Cimetidine Accumulation and Mental Confusion in Cirrhosis

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Abstract
To the Editor: Neurologic side effects from cimetidine have been reported among patients of advanced age and with impaired renal function. A positive correlation has been found between the concentrations of cimetidine in plasma and in cerebrospinal fluid and the occurrence of mental changes.1 , 2 Cimetidine is widely used in patients with liver cirrhosis complicated by peptic-ulcer disease. Recently, mental disturbances in such patients have been connected with cimetidine treatment in several reports.1 2 3 4 However, it is not known whether impaired liver function causes the accumulation of cimetidine. Previous pharmacokinetic studies in patients with cirrhosis but normal renal function have not shown . . .