Histamine H2 Antagonists include- 

Cimetidine, Famotidine, Nizatidine, Ranitidine, Roxatidine
 

Refer - Cimetidine

Interacting drugs - summary

Nizatidine + Salicylates  
 increased serum salicylates levels levels occurred with nizatidine  administered to patients receiving receiving high doses of   aspirin ( 3.9g/day ).
                                                                                                                                       
H2 antogonists + Ethanol
concurrent use increase plasma ethanol levels and AUC. This interaction have minimal clinical importance
                                                                       
Antacids/  Anticholinergics /  Metoclopramide + H2 antogonist
 these agents decrease absorption of cimetidine .     
 Ranitidine absorption decreased by concurrent antacids  Avoid simultaneous administration. Bioavailability of famotidine and nizatidine slightly decreased. No special precautions  necessary.
                                                                                                                                                                                                                                                                                                    
Cigerette smoking + Cimetidine
cigarette smoking reverses cimetidine  inhibition of nocturnal gastric secretion and ulcer healling. Cigarette  use is closely related to ulcer recurrence

Indications: Duodenal ulcer,benign gastric ulcer,gastroesophagal reflux disease (GERD). 

Histamine H2 Antagonists include-

Cimetidine, Famotidine, Nizatidine, Ranitidine, Roxatidine

Refer - Cimetidine 

Adverse Reactions-
        
Nizatidine-

CNS -  Rare cases of reversible mental confusio have been reported

Dermatologic - Sweating, vasculitis has been reported rarey

GU- Clinical pharmacology studies and controlled clinical trials showed no evidence
of antiandrogenic activity due to nizatidine

Hematologic- Aanemia, fatal thrombocytopenia was reported in a patient who was treated with nizatidine and another H2 antagonist. Rare cases of thrombocytopenic purpura
 have been reported

Hepatic- Rare cases of cholestatic or mixed hepatocelluar and cholerstatic injury with jaundice have been reported with reversal of abnormalites after discontinuation of nizatidine 

Miscellaneous -  Serum sickness -like reaction have occurred rarely with nizatidine use
Hyperuremia unassociated with gout or nephritis was reported Eosinophillia and fever have been reported

Lab test abnormalities-
Small increase in serum creatinine and elevated ALT levels (at least pretreatment levels) occurred with ranitidine. Small possibly dose related increases in plasma creatinine and serum transaminase  occurred with cimetidine. These are not common and do not signify deteriorating renal function.
 Elevated AST, ALT, and alkaline phosphatase levels ocur with nizatidine

Reports not available.

Special precautions:

Reports not available

Approved by FDA in April 1988

Indications:

Duodenal ulcer,benign gastric ulcer,gastroesophagal reflux disease (GERD).

Dosage: Active duodenal ulcer- 300mg once daily at bed time, or 150mg twice daily. Maintenance of healed duodenal ulcer- 150mg once daily at bed time.

GERD- 150mg twice daily at bed time

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Gastro Osephageal Reflux Disease (GORD)

  Evidence Based Medicine (MIMS- March 2003)

Beneficial

1. Proton Pump Inhibitors such as omeprazole, Lansoprazole, pantoprazole
2. H-2 Antagonists such as cimetidine, ranitidine, famotidine, (less than proton pump inhibitors)
3. Fundoplication

Likely to be beneficial
1. Medical and surgical tretment of GORD in selected patients with extraoesophageal
   manifestations.

Unknown effectiveness
1. Medical and surgical treatment of GORD in patients with Barrets oesophagus

2. Surgical treatment for non erosive  oesophagitis

Key Points
1. One systemic review of randomised clinical trials has found proton inhibitors to be more
effective than H-2 antagonists in both erosive and non-erosive oesophagitis. One trial has
found no significant differences in the effectiveness of different proton pump inhibitors

2. Surgical treatment has not been adequately evaluated in controlled clinical trials.
Medical and surgical treatments have not been adequately compared

3. It is not clear whether patients with Barretts oesophagitis benefit from medical or surgical
treatment of their gastro oesophageal reflux  

4. There is limited, conflicting evidence on the basis on the benefits of treating gastro
  oesophageal reflux in patients with extra oesophageal manifestations (such as asthma)

Histamine H2 Antagonists include- Cimetidine, Famotidine, Nizatidine, Ranitidine, Roxatidine

Refer - Cimetidine

Histamine H2 Antagonists include- Cimetidine, Famotidine, Nizatidine, Ranitidine, Roxatidine

Refer - Cimetidine

Not avialable.

Pregnancy-

Use only when needed and when the potential benefits outweigh the potentaial hazards to the fetus.

Lactation-

Nizatidine- is excreted in breast milk in a concentration of 0.1% of oral dose in proportion to plasma concentrations. Decide whether to discontinue nursing or discontinue the drug depending on the importance of the drug to the mother.