From: crowem@occ-uky.campus.mci.net (Mike Crowe) Is anyone using Tagamet (cimetidine) alone or in combination with other therapy for resistant warts? What dose have you been using? What type of success. Thanks. Mike Crowe. WARTS AND THE USE OF CIMETIDINE =========================== From: crowem@occ-uky.campus.mci.net (Mike Crowe) Is anyone using Tagamet (cimetidine) alone or in combination with other therapy for resistant warts? What dose have you been using? What type of success. Thanks. Mike Crowe. ========================= From: Christopher Clay I have been using it mainly in combination with topicals, cryo, or cantharidin. I am not sure how useful it is but it seems reasonably safe. It was enthusiastically reported by Gail Fisher from Sydney NSW Australia at a recent meeting of the Australian College. My impression is that is is less effective in adults than children. The dose is 20 to 40 mg per kg. ========================== From: rkurtl@ico.com (Kurt Lofgren) I've been using it in the tough flat wart patients in combination with various other treatments and have been unimpressed. Kurt Lofgren ========================== From: "Jerry D. Eisner" I have used it skeptically and have had some unusual successes. Perhaps it is a combination of physician enthusiasm and placebo effect, but what the heck-use it if it works ( or while it works). One 18 y.o girl saw me for a year for planar warts of the face (facial warts are my best successes) with failures on cryo, Retin-A, Efudex, used multiple times and for many months. Gave her cimetidine 800 BID. They went away in two weeks. I have had most success with kids and young adults, from a great toe covered with mosaic warts in a college student, to kids with fingers covered with periungual warts. Jerry Eisner ============================= From: FVJB41A@prodigy.com ( DANIEL M SIEGEL) I have been using it a lot in patients with extensive warts, especially on their hands who use their hands extensiveley (a pianist, chek, and policeman are among the ranks). I use 40mg/kg/day in kids and 800mg tid inadults, usually in combination with Efudex 5% solution and/or Retin-A Liquid (if together, the Retin-A precedes the Efudex by 15-30 minutes) or Sal acid preparations. Some respond dramatically after a few weeks and some have no response. In the later group, I will apply Cantharone as a kicker and if they are Rhus sensitive, I will let them use a crude extract from my road applied once a day with a toothpick. I always encourage occlusion of the wart with black electrical tape or grey duct tape and encourage those with a hot tub to soak frequently. I have also added on half strength Clorox applied with a toothpick once per day. I have a poster of "classic" wart regimens in my office which I encourage patients to read and am waiting to see back one patient who was going to rub his wart on his modem and then was going to try and Email it to someone. Daniel Mark Siegel MD =========================== From: Daniel F Mitchell I use 300mg bid of Tagamet. Only 1/3 of my pts have cleared, but, boy, was it dramatic! I tell them nothing will happen for the first two months, then the third month will tell the story. =============================== From: taniguch@clin.medic.mie-u.ac.jp (yoshiki taniguchi) I saw an excellent case in last May. A 20-year-old worker with resistant warts on the hands was treated with Cimetidine of 3 tablets per day for a month. Warts were starting to dissapear in 2 weeks and gone in a month. Yoshiki ========================================= From: "L.J. Gregg" <73477.361@compuserve.com> I have been using 25mg/kg for the past year or so since the article appeared from the British literature with quite acceptable results. I treat only problem patients(#'s or recalcitrant or both plus periungual) and am seeing results about like the original studies--75% pre pubes and 50-60% adult cure rates. I tell patients to wait at lease 12-16 weeks before giving up and most are happy to try since they have been abused with one form or another of destructive tx for some time. Most recently saw a 17 year old male with 10 nail periungual warts that had been treated with cryo and elctrocautery for the past 3 years, at 6 weeks he had cleared all of his nails and had several persistent palmar verrucae. Adults seem to do better with occasional irritation of warts. I would try accutane on the dissecting cellulitis patients as have seen favorable results. ================================== From: Peauski@aol.com Have tried it and it does work but so do a whole host of other organic as well as inorganic products. My latest is 10% formalin....amazing results when applied BID.......for now!!!!! H I do not have the references in front of me, but I was under the impression that preliminary studies comparing Tagamet to placebo showed no effect in teenagers and adlust, but were more encouraging in children under the age of 10 (see Dr. Paller's short piece in the Blue Journal). My only successes have been in children to date, but Physician attitude may play a role in the treatment of warts. John Uhlemann =============================== From taniguch@clin.medic.mie-u.ac.jp Tue Dec 5 00:30 PST 1995 I saw an excellent case in last May. A 20-year-old worker with resistant warts on the hands was treated with Cimetidine (200mg) of 3 tablets per day for a month. Warts were starting to disappear in 2 weeks and gone in a month. I found an interesting abstract written in Japanese, although it was published 10 years ago. Title: Combination therapy of Interferon Beta and Cimetidine for verrucae planae juvenales (VPJ) Author: Sanae Horiuchi, Toru Baba, Kennichi Ueno Journal: Nishi-Nihon Journal of Dermatology, 47:970, 1985 (Nishi-Nihon =Western part of Japan) Abstract: Local injection of Interferon beta for verruca vulgaris was efficatious in 98% cases used (Dr. Ueno) and this data was proved in double blind test by Dr. Niimura. However, the effectiveness of local and muscle injection of interferon beta for the patients with VPJ was 25% and 54% respectively. We separated patients of VPJ into two groups and compared the efficacy of the therapy. The first group got muscle injection of Interferon beta 1x10 6 IU per week and the second group had combination of same injection and cimetidine of 600mg per day. Interferon beta alone was effective in 40% of VPJ patients. The combination therapy was excellent in 83% of VPJ patients. Recalcitrant VPJ was well treated with this combination. My comments: I feel cimetidine certainly has a good efficacy on warts. It seems not a placebo. Yoshiki =================== From: KSmithDerm@aol.com I use ranitidine or famotidine rather than cimetidine - higher H2 affinity - no cytochrome P-450 inhibition - no anti-androgenic effects - less drug interactions Need a high dose [eg. ranitidine 300 bid for adults, use the 75 mg/ml syruP for little kids - tastes like mint]. For adults with plantar warts I always use Tegison, Soriatane or Accutane also, because h2 antagonists as a single agent don't work well enough in adults. I agree with Kurt Lofgren that H2 antagonists are not very useful for flat warts. Ranitidine also works very well [but takes several months] for extensive molluscum contagiosa - again, works better for kids than adults - be sure to use a high enough dose, and don't stop Rx when the kid is 95% better or they'll relapse - better to treat till they're clear, then for an extra month after. OK to use Cantharone Plain along with ranitidine to speed things up. For both warts and mollusca I frequently photograph the patients. Improvement is slow and without the photos you might not be impressed. I think the photos improve compliance a lot, because when the patients can see that they ARE improving they are more inclined to stick with the treatment program [and I am more inclined to hang in there]. I think the photos make quite a big difference to my success, and they are objective. The also save a lot time, because instead of spending a few minutes discussing [? negotiating] whether or not the treatment is working we look at the picture then at the lesions for about 10 seconds and there is no argument: either it is working or it isn't. Also have a subset of psoriasis patients doing well on ranitidine or famotidine - had an AIDS patient with terrible resistant psoriasis who cleared right up on ranitidine [I think I put that in the Int. J. Derm.]. Bottom line: cimetidine is about the last choice for an H2 inhibitor as far as I'm concerned. KC Smith, MD, FRCPC