A. SIDNEY BARRITT, M.D.
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To the editor: I prescribe Cimetidine frequently and try to be sensitive to its possible adverse effects. Thus, I was interested in Dr. Kushner's report of a movement disorder linked to use of Cimetidine (1).
His evidence is persuasive. I propose an alternate mechanism in which theophylline is the ultimate culprit. This patient received Cimetidine, theophylline, and terbutaline simultaneously. Cimetidine alters the metabolism of other drugs, including theophylline (2, 3). I propose that Cimetidine delayed elimination of theophylline, allowing a previously therapeutic dose to become toxic. I have not seen chorea as a toxic effect of theophylline, but tremors have
BARRITT AS. Cimetidine-Theophylline-Terbutaline. Ann Intern Med. 1982;96:530–531. doi: 10.7326/0003-4819-96-4-530
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Published: Ann Intern Med. 1982;96(4):530-531.
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