Pharmaceutisch Weekblad

, Volume 12, Issue 4, pp 151–153 | Cite as

Ascorbic acid prevents cimetidine-induced decrease of serum hydrocortisone concentrations

  • Marinus P. Boidin
  • Arie Stuurman
  • Wilhelm Erdmann


A blind, parallel, prospective, clinical study was conducted to investigate the effect of ascorbic acid on human serum hydrocortisone concentrations which were decreased by the administration of cimetidine. The study population included 16 male adults scheduled for major abdominal vascular surgery. The study was conducted in surgical patients under anaesthesia, in which steroidogenesis was inhibited by cimetidine. The results showed a reduction in serum hydrocortisone concentrations in patients receiving a placebo. In patients receiving ascorbic acid, there was a significant increase in serum hydrocortisone concentration. This reflects the normal serum hydrocortisone profile for this operation and anaesthetic technique. Cimetidine can bind to cytochrome P-450 covering the active haem group, the cytochrome proves to be of vital importance for hydroxylation reactions, involved in human steroidogenesis. Serum hydrocortisone concentrations will decrease when cytochrome P-450 becomes blocked. Intravenous administration of ascorbic acid was supposed to cause relief for this decrease. The reasons are undetermined yet. This investigation proved that ascorbic acid can prevent cimetidine-induced decrease of human serum hydrocortisone concentrations.


Ascorbic acid Cimetidine Cytochrome P-450 Hydrocortisone Metabolism Steroid hydroxylases 


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  1. 1.
    Dell Fave GF, Tamburrano G, De Magistris L. Gynecomastia with cimetidine. Lancet 1978;1:1319.Google Scholar
  2. 2.
    Winters SJ, Banks JL, Loriaux DL. The histamine H-2 antagonist cimetidine is an antiandrogen. Gastroenterology 1987;76:504–8.Google Scholar
  3. 3.
    Boidin MP, Stuurman A, Erdmann W. Inhibition of steroidogenesis by cimetidine in man. Scand J Gastroenterol 1988;23:(Suppl 154):41.Google Scholar
  4. 4.
    Somogy A, Gugler R. Drug interactions with cimetidine. Clin Pharmacokinet 1982;7:23–41.PubMedGoogle Scholar
  5. 5.
    Wagner RL, White PF, Kan PB, Rosenthal MH, Feldman D. Inhibition of adrenal steroid genesis by the anesthetic etomidate. N Engl J Med 1984;310: L1415–21.Google Scholar
  6. 6.
    Van Thiel DH, Galaver JS, Smith WI, Paul G. Hypothalamic-pituitary-gonadal dysfunction in man using cimetidine. N Engl J Med 1979;300:1012–5.PubMedGoogle Scholar
  7. 7.
    Boidin MP. Steroid response to ACTH and to ascorbic acid during infusion of etomidate for general surgery. Acta Anesthesiol Belg 1985;36:15–22.Google Scholar
  8. 8.
    Godfrey K. Statistics in practice. N Engl J Med 1985;313:1450–6.PubMedGoogle Scholar
  9. 9.
    Oyama T, Takiguchi M. Plasma levels of cortisol in man during spinal anaesthesia and surgery. Can Anaesth Soc J 1970;17:234–8.PubMedGoogle Scholar
  10. 10.
    Carlson HE, Ippoliti AF. Cimetidine, an H-2 antihistamine stimulates prolactin secretion in man. J Clin Endocrinol Metab 1977;45:367–70.PubMedGoogle Scholar
  11. 11.
    Feely J, Robertson D, Island DR. Cimetidine alters plasma catecholamine levels and cortisol and aldosterone excretion. N Engl J Med 1982;306:1054–9.Google Scholar
  12. 12.
    Kenyon CJ, Fraser R, Birnie GG. Dose relatedin vitro effects of ranitidine and cimetidine on basal and ACTH-stimulated steroidogenesis. Gut 1986;27:1143–6.PubMedGoogle Scholar
  13. 13.
    De Natale G, Vacca M, Prezosi P. Cimetidine and adrenals. Drug Res 1980;30:1635–9.Google Scholar
  14. 14.
    Boidin MP, Erdmann WE, Faithfull NS. The role of ascorbic acid in etomidate toxicity. Eur J Anaesthiol 1986;3:417–20.Google Scholar
  15. 15.
    Hornsby PJ, Harris SE, Aldern KA. The role of ascorbic acid in the function of the adrenal cortex: studies in adrenocortical cells in culture. Endocrinology 1985;117:1264–71.PubMedGoogle Scholar
  16. 16.
    Boidin MP. Can etomidate cause an addisonian crisis? Acta Anaesthiol Belg 1986;37:165–70.Google Scholar

Copyright information

© Royal Dutch Association for Advancement of Pharmacy 1990

Authors and Affiliations

  • Marinus P. Boidin
    • 1
  • Arie Stuurman
    • 2
  • Wilhelm Erdmann
    • 1
  1. 1.Department of AnaesthesiologyErasmus University RotterdamDR Rotterdamthe Netherlands
  2. 2.Department of Hospital PharmacyFoundation Ignatius Hospital BredaJX Bredathe Netherlands

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