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DRUG INFORMATION ROUNDS

Use of Histamine₂-Antagonists for the Treatment of Verruca Vulgaris

Assistant Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL

Patrick C Williams, PharmD

at time of writing, PharmD student, Midwestern University Chicago College of Pharmacy; now, Pharmacist, US Army

Reprints: Dr. Fit, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, 555 31st St., Downers Grove, IL 60515, fax 630/515-6958, kfitxx{at}midwestern.edu

OBJECTIVE: To review the evidence for histamine₂ (H₂)-antagonists in the treatment of common warts.

DATA SOURCES: Relevant publications were identified through a systematic search of PubMed English-language literature using the MeSH terms and key words cimetidine, ranitidine, famotidine, nizatidine, histamine H₂-antagonists, and warts. Additional articles were identified using the same key words in the Cochrane Database and International Pharmaceutical Abstracts. Systematic searches were conducted through January 2007. In addition, pertinent references from identified articles were reviewed.

STUDY SELECTION AND DATA EXTRACTION: The literature search retrieved 21 relevant citations, excluding review articles. Five open-label studies and 7 randomized controlled clinical trials were evaluated. Cimetidine was the focus of 11 studies, and ranitidine was evaluated in 1 study. No data regarding the other H₂-antagonists were found. The other retrieved citations were not evaluated due to their design (case reports or case series) and/or focus on specific wart subtypes, not common warts.

DATA SYNTHESIS: The use of H₂-antagonists in the treatment of common warts is not associated with significant improvements in resolution rates. Open-label studies were promising with an estimated 48-81% response rate. However, randomized controlled trials have failed to show significant efficacy when cimetidine was compared with placebo or topical agents, and ranitidine has never been evaluated in a randomized controlled trial. Adverse effects, specifically gastrointestinal complaints, were documented. Efficacy may have been limited by inadequate dosing in some of the trials. The studies were limited by the small sample size and lack of power in a number of the trials, as well as the documented spontaneous resolution rate for warts.

CONCLUSIONS: Several open-label trials evaluating the use of H₂-antagonists for verruca vulgaris reported high response rates, but these results have not been corroborated by more rigorous clinical trials. Current data do not support the use of H₂-antagonists for the treatment of common warts.

Key Words: cimetidine, H₂-antagonists, ranitidine, verruca vulgaris

Published Online, May 29, 2007. www.theannals.com, DOI 10.1345/aph.1H616