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Peds Calc

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Cimetidine Indications & Clinical Uses

Evidence-based guide for pediatric prescribing

Cimetidine is an older H2 receptor antagonist with significant drug–drug interaction potential; reserve it for short-term acid suppression when safer agents are unavailable or contraindicated.

Primary FDA-Approved Indications

Use cimetidine sparingly—prefer famotidine or nizatidine for routine pediatric H2 blockade. When cimetidine is employed, keep courses short, reassess frequently, and review the full medication list for CYP-mediated interactions.

Short-term symptomatic gastroesophageal reflux disease (GERD)

FDA Approved
Children and adolescentsModerate

Consider when famotidine unavailable and proton pump inhibitors are not indicated; evaluate for tachyphylaxis within 2–4 weeks.

Evidence Sources

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Secondary Clinical Uses

Nocturnal acid breakthrough in refractory GERD on optimized PPI therapy

Secondary Use
AdolescentsLow

Dose at bedtime for ≤14 nights; monitor for QT prolongation when combined with interacting agents.

Evidence Sources

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Off-Label Uses

Note: Off-label uses may be clinically appropriate based on evidence and expert consensus, but are not FDA-approved for these indications. Always consider the evidence base and document clinical reasoning.

Histamine-mediated flushing in mast cell disorders

Off-Label
Specialist-managed patients

Occasionally combined with H1 blockade; requires hematology/allergy oversight.

Evidence Sources

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•Evidence quality: 70/10
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