Cimetidine (Tagamet) combined with steroids and H1 antihistamines for the prevention of serious radiographic contrast material reactions.

Cimetidine has recently proved useful in the prophylaxis of certain allergic and other histamine-mediated reactions. We have encountered a patient who had a serious cutaneous and respiratory reaction to Renografin-76 during cardiac catheterization. For the four days preceding his second catheterization, the patient was treated with prednisone, 30 mg daily, diphenhydramine, 25 mg orally, three times a day, intravenous diphenhydramine, 25 mg, three times a day, and Solu-Cortef, 500 mg, intravenously, every six hours. Despite this preparation, he developed an intense reaction to Renografin-76, which did not respond to further doses of Solu-Cortef and diphenhydramine in the catheterization laboratory. Cimetidine, 300 mg, in 100 ml of D5W over 15 minutes, rapidly reversed the entire cutaneous and respiratory phenomenon. In the future, strong consideration should be given to using cimetidine, in its intravenous form, as a routine medication in angiographic laboratories where radiographic contrast materials (RCM) are used. It may be helpful as a pretreatment for recognized RCM reactive patients when catheterization is essential.