Cimetidine (Tagamet) for Warts

Cimetidine (Tagamet) for Warts (verrucae)
Cimetidine (Tagamet) is a histamine H2 receptor antagonist which was mainly used to inhibit stomach acid production for the treatment of gastroesophageal reflux disease and peptic ulcers. It has been suggested as being effective for viral warts (verrucae) and started being used for this in the 1990’s.

The proposed mechanism is an immune stimulant. Mitsuishi et al (2003) showed that the IL‐2 and IFN‐γ mRNA levels were significantly increased and IL‐18 mRNA levels were decreased in tissues of those who were treated with cimetidine successfully in their uncontrolled study.

There are plenty of anecdotes that cimetidine (Tagament) does work for verrucae and several uncontrolled studies or case series have claimed to show that it is effective. Generally, the properly blinded and placebo controlled trials have not shown that it is effective and was generally no better than the placebo.

The recommended dose for those that advocate its use is 40 mg/kg/day (link).

Research on the use of Cimetidine (Tagamet) for Warts (Verruca):

Study:Results:Comments:
Mullen et al (2005)Retrospective review of 216 patients given oral cimetidine for pedal verruca; 84.3%. resolution.No blinding; no control group or placebo
Glass and Solomon (1996)"20 adult patients with recalcitrant warts. Of the 18 patients who completed the study, 16 patients (84%) had either dramatic clinical improvement or complete resolution of their wart lesions after 3 months of cimetidine therapy without any adverse effects. "No blinding; no control group or placebo
Gooptu et al (2000)47 patients; treated with oral cimetidine in a 3-month open-label study; "87% of children and 68% of adults improved with treatment."No blinding; no control group or placebo
Yilmaz et al (1996)70 participants; placebo-controlled, double-blind study; "Cure rates obtained were 32% (9 of 28) in the cimetidine-treated group and 30.7% (8 of 26) in the placebo-treated group. No significant difference was found between cimetidine and placebo in effectiveness (p = 0.85)."
Rogers et al (1999)"This double-blind, placebo-controlled study was designed with stringent enrollment and outcome criteria to minimize the confounding issue of spontaneous remission. Efficacy was not statistically superior to that of placebo, but a trend toward efficacy was suggested for younger subjects."
Ardabili & Majid (2014) "This study showed that cimetidine is not more effective than placebo in treatment of warts. "
Mitsuishi et al (2003)55 patients; "group A received oral cimetidine ( 20 mg\kg\day) and group B received the drug (30 to 40 mg\kg\day)." "34.5% (19\55) had a dramatic clinical improvement or complete remission and 23.6% (13\55) had partial responses within 4 months of cimetidine therapy" "These results suggest that cimetidine is an effective treatment for viral warts."No controls or placebo
Parsad et al 2008Compared Cimetidine and Levamisole versus Cimetidine alone; "Combination of cimetidine with levamisole is more effective than cimetidine alone."Would the levamisole have worked as well on its own?
Das et al 20188 pediatric patients with heart transplants and recalcitrant verruca; given cimetidine (30–40 mg/kg/day); 7 had complete resolutionNo control group.
Kim and Chung (2002)24 patients; "19 patients (79.2%) had either complete resolution or partial resolution of their warts within 3 months of cimetidine therapy without any adverse effects. "No control group.
Systematic reviews and/or meta-anaylsis:
Fit & Williams (2007)"Open-label studies were promising with an estimated 48-81% response rate. However, randomized controlled trials have failed to show significant efficacy when cimetidine was compared with placebo or topical agents""Current data do not support the use of H2-antagonists for the treatment of common warts."

Commentary:

  • The narrative of the use of cimetidine (Tagamet) for warts or verrucae follow the typical pattern that is often seen in a number of conditions for a number of interventions with anecdotes and uncontrolled trials or case series reporting dramatic results, but then the subsequent controlled trials with a placebo and proper blinding of the participants showing that the treatment is no better than a placebo. This indicates that the apparent success of the treatment could all be put down to the natural history or the placebo effect.
  • It is possible that the controlled trials did not show an effect due to the dose of cimetidine (Tagamet) being too low, but that is not clear.
  • There may still be some benefit of use in children as they did appear to possibly do better in the controlled trials.
  • The use of cimetidine (Tagamet) does carry a slight risk for side effects (eg diarrhea; skin rash; dizziness; fatigue; constipation; muscle pain, confusion, headache) and other treatments for verrucae do not have a risk for any side effects.

Related Topics:
H2 Antagonists | Cimetidine | Verrucae

External Links:
Tagamet (cimetidine) for wart treatment (Podiatry Arena)

Page last updated: @ 10:26 pm

 
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