Histamine 2 Blocker Drugs - Cimetidine

Generic Name

cimetidine                                                                                                                                               

Strength

300 mg, 400 mg, 600 mg

Form

tablet

Special Authority Criteria

Approval Period

Treatment failure on prescription dose of, or intolerance to, ranitidine.

Indefinite

Practitioner Exemptions

  • Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:
    • Paediatric Cardiology
    • Paediatrics
    • Paediatric general surgery

Special Notes

  • Prescription dose of ranitidine for adults is considered to be 150 mg twice daily or 300 mg once daily.

Special Authority Request Form(s)