Since the introduction of cimetidine in 1977, hospital expenditures for the histamine2-receptor antagonists have steadily increased, making them one of the most costly classes of therapeutic agents. As a result of cost considerations, we reviewed the available antiulcer agents in our hospital and evaluated the potential for therapeutic interchange within this group of agents. We found that by using famotidine as the principal agent in our hospital, drug cost savings of approximately $65 000 were realized. Additionally, avoiding the administration of approximately 13 000 parenteral doses with the selection of famotidine resulted in further reduction of drug administration costs. We conclude that the histamine2-receptor antagonists represent a cost-effective target for pharmacy cost-containment programs, without affecting patient therapeutic outcomes.
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References
1.
KongKMJohnsonWFAndersonPOSatoLASimonianRI. Effect of a pharmacy-based cost-containment program on cimetidine costs and use. Am J Hosp Pharm1987; 44: 2068–73.
2.
SavitskyMEKirkingDMCornishLACrudoDJBerardiRR. Costs associated with the inappropriate route of administration of parenteral histamine2-receptor antagonists. Drug Intell Clin Pharm1987; 21: 885–9.
3.
CaldwellRDDavidSK. Use of staff pharmacists to reduce the inappropriate use of parenteral histamine-2 antagonist therapy. Hosp Pharm1987; 22: 1205–9.
4.
KowalskySFAndrttzMBCalvertJFHamiltonRAPlatekTEStollWR. A prospective evaluation of cimetidine drug use. Hosp Pharm1989; 24: 105–8.
5.
SmithJLGrahamDYGreeneWLPhelpsSJGreenBG. Famotidine: A long-acting H2-receptor antagonist. Comparison with cimetidine and ranitidine. Hosp Formul1987; 22 (suppl B): 15–27.
6.
BerardiRRTankanowRMNostrantTT. Comparison of famotidine with cimetidine and ranitidine. Clin Pharm1988; 7: 271–84.
7.
RatonNM. Estimating the true cost of parenteral antibiotic therapy. Hosp Ther1986; 11 (12): 17–32.
8.
FrankWOPeaceKEWatsonM., The effect of single intravenous doses of cimetidine or ranitidine on gastric secretion. Clin Pharmacol Ther1986; 40: 665–72.
9.
RyanJRVargasR.McMahonFGChremosAN. Comparison of effects of oral and intravenous famotidine on inhibition of nocturnal gastric acid secretion. Am J Med1986; 81 (suppl 4B): 60–4.
10.
RoversJPSouneyPF. A critical review of continuous infusion H2-receptor antagonist therapy. Crit Care Med1989: (in press).
11.
SieplerJK. A dosage alternative for H2-receptor antagonists—constant infusion. Clin Ther1986; 8 (suppl A): 24–33.
12.
OstroMJRussellJASoldinSJMahonWAJeejeebhoyKN. Control of gastric pH with cimetidine: Boluses versus primed infusions. Gastroenterology1985; 89: 532–7.
13.
WilliamsSKBaptistaRJEcheniqueMM, Dosing cimetidine HCl as a continuous infusion via parenteral nutrient solutions. Infusion1985; 9: 45–7.
14.
AlbinM.FriedlosJ.HillmanK.Continuous intragastric pH measurement in the critically ill and treatment with parenteral ranitidine. Intensive Care Med1985; 11: 295–9.
15.
DastaJF. Drug use in a surgical intensive care unit. Drug Intell Clin Pharm1986; 20: 752–6.
16.
BaptistaRJ. Role of histamine (H2)-receptor antagonists in total parenteral nutrition patients. Am J Med1987; 83 (suppl 6A): 53–7.
17.
WelageLSWingPESchentagJJWilliamsJSRootJKBerlinRG. An evaluation of the intravenous famotidine versus cimetidine therapy in the critically ill (abstract). Gastroenterology1988; 94: A491.
18.
PrestonJW. Cimetidine II. Adverse reaction and patterns of use. Ann Intern Med1982; 97: 728–34.
McCarthyDM. Ranitidine or cimetidine. Ann Intern Med1983; 99: 551–3.
21.
Campoli-RichardsDMClissoldSP. Famotidine: Pharmacodynamic and pharmacokinetic properties and a preliminary review of its therapeutic use in peptic ulcer disease and Zollinger-Ellison syndrome. Drugs1986; 32: 197–221.
22.
SaxMJ. Clinically important adverse effects and drug interactions with H2-receptor antagonists: An update. Pharmacotherapy1987; 7: 110S–5S.
23.
Dal NegroR.TurcoP.TrevisanF.Famotidina e teofillina: Interferenza farmacocinetica cimetidino-simile? Ital J Chest Dis1988; 42: 185–6.
24.
HumphriesTJ. Famotidine: A notable lack of drug interactions. Scand J Gastroenterol1987; 22 (suppl 134): 55–60.
25.
ShumanRBSchusterDPZuckermanGR. Prophylactic therapy for stress ulcer bleeding: A reappraisal. Ann Intern Med1987; 106: 562–7.
26.
LayneEAMellowMHLipmanTO. Insensitivity of guaiac slide tests for detection of blood in gastric juice. Ann Intern Med1981; 94: 774–6.
27.
NorfleetRGRhodesRASaviageK.False-positive “hemoccult” reaction with cimetidine (letter). N Engl J Med1980; 302: 467.
28.
HauserA.QuigleyMLDrieverCWMontalvoAARobbinsT.More on false-positive “hemoccult” reaction with cimetidine (letter). N Engl J Med1981; 304: 847–8.
29.
PeuraDAJohnsonLF. Cimetidine for prevention and treatment of gastroduodenal mucosal lesions in patients in an intensive care unit. Ann Intern Med1985; 103: 173–7.
30.
KleimanRLAdairCGEphgraveKS. Stress ulcers: Current understanding of pathogenesis and prophylaxis. Drug Intell Clin Pharm1988; 22: 452–60.
31.
ZinnerMJZuidemaGDSmithPLMignosaM.The prevention of upper gastrointestinal tract bleeding in patients in an intensive care unit. Surg Gynecol Obstet1981; 153: 214–20.
32.
BorreroE.BankS.MargolisI.SchulmanNDChardavoyneR.Comparison of antacid and sucralfate in the prevention of gastrointestinal bleeding in patients who are critically ill. Am J Med1985; 79 (suppl 2C): 62–4.
33.
TrybaM.ZevounouF.TorkM.ZenzM.Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. Am J Med1985; 79 (suppl 2C): 55–61.
34.
CannonLAHeiselmanD.GardnerW.JonesJ.Prophylaxis of upper gastrointestinal tract bleeding in mechanically ventilated patients. Arch Intern Med1987; 147: 2101–6.
35.
CravenDEDriksMR. Nosocomial pneumonia in the intubated patient. Semin Resp Inf1987; 2: 20–33.
36.
DriksMRCravenDECelliBR, Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. N Engl J Med1987; 317: 1376–82.
37.
SchneiderJSOuelletteSM. Sucralfate administration via nasogastric tube (letter). N Engl J Med1984; 310: 990.
38.
JoyceTH. Prophylaxis of pulmonary aspiration. Am J Med1987; 83 (suppl 6A): 46–52.
39.
PeuraDA. Recognizing, setting therapeutic goals, and selecting therapy for the prevention and treatment of stress-related mucosal damage. Pharmacotherapy1987; 7: 95S–103S.
