Famotidine

Oral
Intravenous
Class
Acid suppression agents
Subclass
H2-antihistamines
Substance name
Famotidine
Brand names
Pepcid®
Common formulations
Film-coated tablet
Dosage and administration
Adults patients
Symptomatic relief
Dyspepsia
10-20 mg PO BID
Treatment
Gastric hypersecretory conditions
Start at: 20 mg PO QID
Maintenance: 20-160 mg PO QID as long as clinically indicated
Maximum: 640 mg per day
Adjust dose to individual patient needs.
GERDErosive
20 mg PO BID for up to 12 weeks
Alternative
40 mg PO BID for up to 12 weeks
GERDNonerosive
20 mg PO BID for up to 6 weeks
Peptic ulcer diseaseGastric
40 mg PO daily for up to 8 weeks
Peptic ulcer diseaseDuodenal
40 mg PO daily for up to 8 weeks
Alternative
20 mg PO BID for up to 8 weeks
Laryngopharyngeal refluxOff-label
20 mg PO qHS
Prevention
NSAID-induced peptic ulcerOff-label
20 mg PO BID
Stress ulcerOff-label
20 mg PO BID
Secondary prevention
Secondary prevention of peptic ulcer diseaseDuodenal
20 mg PO daily for 1 year or as long as clinically indicated
Indications for use
Labeled indications
Adults
Symptomatic relief of dyspepsia
Treatment of gastric hypersecretory conditions
Treatment of GERD (erosive)
Treatment of GERD (nonerosive)
Treatment of peptic ulcer disease (duodenal)
Treatment of peptic ulcer disease (gastric)
Secondary prevention of peptic ulcer disease (duodenal)
Children
Treatment of GERD
Off-label indications
Adults
Treatment of laryngopharyngeal reflux
Prevention of NSAID-induced peptic ulcer
Prevention of stress ulcer
Safety risks
Contraindications
Hypersensitivity to famotidine or its components or other H2RAs
Warnings and precautions
CNS adverse events
Maintain a high level of suspicion, as famotidine has been associated with confusion, delirium, hallucinations, disorientation, agitation, seizures, and lethargy in elderly patients and patients with renal impairment.
Mask symptoms of gastric cancer
Use caution in patients with suboptimal response or early symptomatic relapse after completing treatment.
Specific populations
Renal impairment
GFR > 50 mL/min
Reduce dose by 50%.
CrCl 10-50 mL/min
Use with caution. Reduce dose by 75%.
CrCl < 10 mL/min
Use with extreme caution. Reduce dose by 90%.
Renal replacement therapy
Continuous renal replacement
Reduce dose.
Intermittent hemodialysis
Reduce dose. Administer the dose after dialysis session. Maximal dose of 60 mg/week.
Peritoneal dialysis
Reduce dose.
Hepatic impairment
Any severity
Use acceptable. No dose adjustment required. Prefer famotidine in patients with hepatic impairment, as it undergoes minimal first-pass metabolism.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B1
Use with caution.
Breastfeeding
Acceptable for use during breastfeeding.
Unknown drug levels in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Common 1-10%
↑ liver enzymes, constipation, diarrhea, dizziness, dry mouth, fatigue, hallucinations, headache, nausea, vomiting
Uncommon < 1%
Seizure, skin rash
Unknown frequency
Agitation, angioedema, bronchospasm, ↓ platelet count, delirium, lethargy, pernicious anemia, ↑QT interval, anxiety, arthralgia, asthenia, confusion, ↓ libido, depression, dry mouth, dysgeusia, impotence, insomnia, musculoskeletal pain, palpitations, paranoid ideation, paresthesia, pruritus, skin flushing, tinnitus, rhabdomyolysis, Stevens-Johnson syndrome, toxic epidermal necrolysis, vitamin B12 deficiency
Interactions
Drug(s)
Check Interactions
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