test is completed.  
The doctor I saw today told me something interesting.  I had been taking the Tagamet for abdominal pain (in the center just below the breast bone) and back pain (just below right shoulderblade next to spine and occaisionally between the shoulder blades).  Several doctors had suggested the pain was related to gall bladder but were baffled as to why the pain would go away after eating (usually) or taking Tagamet (almost always).  The doctor I saw today (not a gastro)  thought the condition I was seeing him for (lots of phlegm after meals, thought to be food allergy) could also be related to reflux.  I asked him if the back and abdominal pain could also be related to reflux and he said 'absolutely'.  
In my research I haven't run across any references to back pain and reflux.  What do you think about the possibility?  
Dear Amei,
Chest or back pain can be atypical manifestations of gastroesophageal reflux disease, symptoms of an esophageal motility disorder (such as diffuse esophageal spasm) or symptoms associated with disorders outside of the gastrointestinal tract (such as coronary heart disease or musculoskeletal disorders). To further suggest that the chest pain that you are experiencing is esophageal in origin you might want to see if your pain is related to food intake. Are you getting symptoms with any particular type of foods? Is your chest pain associated with other typical and atypical symptoms of gastroesophageal reflux such as heartburn, nausea, abdominal bloating, belching, burping, difficulty swallowing, hoarseness, dental problems, choking sensation or asthma? Do your symptoms improve on an anti-reflux diet? Are you taking any medications that could worsen acid reflux?
If your back pain persists despite treatment, it may be necessary to perform a diagnostic evaluation. A number of tests provide important information about your gastrointestinal tract and can help confirm the diagnosis of gastroesophageal reflux or esophageal dysmotility. These include barium x-rays, upper GI endoscopy, ambulatory pH monitoring and esophageal manometry. You can consult your doctor to decide whether it is time for you to have any of these tests. I hope you find this information helpful. Good luck to you. If you are seen at our institution I look forward to meeting with you personally.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
Keywords: gastroesophageal reflux, chest pain, esophageal motility disorder




Thanks for the straight answers.  Your information is very well presented and I intend to print a copy for my gastroenterologist.  Unfortunately, I am several thousand miles from your facility or I would love to come there.  
To answer a few questions you posed above:
The pain usually happens in the morning and is located in the center just below the breastbone.  It is pretty mild or absent altogether when I wake up but will gradually get worse over the next 1/2 to 1 hour.  For a long time it was almost every day but lately it is only a couple of days a week.  I started taking Tagamet for it about 6 months ago even though I don't have any of the standard symptoms you mentioned above.  (It was basically the Dr saying "I don't think you have an ulcer but take this anyway just to see if it helps")  It has been since I started taking the Tagamet that I have noticed a decrease in frequency.  H. pylori test was negative.  (Pepcid, Axcid and tums also help and it doesn't seem to matter whether I take prescription of OTC strength.)
I have noticed a link to food but not the way I think you mean it.  
When I eat the pain lessens or goes away.  I read in this forum where a man had similar pain and ate protein in the morning to minimize it so I tried it and it helps somewhat but usually I have to take something to go with it.  I had a food allergy test last week but it turned up only rye which I don't eat anyway.  There was also a mild reaction to beef so I am eliminating it from my diet to see what happens.  I ate no beef for many years and did have the back pain occaisionally (I thought at the time it was a pinched nerve) but didn't have the abdominal pain until I started eating beef again.  I think there is a connection there because I ended up eating beef almost every night for several weeks and that is when the pain was at its worst.  Recently I have been eating it only 2-4 times/week.  
The back pain sometimes comes without the abdominal pain and is located right where my bra strap rests in the back on the right side of the spine.  When the pain is really intense I will take the bra off and it helps a little.  Wearing a tight waistband increases the discomfort but it has to be very tight.  Bending over is also painful when I'm having the abdominal pain.  
The only other symptom which might be indicating reflux is the fact that I get a lot of phlegm in my throat after dinner.  It rarely happens after any other meal or snack and has no associated pain.  I tried eliminating various foods from my diet with no success or change in symptoms.  When this happens I will sometimes (not always) get a foamy, sweet tasting substance in my mouth when I clear my throat.  Almost never do I get an acid taste.  I used to have a mint or cough drop after dinner but this is no longer enough.
I have had an ultrasound and oral cholecystogram which showed probable gall stones but all other tests were negative.  Insurance denied an endoscopy but I have recently changed insurance and will try again.  
I have recently found a wonderful doctor who listens and doesn't rush me (kind of like you guys).  He also is willing to suggest alternative reasons for my pain.  Too bad he's not a gastroenterologist so he can't do tests, etc.  
I know this has gotten very long.  I apologize for taking so much time but it is very hard for me to get time off to go to the doctor so having you answer a few questions before my appointment so I can go in informed is a great help.  
This service is invaluable, I don't know where I would be without it (besides still ignorant and a lot more frustrated).