Summary
The effect-of cimetidine on hepatic and systemic haemodynamic parameters was studied in seven patients with portal hypertension due to alcohol-induced cirrhosis of the liver and in one patient with peliosis hepatis following oral contraceptive steroids. The intravenous administration of cimetidine (350 mg as bolus, followed by 2 mg/min over 60 min) reduced the hepatic extraction of continuously infused indocyanine green (ICG) by 27%; this was statistically significant (P<0.01). Since the ICG clearance, calculated independently of hepatic perfusion, was lowered by 19%, this effect seems to be mainly due to a reduced capacity of the liver to remove the dye from the blood, rather than due to changes in perfusion. Cimetidine did not influence the elevated portal pressure in the patients with cirrhosis, or the normal pressure in the patient with peliosis hepatis. No significant effect was observed on heart rate, mean arterial pressure, pulmonary artery pressure, pulmonary capillary pressure and cardiac output. These studies indicate that the reduction of the hepatic ICG extraction following cimetidine is more the result of an inhibited capacity of the liver to remove the dye than of changes in the hepatic perfusion or in the systemic circulation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bircher J, Blankart R, Halpern A, Häcki W, Laissue J, Preisig R (1973) Criteria for assessment of functional impairment in patients with cirrhosis of the liver. Eur J Clin Invest 3:72–85
Bradley SE, Ingelfinger FJ, Bradley GP, Curry JJ (1945) The estimation of hepatic blood flow in man. J Clin Invest 24:890–897
Burroughs AK, Walt R, Dunk A, Jenkins W, Sherlock S, Mackie S, Dick R (1982) Effect of cimetidine on portal hypertension in cirrhotic patients. Br Med J 284:1159–1160
Charbon GA, Brouwers HAA, Sala A (1980) Histamine H1-and H2-receptors in the gastrointestinal circulation Naunyn-Schmiedebergs Arch Pharmacol 312:123–129
Desmond PV, Patwardhan RV, Schenker S, Speeg Jr KV (1980) Cimetidine impairs elimination of chlordiazepoxide (Librium) in man. Ann Intern Med 93:266–268
El-Gendi MA, Nassar SH (1980) Effect of histamine and histamine antagonists on portal blood pressure in patients with hepatosplenic schistosomiasis. Br J Clin Pharmacol 10:157–161
Engel TR, Luck JC (1979) Histamine H2-receptor antagonism by cimetidine and sinus-node function. N Engl J Med 301:591–592
Feely J, Wilkinson GR, Wood AJJ (1981) Reduction of liver blood flow and propranolol metabolism by cimetidine. N Engl J Med 304:692–695
Flynn SB, Johnston BM, Owen DAA (1977) The cardiovascular response to dimaprit, a selective histamine H2-receptor agonist. Br J Pharmacol 61:101–107
Häcki W, Bircher J, Preisig R (1976) A new look at the plasma disappearance of sulfobromophthalein (BSP). Correlation with the BSP-transport maximum and the hepatic plasma flow. J Lab Clin Med 88:1019–1031
Harvey CA, Owen DAA, Shaw KD (1980) Evidence for both histamine H1- and H2-receptors in the gastric vasculature of the cat. Br J Pharmacol 69:21–27
Imesch B, Häcki W, Bircher J (1973) Was mißt die BSP-Retention? Ein Vergleich mit BSP-Transportmaximum, -Speicherkapazität und Galaktoseeliminationskapazität. Schweiz Med Wochenschr 103:397–403
Jackson JE (1981) Reduction of liver blood flow by cimetidine. N Engl J Med 305:99–100
Klotz U, Reimann I (1980) Delayed clearance of diazepam due to cimetidine. N Engl J Med 302:1012–1014
Krarup N, Larsen JA (1976) The influence of dye infusion rate and hepatic plasma flow on indocyanine green clearance. Scand J Clin Lab Invest 36:183–188
Kutz K, Deres M, Schnarr S, Schiermeyer B, Haberland D (1982) 11th Meeting of the European Association for the Study of the Liver. Göteborg, Abstract No. 172
Larsen NE, Hesselfeld P, Rune SJ (1979) Cimetidine assay in human plasma by liquid chromatography. J Chromatogr 163:57–63
Lebrec D, Goldfarb G, Benhamou J-P (1981) Reduction of liver blood flow by cimetidine. N Engl J Med 305:100
McIsaac RL, Johnston BJ, Fielding LP (1981) Gastric mucosal blood flow and acid secretory changes in man with impromidine: A new specific histamine H2-receptor agonist. Gut 22:529–533
Paumgartner G, Vasella DL, Herz R, Reichen J, Preisig R (1979) Hepatische Extraktion von Taurocholat und Indocyaningrün bei Patienten mit Lebererkrankungen. Z Gastroenterol 17:753–761
Pawlik W, Tague LL, Tepperman BL, Miller TA, Jacobson ED (1977) Histamine H1-receptor and H2-receptor vasodilation of canine intestinal circulation. Am J Physiol 233:E219-E224
Pilz W (1974) Cholinesterasen. In: Bergmayer HU (Ed) Methoden der enzymatischen Analyse. Verlag Chemie, Weinheim (3rd ed, Vol 1)
Preisig R, Rankin JG, Sweeting J, Bradley SE (1966) Hepatic hemodynamics during viral hepatitis in man. Circulation 34:188–197
Richardson PDI, Withrington PG (1977) A comparison of the effects of bradycinin, 5-hydroxytryptamine and histamine on the hepatic arterial and portal venous vascular beds of the dog: Histamine H1- and H2-receptor populations. Br J Pharmacol 60:123–133
Richardson PDI, Withrington PG (1981) Liver blood flow. II. Effects of drugs and hormones on liver blood flow. Gastroenterology 81:356–375
Serlin MJ, Mossmann C, Sibeon RG (1979) Cimetidine: Interactions with oral anticoagulants in man. Lancet 2:317–319
Saltissi S, Crowther A, Byrne C, Coltart DJ (1981) The effects of chronic oral cimetidine therapy on the cardiovascular system in man. Br J Clin Pharmacol 11:497–503
Taylor DC, Cresswell PR, Bartlett DC (1978) The mechanism and elimination of cimetidine, a histamine H2-receptor antagonist in the rat, dog and man. Drug Metab Dispos 6:21–30
Tygstrup N (1963) Determination of the hepatic galactose elimination capacity after a single intravenous injection in man. The reproducibility and the influence of uneven distribution. Acta Physiol Scand 58:162–172
Author information
Authors and Affiliations
Additional information
This work was presented in part at the annual meeting of the American Association for the Study of Liver Diseases, November 1981, in Chicago, and appeared in abstract form in Hepatology (1981) 1:515, No. 25 B
Rights and permissions
About this article
Cite this article
Herz, R., Rössle, M., Bonzel, T. et al. Effect of cimetidine on the hepatic extraction of indocyanine green, the portal pressure and the systemic circulation in patients with cirrhosis of the liver. Klin Wochenschr 62, 759–764 (1984). https://doi.org/10.1007/BF01721773
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01721773