Histamine 2 blocker drugs – cimetidine

Last updated on August 20, 2024

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)