DRUGS & SUPPLEMENTS
Apo-Cimetidine is a histamine H2-receptor antagonist. Chemically it is N”-cyano-N-methyl-N’-[2-[[methyl]thio]-ethyl], guanidine.
The molecular formula for Apo-Cimetidine is C10H16N6S; and the molecular weight is 252.35. The structural formula for Apo-Cimetidine is:
Apo-Cimetidine contains an imidazole ring, and is chemically related to histamine. Apo-Cimetidine has a bitter taste and characteristic odor.
Apo-Cimetidine is soluble in alcohol, slightly soluble in water, very slightly soluble in chloroform and insoluble in ether.
Each tablet, for oral administration, contains 300 mg, 400 mg, or 800 mg Apo-Cimetidine. In addition, each tablet contains the following inactive ingredients: corn starch, magnesium stearate, microcrystalline cellulose, povidone, sodium lauryl sulfate and sodium starch glycolate. The coating for the tablets contains: carnauba wax, hypromellose, polyethylene glycol, polysorbate 80, talc, titanium dioxide, and triethyl citrate. The coating for the 300 mg and 400 mg tablets also contains D&C Yellow No. 10 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake, and FD&C Yellow No. 6 Aluminum Lake.
Apo-Cimetidine competitively inhibits the action of histamine at the histamine H2 receptors of the parietal cells and thus is a histamine H2-receptor antagonist.
Apo-Cimetidine is not an anticholinergic agent. Studies have shown that Apo-Cimetidine inhibits both daytime and nocturnal basal gastric acid secretion. Apo-Cimetidine also inhibits gastric acid secretion stimulated by food, histamine, pentagastrin, caffeine and insulin.
1) Acid Secretion
Apo-Cimetidine 800 mg orally at bedtime reduces mean hourly H+ activity by greater than 85% over an eight-hour period in duodenal ulcer patients, with no effect on daytime acid secretion. Apo-Cimetidine 1600 mg orally at bedtime produces 100% inhibition of mean hourly H+ activity over an eight-hour period in duodenal ulcer patients, but also reduces H+ activity by 35% for an additional five hours into the following morning. Apo-Cimetidine 400 mg twice daily and 300 mg four times daily decrease nocturnal acid secretion in a dose-related manner, i.e., 47% to 83% over a six- to eight-hour period and 54% over a nine-hour period, respectively.
During the first hour after a standard experimental meal, oral Apo-Cimetidine 300 mg inhibited gastric acid secretion in duodenal ulcer patients by at least 50%. During the subsequent two hours Apo-Cimetidine inhibited gastric acid secretion by at least 75%.
The effect of a 300 mg breakfast dose of Apo-Cimetidine continued for at least four hours and there was partial suppression of the rise in gastric acid secretion following the luncheon meal in duodenal ulcer patients. This suppression of gastric output was enhanced and could be maintained by another 300 mg dose of Apo-Cimetidine given with lunch.
In another study, Apo-Cimetidine 300 mg given with the meal increased gastric pH as compared with placebo.
24-Hour mean H+ activity
Apo-Cimetidine 800 mg at bedtime, 400 mg twice daily and 200 mg four times daily all provide a similar, moderate level of 24-hour acid suppression. However, the 800 mg at bedtime regimen exerts its entire effect on nocturnal acid, and does not affect daytime gastric physiology.
Oral Apo-Cimetidine significantly inhibited gastric acid secretion stimulated by betazole (an isomer of histamine), pentagastrin, caffeine and insulin as follows:
When food and betazole were used to stimulate secretion, inhibition of hydrogen ion concentration usually ranged from 45 to 75% and the inhibition of volume ranged from 30 to 65%.
Oral Apo-Cimetidine 300 mg reduced total pepsin output as a result of the decrease in volume of gastric juice.
3) Intrinsic Factor
Intrinsic factor secretion was studied with betazole as a stimulant. Oral Apo-Cimetidine 300 mg inhibited the rise in intrinsic factor concentration produced by betazole, but some intrinsic factor was secreted at all times.
Lower Esophageal Sphincter Pressure and Gastric Emptying
Apo-Cimetidine has no effect on lower esophageal sphincter pressure or the rate of gastric emptying.
Apo-Cimetidine is rapidly absorbed after oral administration and peak levels occur in 45 to 90 minutes. The half-life of Apo-Cimetidine is approximately 2 hours. Blood concentrations remain above that required to provide 80% inhibition of basal gastric acid secretion for 4 to 5 hours following a dose of 300 mg.
The principal route of excretion of Apo-Cimetidine is the urine. Following oral administration, the drug is extensively metabolized, the sulfoxide being the major metabolite. Following a single oral dose, 48% of the drug is recovered from the urine after 24 hours as the parent compound.
Apo-Cimetidine has been shown to be effective in the treatment of active duodenal ulcer and, at reduced dosage, in maintenance therapy following healing of active ulcers.
Active duodenal ulcer
Apo-Cimetidine accelerates the rate of duodenal ulcer healing. Healing rates reported in U.S. and foreign controlled trials with oral Apo-Cimetidine are summarized below, beginning with the regimen providing the lowest nocturnal dose.
A U.S., double-blind, placebo-controlled, dose-ranging study demonstrated that all once-daily at bedtime Apo-Cimetidine regimens were superior to placebo in ulcer healing and that Apo-Cimetidine 800 mg at bedtime healed 75% of patients at four weeks. The healing rate with 800 mg at bedtime was significantly superior to 400 mg at bedtime and not significantly different from 1600 mg at bedtime (81%).
In the U.S. dose-ranging trial, over 80% of patients receiving Apo-Cimetidine 800 mg at bedtime experienced nocturnal pain relief after one day. Relief from daytime pain was reported in 70% of patients after two days. As with ulcer healing, the 800 mg at bedtime dose was superior to 400 mg at bedtime and not different from 1600 mg at bedtime.
In foreign, double-blind studies with Apo-Cimetidine 800 mg at bedtime, 79 to 85% of patients were healed at four weeks.
While short-term treatment with Apo-Cimetidine can result in complete healing of the duodenal ulcer, acute therapy will not prevent ulcer recurrence after Apo-Cimetidine has been discontinued. Some follow-up studies have reported that the rate of recurrence once therapy was discontinued was slightly higher for patients healed on Apo-Cimetidine than for patients healed on other forms of therapy; however, the cimetidine-treated patients generally had more severe disease.
Maintenance therapy in duodenal ulcer
Treatment with a reduced dose of Apo-Cimetidine has been proven effective as maintenance therapy following healing of active duodenal ulcers.
In numerous placebo-controlled studies conducted worldwide, the percent of patients with observed ulcers at the end of one year’s therapy with Apo-Cimetidine 400 mg at bedtime was significantly lower (10% to 45%) than in patients receiving placebo (44% to 70%). Thus, from 55% to 90% of patients were maintained free of observed ulcers at the end of one year with Apo-Cimetidine 400 mg at bedtime.
Factors such as smoking, duration and severity of disease, gender, and genetic traits may contribute to variations in actual percentages.
Trials of other anti-ulcer therapy, whether placebo-controlled, positive-controlled or open, have demonstrated a range of results similar to that seen with Apo-Cimetidine.
Active Benign Gastric Ulcer
Apo-Cimetidine has been shown to be effective in the short-term treatment of active benign gastric ulcer.
In a multicenter, double-blind U.S. study, patients with endoscopically confirmed benign gastric ulcer were treated with Apo-Cimetidine 300 mg four times a day or with placebo for six weeks. Patients were limited to those with ulcers ranging from 0.5 to 2.5 cm in size. Endoscopically confirmed healing at six weeks was seen in significantlya more cimetidine-treated patients than in patients receiving the placebo, as shown below:
In a similar multicenter U.S. study of the 800 mg at bedtime oral regimen, the endoscopically confirmed healing rates were:
Similarly, in worldwide double-blind clinical studies, endoscopically evaluated benign gastric ulcer healing rates were consistently higher with Apo-Cimetidine than with placebo.
Gastroesophageal Reflux Disease
In two multicenter, double-blind, placebo-controlled studies in patients with gastroesophageal reflux disease (GERD) and endoscopically proven erosions and/or ulcers, Apo-Cimetidine was significantly more effective than placebo in healing lesions. The endoscopically confirmed healing rates were:
In these trials Apo-Cimetidine was superior to placebo by most measures in improving symptoms of day- and night-time heartburn, with many of the differences statistically significant. The four times daily regimen was generally somewhat better than the twice daily regimen where these were compared.
Pathological Hypersecretory Conditions
Apo-Cimetidine significantly inhibited gastric acid secretion and reduced occurrence of diarrhea, anorexia and pain in patients with pathological hypersecretion associated with Zollinger-Ellison Syndrome, systemic mastocytosis and multiple endocrine adenomas. Use of Apo-Cimetidine was also followed by healing of intractable ulcers.
INDICATIONS AND USAGE
Apo-Cimetidine tablets are indicated in:
Apo-Cimetidine is contraindicated for patients known to have hypersensitivity to the product.
Rare instances of cardiac arrhythmias and hypotension have been reported following the rapid administration of Apo-Cimetidine hydrochloride by intravenous bolus.
Symptomatic response to Apo-Cimetidine therapy does not preclude the presence of a gastric malignancy. There have been rare reports of transient healing of gastric ulcers despite subsequently documented malignancy.
Reversible confusional states have been observed on occasion, predominantly, but not exclusively, in severely ill patients. Advancing age (50 or more years) and preexisting liver and/or renal disease appear to be contributing factors. In some patients these confusional states have been mild and have not required discontinuation of Apo-Cimetidine therapy. In cases where discontinuation was judged necessary the condition was usually cleared within 3 to 4 days of drug withdrawal.
Apo-Cimetidine, apparently through an effect on certain microsomal enzyme systems, has been reported to reduce the hepatic metabolism of warfarin-type anticoagulants, phenytoin, propanolol, nifedipine, chlordiazepoxide, diazepam, certain tricyclic antidepressants, lidocaine, theophylline and metronidazole, thereby delaying elimination and increasing blood levels of these drugs.
Clinically significant effects have been reported with the warfarin anticoagulants; therefore, close monitoring of prothrombin time is recommended, and adjustment of the anticoagulant dose may be necessary when Apo-Cimetidine is administered concomitantly. Interaction with phenytoin, lidocaine and theophylline has also been reported to produce adverse clinical effects.
However, a crossover study in healthy subjects receiving either Apo-Cimetidine 300 mg four times daily or 800 mg at bedtime concomitantly with a 300 mg twice daily dosage of theophylline extended-release tablets (Theo-Dur®*) demonstrated less alteration in steady-state theophylline peak serum levels with the 800 mg at bedtime regimen, particularly in subjects aged 54 years and older. Data beyond ten days are not available. (Note: All patients receiving theophylline should be monitored appropriately, regardless of concomitant drug therapy.)
Dosage of the drugs mentioned above and other similarly metabolized drugs, particularly those of low therapeutic ratio or in patients with renal and/or hepatic impairment, may require adjustment when starting or stopping concomitantly administered Apo-Cimetidine to maintain optimum therapeutic blood levels.
Alteration of pH may affect absorption of certain drugs (e.g., ketoconazole). If these products are needed, they should be given at least 2 hours before Apo-Cimetidine administration.
Additional clinical experience may reveal other drugs affected by the concomitant administration of Apo-Cimetidine.
Carcinogenesis, Mutagenesis, Impairment of Fertility
In a 24 month toxicity study conducted in rats, at dose levels of 150, 378 and 950 mg/kg/day, there was a small increase in the incidence of benign Leydig cell tumors in each dose group; when the combined drug-treated groups and control groups were compared, this increase reached statistical significance. In a subsequent 24 month study, there were no differences between the rats receiving 150 mg/kg/day and the untreated controls. However, a statistically significant increase in benign Leydig cell tumor incidence was seen in the rats that received 378 and 950 mg/kg/day. These tumors were common in control groups as well as treated groups and the difference became apparent only in aged rats.
Apo-Cimetidine has demonstrated a weak antiandrogenic effect. In animal studies this was manifested as reduced prostate and seminal vesicle weights. However, there was no impairment of mating performance or fertility, nor any harm to the fetus in these animals at doses 8 to 48 times the full therapeutic dose of Apo-Cimetidine, as compared with controls. The cases of gynecomoastia seen in patients treated for one month or longer may be related to this effect.
In human studies, Apo-Cimetidine has been shown to have no effect on spermatogenesis, sperm count, motility, morphology or in vitro fertilizing capacity.
Pregnancy category B
Reproduction studies have been performed in rats, rabbits and mice at doses up to 40 times the normal human dose and have revealed no evidence of impaired fertility or harm to the fetus due to Apo-Cimetidine. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproductive studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Apo-Cimetidine is secreted in human milk and, as a general rule, nursing should not be undertaken while a patient is on this drug.
Clinical experience in pediatric patients is limited. Therefore, Apo-Cimetidine therapy cannot be recommended for pediatric patients under 16, unless, in the judgment of the physician, anticipated benefits outweigh the potential risks. In very limited experience, doses of 20 to 40 mg/kg/day have been used.
In immunocompromised patients, decreased gastric acidity, including that produced by acid-suppressing agents such as Apo-Cimetidine, may increase the possibility of a hyperinfection of strongyloidiasis.
Adverse effects reported in patients taking Apo-Cimetidine are described below by body system. Incidence figures of 1 in 100 and greater are generally derived from controlled clinical studies.
Diarrhea has been reported in approximately 1 in 100 patients.
Headaches, ranging from mild to severe, have been reported in 3.5% of 924 patients taking 1600 mg/day, 2.1% of 2,225 patients taking 800 mg/day and 2.3% of 1,897 patients taking placebo. Dizziness and somnolence (usually mild) have been reported in approximately 1 in 100 patients on either 1600 mg/day or 800 mg/day.
Reversible confusional states, e.g., mental confusion, agitation, psychosis, depression, anxiety, hallucinations, disorientation, have been reported predominantly, but not exclusively, in severely ill patients. They have usually developed within 2 to 3 days of initiation of Apo-Cimetidine therapy and have cleared within 3 to 4 days of discontinuation of the drug.
Gynecomastia has been reported in patients treated for one month or longer. In patients being treated for pathological hypersecretory states, this occurred in about 4% of cases while in all others the incidence was 0.3% to 1% in various studies. No evidence of induced endocrine dysfunction was found, and the condition remained unchanged or returned toward normal with continuing Apo-Cimetidine treatment.
Reversible impotence has been reported in patients with pathological hypersecretory disorders, e.g., Zollinger-Ellison Syndrome, receiving Apo-Cimetidine, particularly in high doses for at least 12 months. However, in large-scale surveillance studies at regular dosage, the incidence has not exceeded that commonly reported in the general population.
Decreased white blood cell counts in cimetidine-treated patients (approximately 1 per 100,000 patients), including agranulocytosis (approximately 3 per million patients, have been reported, including a few reports of recurrence on rechallenge. Most of these reports were in patients who had serious concomitant illnesses and received drugs and/or treatment known to produce neutropenia. Thrombocytopenia (approximately 3 per million patients) and, very rarely, cases of pancytopenia or aplastic anemia have also been reported. As with some other H2-receptor antagonists, there have been extremely rare reports of immune hemolytic anemia.
Dose-related increases in serum transaminase have been reported. In most cases they did not progress with continued therapy and returned to normal at the end of therapy. There have been rare reports of cholestatic or mixed cholestatic-hepatocellular effects. These were usually reversible. Because of the predominance of cholestatic features, severe parenchymal injury is considered highly unlikely. However, as in the occasional liver injury with other H2-receptor antagonists, in exceedingly rare circumstances fatal outcomes have been reported.
There has been reported a single case of biopsy-proven periportal hepatic fibrosis in a patient receiving Apo-Cimetidine.
Rare cases of pancreatitis, which cleared on withdrawal of the drug, have been reported.
Rare cases of fever and allergic reactions including anaphylaxis and hypersensitivity vasculitis, which cleared on withdrawal of the drug, have been reported.
Small, possibly dose-related increases in plasma creatinine, presumably due to competition for renal tubular secretion, are not uncommon and do not signify deteriorating renal function. Rare cases of interstitial nephritis and urinary retention, which cleared on withdrawal of the drug, have been reported.
Rare cases of bradycardia, tachycardia and A-V heart block have been reported with H2-receptor antagonists.
There have been rare reports of reversible arthralgia and myalgia; exacerbation of joint symptoms in patients with preexisting arthritis has also been reported. Such symptoms have usually been alleviated by a reduction in Apo-Cimetidine dosage. Rare cases of polymyositis have been reported, but no causal relationship has been established.
Mild rash and, very rarely, cases of severe generalized skin reactions including Stevens-Johnson syndrome, epidermal necrolysis, erythema multiforme, exfoliative dermatitis and generalized exfoliative erythroderma have been reported with H2-receptor antagonists. Reversible alopecia has been reported very rarely.
There have been extremely rare reports of strongyloidiasis hyperinfection in immunocompromised patients.
A large epidemiological study suggested an increased risk of developing pneumonia in current users of histamine-2-receptor antagonists (H2RAs) compared to patients who had stopped H2RA treatment, with an observed adjusted relative risk of 1.63 (95% CI, 1.07 to 2.48). However, a causal relationship between use of H2RAs and pneumonia has not been established.
Studies in animals indicate that toxic doses are associated with respiratory failure and tachycardia that may be controlled by assisted respiration and the administration of a beta-blocker.
Reported acute ingestions orally of up to 20 grams have been associated with transient adverse effects similar to those encountered in normal clinical experience. The usual measures to remove unabsorbed material from the gastrointestinal tract, clinical monitoring, and supportive therapy should be employed.
There have been reports of severe CNS symptoms, including unresponsiveness, following ingestion of between 20 and 40 grams of Apo-Cimetidine, and extremely rare reports following concomitant use of multiple CNS active medications and ingestion of Apo-Cimetidine at doses less than 20 grams. An elderly, terminally ill dehydrated patient with organic brain syndrome receiving concomitant antipsychotic agents and Apo-Cimetidine 4800 mg intravenously over a 24 hour period experienced mental deterioration with reversal on Apo-Cimetidine discontinuation.
There have been two deaths in adults who have been reported to ingest over 40 grams orally on a single occasion.
DOSAGE AND ADMINISTRATION
Active Duodenal Ulcer
Clinical studies have indicated that suppression of nocturnal acid is the most important factor in duodenal ulcer healing. This is supported by recent clinical trials (see Clinical Trials, Active duodenal ulcer). Therefore, there is no apparent rationale, except for familiarity with use, for treating with anything other than a once-daily at bedtime oral dosage regimen.
In a U.S. oral dose-ranging study of 400 mg at bedtime, 800 mg at bedtime and 1600 mg at bedtime, a continuous dose response relationship for ulcer healing was demonstrated.
However, 800 mg at bedtime is the dose of choice for most patients, as it provides a high healing rate (the difference between 800 mg at bedtime and 1600 mg at bedtime being small), maximal pain relief, a decreased potential for drug interactions (see PRECAUTIONS, Drug Interactions) and maximal patient convenience. Patients unhealed at four weeks, or those with persistent symptoms, have been shown to benefit from two to four weeks of continued therapy.
It has been shown that patients who both have an endoscopically demonstrated ulcer larger than 1 cm and are also heavy smokers (i.e., smoke one pack of cigarettes or more per day) are more difficult to heal. There is some evidence which suggests that more rapid healing can be achieved in this subpopulation with Apo-Cimetidine 1600 mg at bedtime. While early pain relief with either 800 mg at bedtime or 1600 mg at bedtime is equivalent in all patients, 1600 mg at bedtime provides an appropriate alternative when it is important to ensure healing within four weeks for this subpopulation. Alternatively, approximately 94% of all patients will also heal in eight weeks with Apo-Cimetidine 800 mg at bedtime.
Other Apo-Cimetidine oral regimens in the U.S. which have been shown to be effective are: 300 mg four times daily, with meals and at bedtime, the original regimen with which U.S. physicians have the most experience, and 400 mg twice daily, in the morning and at bedtime (see Clinical Trials, Active duodenal ulcer).
Concomitant antacids should be given as needed for relief of pain. However, simultaneous administration of oral Apo-Cimetidine and antacids is not recommended, since antacids have been reported to interfere with the absorption of Apo-Cimetidine.
While healing with Apo-Cimetidine often occurs during the first week or two, treatment should be continued for 4 to 6 weeks unless healing has been demonstrated by endoscopic examination.
Maintenance Therapy for Duodenal Ulcer
In those patients requiring maintenance therapy, the recommended adult oral dose is 400 mg at bedtime.
Active Benign Gastric Ulcer
The recommended adult oral dosage for short-term treatment of active benign gastric ulcer is 800 mg at bedtime, or 300 mg four times a day with meals and at bedtime. Controlled clinical studies were limited to six weeks of treatment. 800 mg at bedtime is the preferred regimen for most patients based upon convenience and reduced potential for drug interactions. Symptomatic response to Apo-Cimetidine dose not preclude the presence of a gastric malignancy. It is important to follow gastric ulcer patients to assure rapid progress to complete healing.
Erosive Gastroesophageal Reflux Disease (GERD)
The recommended adult oral dosage for the treatment of erosive esophagitis that has been diagnosed by endoscopy is 1600 mg daily in divided doses (800 mg twice daily or 400 mg four times daily) for 12 weeks. The use of Apo-Cimetidine beyond 12 weeks has not been established.
Pathological Hypersecretory Conditions
Recommended adult oral
Dosage: 300 mg four times a day with meals at bedtime. In some patients it may be necessary to administer higher doses more frequently. Doses should be adjusted to individual patient needs, but should not usually exceed 2400 mg per day and should continue as long as clinically needed.
Dosage Adjustments for Patients with Impaired Renal Function
Patients with severely impaired renal function have been treated with Apo-Cimetidine. However, such dosage has been very limited. On the basis of this experience the recommended dosage is 300 mg every 12 hours orally. Should the patient’s condition require, the frequency of dosing may be increased to every 8 hours or even further with caution. In severe renal failure, accumulation may occur and the lower frequency of dosing comparable with an adequate patient response should be used. When liver impairment is also present, further reductions in dosage may be necessary. Hemodialysis reduces the level of circulating Apo-Cimetidine. Ideally, the dosage schedule should be adjusted so that the timing of a scheduled dose coincides with the end of hemodialysis.
Apo-Cimetidine tablets USP, 300 mg are dark-green, oval-shaped, film-coated tablets, debossed with N192 on one side and 300 on the reverse. They are supplied as follows:
NDC 0093-8192-01 bottles of 100
NDC 0093-8192-05 bottles of 500
Apo-Cimetidine tablets USP, 400 mg are dark-green, oval-shaped, film-coated tablets, debossed with N vertical bisect 204 on one side and partial bisect 400 on the reverse. They are supplied as follows:
NDC 0093-8204-01 bottles of 100
NDC 0093-8204-05 bottles of 500
Apo-Cimetidine tablets USP, 800 mg are white, oval-shaped, film-coated tablets, debossed with N vertical bisect 305 on one side and partial bisect 800 on the reverse. They are supplied as follows:
NDC 0093-8305-01 bottles of 100
Store at 20° to 25°C (68° to 77°F).
Dispense in a tight, light-resistant container, as defined in the USP, with a child-resistant closure (as required).
* Theo-Dur® is a registered trademark of Key Pharmaceuticals Inc.
Manufactured In Canada By:
Toronto, Canada M1B 2K9
TEVA PHARMACEUTICALS USA
Sellersville, PA 18960
Rev. D 10/2010
Apo-Cimetidine 800mg Tablet
Structural formula for cimetidine
Apo-Cimetidine pharmaceutical active ingredients containing related brand and generic drugs:
Active ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.
Apo-Cimetidine available forms, composition, doses:
Form of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.
Apo-Cimetidine destination | category:
Destination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.
Apo-Cimetidine Anatomical Therapeutic Chemical codes:
A medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.
Apo-Cimetidine pharmaceutical companies:
Pharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.
Frequently asked QuestionsCan i drive or operate heavy machine after consuming Apo-Cimetidine?
Depending on the reaction of the Apo-Cimetidine after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Apo-Cimetidine not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.Is Apo-Cimetidine addictive or habit forming?
Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
Reviewsdrugs.com conducted a study on Apo-Cimetidine, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Apo-Cimetidine consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.
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The information was verified by Dr. Arunabha Ray, MD Pharmacology