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May 4, 1984

Cimetidine and Ranitidine-Reply

JAMA. 1984;251(17):2212. doi:10.1001/jama.1984.03340410023025

In Reply.—  I appreciate Dr Rubin's thoughtful comments. We are in agreement on the most critical issue: both cimetidine and ranitidine are excellent drugs, although neither is without occasional adverse effects. Approximately 2 million prescriptions for ranitidine in the United States and 24 million prescriptions outside the United States have been filled (Glaxo, Inc, written communication, March 14,1984). Dr Rubin and I may be in agreement on two other issues: (1) The rare, unpredictable, idiosyncratic side effects of ranitidine will require more time and use to identify. Certainly no one should be surprised if additional side effects from ranitidine appear. (2) The lowest dose of H2-receptor antagonists that produces the desired effect should be the goal of therapy.Where Dr Rubin and I do not agree is on the issue of the dose-dependent, and thereby more predictable, adverse effects of cimetidine for which there is scientific evidence to