Histamine 2 blocker drugs – cimetidine

Last updated on October 7, 2022

Special Authority requests can now be submitted online. It's simple and quick!

Generic name	cimetidine
Strength	200 mg, 300 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:

Pediatrics
Pediatric cardiology
Pediatric 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)

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5328 - General Special Authority Request Form (PDF, 656KB)

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Histamine 2 blocker drugs – cimetidine

Practitioner exemptions

Special notes

Special Authority request form(s)