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Peds Calc

Pediatric Reference

Cimetidine Side EffectsComprehensive Pediatric Safety Guide

Cimetidine is generally well tolerated for short courses, but gastrointestinal upset and headache are common. Longer courses or higher doses can unmask endocrine and neurologic adverse effects, especially when renal function is impaired.

5 Categories
14 Clinical Sources
Evidence-Based
Back to Cimetidine Overview

Essential Information

1

Call promptly for persistent vomiting, confusion, or signs of allergic reaction (hives, swelling, breathing difficulty)

2

Report menstrual changes, breast tenderness, or galactorrhea with prolonged use

3

Review OTC medications and supplements—cimetidine alters CYP-mediated drug clearance

Clinical Overview

Monitor for GI changes during the first week, review medication lists for CYP interactions, and reassess chronic therapy to avoid endocrine or neuropsychiatric adverse effects.

Side Effect Categories

5 Systems

Gastrointestinal

2 documented effects

Total Sources: 3

Diarrhea / loose stools

Incidence: Common
Onset: Often within the first few days
mild
2 sources
Duration

Not specified

Management

Encourage hydration, bland diet; call if stools are watery, bloody, or accompanied by fever

Monitoring Guidelines

Escalate if diarrhea lasts >48 hours or dehydration signs appear

2 clinical sources• PubMed • Clinical Guidelines • FDA

Nausea or abdominal discomfort

Incidence: Common
Onset: Not specified
mild
1 sources
Duration

Not specified

Management

Offer small frequent meals; consider dosing with meals if tolerated

Monitoring Guidelines

Assess for persistent pain or vomiting that limits intake

1 clinical sources• PubMed • Clinical Guidelines • FDA

Neurologic / behavioral

2 documented effects

Total Sources: 4

Headache or dizziness

Incidence: Common
Onset: Not specified
mild
2 sources
Duration

Not specified

Management

Hydration, rest; consider evening dosing

Monitoring Guidelines

Evaluate if severe, persistent, or associated with visual changes

2 clinical sources• PubMed • Clinical Guidelines • FDA

Confusion or agitation (renal impairment or high doses)

Incidence: Rare
Onset: Typically within days to weeks
moderate
2 sources
Duration

Not specified

Management

Stop medication and contact clinician; assess renal function and medication interactions

Monitoring Guidelines

Watch for sudden behavior changes, disorientation, or hallucinations

2 clinical sources• PubMed • Clinical Guidelines • FDA

Endocrine / metabolic

2 documented effects

Total Sources: 3

Gynecomastia or breast tenderness

Incidence: Uncommon
Onset: After several weeks of therapy (dose-dependent)
mild
2 sources
Duration

Not specified

Management

Discuss with prescriber; consider alternative acid suppression therapy

Monitoring Guidelines

Monitor for galactorrhea or menstrual changes in adolescents

2 clinical sources• PubMed • Clinical Guidelines • FDA

Vitamin B12 depletion (long-term use)

Incidence: Rare
Onset: >= 2 years of continuous therapy
moderate
1 sources
Duration

Not specified

Management

Assess nutritional status; supplement B12 if deficiency suspected

Monitoring Guidelines

Watch for fatigue, paresthesias, or anemia in chronic users

1 clinical sources• PubMed • Clinical Guidelines • FDA

Hematologic / immune

2 documented effects

Total Sources: 2

Neutropenia or thrombocytopenia

Incidence: Very rare
Onset: Usually after weeks of therapy
severe
1 sources
Duration

Not specified

Management

Discontinue and arrange urgent evaluation with CBC

Monitoring Guidelines

Watch for fever, infections, unusual bruising, or bleeding

1 clinical sources• PubMed • Clinical Guidelines • FDA

Hypersensitivity reactions (rash, urticaria)

Incidence: Rare
Onset: Any time
moderate
1 sources
Duration

Not specified

Management

Stop immediately; seek urgent care for anaphylaxis or swelling

Monitoring Guidelines

Assess for rash, pruritus, wheezing, or facial swelling

1 clinical sources• PubMed • Clinical Guidelines • FDA

Hepatic / renal

2 documented effects

Total Sources: 2

Elevated liver enzymes

Incidence: Rare
Onset: Weeks to months
moderate
1 sources
Duration

Not specified

Management

Monitor liver function tests if symptoms develop; discontinue if significant elevations occur

Monitoring Guidelines

Watch for jaundice, dark urine, or persistent nausea

1 clinical sources• PubMed • Clinical Guidelines • FDA

Bradycardia or hypotension (rapid IV dosing)

Incidence: Very rare
Onset: During or immediately after IV administration
severe
1 sources
Duration

Not specified

Management

Slow infusion rate; monitor vitals; discontinue if symptomatic

Monitoring Guidelines

Applicable in inpatient settings with IV use

1 clinical sources• PubMed • Clinical Guidelines • FDA

Parent Communication Guide

Age-Appropriate Explanations

Infants (0-12 months)

For babies taking Cimetidine, watch for signs of side effects. This medication is generally well-tolerated in infants when used as directed.

Toddlers (1-3 years)

This medicine calms tummy acid. Call us if there is bad diarrhea, a rash, or trouble waking up.

Children (4-12 years)

Tell us about stomach pain, headaches, or if you feel dizzy or confused after taking the medicine.

Adolescents (13+ years)

Report any breast tenderness, menstrual changes, or new medicines you start while on cimetidine.

Common Parent Concerns

Q: Mild diarrhea or stomach upset

A: This is common and usually improves within a few days. Keep fluids up and call if diarrhea becomes severe, lasts more than two days, or has blood.

When to validate: Escalate if dehydration signs, high fever, or blood in stool

Q: Behavior changes (confusion, agitation)

A: Stop the medication and contact your clinician immediately. We will review dosing, kidney function, and other medicines.

When to validate: Same-day clinician evaluation

Q: Breast changes or galactorrhea

A: These rare effects should be reported promptly; an alternative acid reducer may be recommended.

When to validate: Schedule clinic visit for exam and medication review

Clinical Decision Support

Severity Assessment Framework

Screen for neurologic and endocrine adverse effects

Mild
Indicators: Brief headache, Transient loose stools
Action: Supportive care, continue therapy
Moderate
Indicators: Persistent diarrhea, Breast tenderness, Early confusion
Action: Assess adherence, review drug interactions, consider dose adjustment or switch
Severe
Indicators: Altered mental status, Severe rash, Hematologic abnormalities
Action: Stop therapy, obtain urgent labs, arrange higher level of care if needed

Treatment Decision Guidelines

Immediate Discontinuation

    Consider Alternatives

      Dose Modification

        Clinical References

        Cimetidine — FDA DailyMedU.S. National Library of Medicine (2025)Label
        Cimetidine — MedlinePlus Drug InformationMedlinePlus / NIH (2025)Database
        CimetidineStatPearls Publishing (2024)Review

        Frequently Asked Questions

        Parent and clinician concerns about Cimetidine