Pepcid (Famotidine) Uses, Dosage, Side effects

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pepcid famotidine

Pepcid (Famotidine) is used to treat ulcers of the stomach and intestines and to prevent intestinal ulcers from coming back after they have healed.

It is also used to treat certain problems in the stomach and throat (esophagus), such as erosive esophagitis or gastroesophageal acid disease (GERD), Zollinger Ellison syndrome, NSAID-induced Gastritis, and gastroesophageal recurrent ulcers.

It reduces the acidity of your stomach. It can relieve symptoms like a persistent cough, stomach pain, heartburn, and difficulty swallowing.

Famotidine belongs in the H2 blocker class. It is administered orally and intravenously to relieve symptoms such as a persistent cough, stomach pain, heartburn, and difficulty swallowing. In mild to moderate symptoms, your doctor will switch you to using this medication by mouth.

Famotidine (Pepcid) Detailed Drug Information

Adult Pepcid Dosage Forms and Strengths in Adults

Injection solution

  • 10 mg/mL
  • 0.4 mg/mL

Oral suspension

  • 40mg/5mL

Tablet

  • 10mg
  • 20mg
  • 40mg

Chewable Tablets

  • 10mg
  • 20mg

Pepcid Dosage for Duodenal Ulcer

  • Acute Treatment: 20 mg PO/IV for 12 hours or 40 mg PO at bedtime, 8 weeks
  • Maintenance: 20 mg PO at night
  • Reduction in recurrence risk: 20mg PO daily for one year or as clinically recommended

Pepcid Dosage for Benign Gastric Ulcer

  • 40 mg PO at bedtime for up to 8 weeks

Pepcid Dosage for Gastroesophageal reflux disease

  • Nonerosive: 20mg q12hr for up to 6 weeks
  • Endoscopy can diagnose erosive conditions: 20-40 mg PO for up to 12 months
  • Hypersecretory Conditions
  • 20 mg orally or intravenously every six hourly up to a maximum of 160 mg every six hours.

Pepcid Dosage for Heartburn:

  • 10-20 mg q12hr; it may take between 15-60 minutes before you eat foods that can cause heartburn

Pepcid Dosage in Renal Failure:

  • CrCl 50 mL/min or less: Increase the dose by 50% or increase the interval to q36-48hr

Pepcid Pediatric Dosage Forms and Strengths

Injection solution

  • 10mg/mL
  • 0.4mg/mL

Oral suspension

  • 40mg/5mL

Tablet

  • 10mg
  • 20mg
  • 40mg

Chewable Tablets

  • 10mg
  • 20mg

Pepcid Dosage for Peptic Ulcer Disease:

  • 1-17 years:
    • 0.25 mg/kg IV twice daily or 0.5 mg/kg orally at bedtime.
    • The dose may be increased to 1 mg/kg once daily at bedtime or 0.5 mg/kg twice daily for up to 8 weeks not to exceed 40 mg/day

Pepcid Dosage for Gastroesophageal reflux disease

  • <3 months:
    • 0.5 mg/kg PO once daily. The dose may be increased to 1 mg/kg once daily for up to 8 weeks
  • 3-12 Months:
    • 0.5 mg/kg orally two times a day. The dose can be increased to 1 mg/kg twice per day for up to 8 weeks not exceeding 40 mg/day
  • For 1-17-year-olds with or without esophagitis or ulceration:
    • 0.5 mg/kg twice per day; for 6-12 weeks; not to exceed 40mg twice daily

Pepcid Dosage for Heartburn:

  • 12 Years: Not established
  • >12 years: 10 – 20mg every twelve hourly. It may take between 15-60 minutes before you eat foods that can cause heartburn

Side Effects of Pepcid (Famotidine)

Frequent side effects affecting 1-10% of the patients:

famotidine pepcid side effects
Frequent Side effects of Pepcid (Famotidine)

Frequency of side effects not defined:

General:

  • Asthenia, fever, and fatigue in the whole body

Cardiac:

  • Very rare reports of arrhythmia, AV blocking, palpitation, and prolonged QT intervals in patients with impaired renal function have been made

Gastrointestinal:

  • Cholestatic jaundice and hepatitis, liver enzyme abnormalities, vomiting, nausea, abdominal discomfort, and Dry mouth.

Hematologic:

  • Very rare cases of agranulocytosis and pancytopenia.

Hypersensitivity:

  • Anaphylaxis, angioedema, orbital or facial edema, urticaria, rash, and conjunctival injection

Musculoskeletal:

  • Rhabdomyolysis and musculoskeletal pain, including muscle cramps, and arthralgia

Nervous system/psychiatric:

  • Grand mal seizure; psychic disorders, which were reversible when follow up was obtained in cases including hallucinations and confusion, anxiety, decreased fertility; paresthesia, insomnia, somnolence, and convulsions in patients who have impaired renal function.

Respiratory:

  • Bronchospasm and interstitial pneumonia

Skin:

  • Toxic epidermal necrolysis/Stevens-Johnson syndrome (very rare), alopecia, acne, pruritus, dry skin, and flushing

Special senses:

  • Tinnitus and taste disorder

Rare cases of impotence, and gynecomastia.

Pepcid (Famotidine) Warnings and Contraindications:

Contraindications

  • Hypersensitivity to famotidine and other H2-receptor antagonists

Caution:

  • Take care when you have renal impairment. Dosage adjustment is recommended for moderate to severe renal impairment (CrCl 50mL/min).
  • Patients with renal impairment have a rare history of prolonged QT intervals. Doses or intervals may not be adjusted properly.
  • A variety of adverse effects in the central nervous system (CNS), including confusion, hallucinations and disorientation, agitation, and seizures, have been reported in moderate-to-severe kidney impairment. Because famotidine blood level is higher in patients suffering from renal impairment than in those with normal renal function patients, dosage adjustments should be made in these patients.
  • Gastric malignancy can be treated even if symptoms are relieved. Adult patients with suboptimal responses or early symptomatic relapses should be evaluated for it.
  • Use of the drug may cause confusion. Risk increases for those over 50 years old and/or with renal/hepatic impairment
  • Vitamin B12 malabsorption can occur if prolonged treatment is continued for more than 2 years. This can lead to vitamin B12 deficiency. The severity of vitamin B12 deficiency depends on the dose. It occurs most often in women and in those under 30 years.
  • OTC should not be used by patients who have difficulty swallowing, vomiting, or have a black stool.
  • Patients who are taking prescription drugs should consult their doctor or pharmacist to determine if acid reducers may be used in conjunction with them.
  • Before using, patients with kidney disease should consult their doctor

Overview of Pepcid drug interactions

  • Because of its effect on intragastric acidity reduction, treatment can decrease absorption of other drugs. Concomitant administration of dasatinib and delavirdine methylate, cefditoren, fosamprenavir is not recommended.
  • See prescribing information for other drugs dependent on gastric pH for absorption for administration instructions, including atazanavir, erlotinib, ketoconazole, itraconazole, ledipasvir/sofosbuvir, nilotinib, and rilpivirine
  • Although it has not been clinically studied, this drug is considered a weak CYP1A2 inhibitor and could cause substantial increases in blood levels of tizanidine. If concomitant, be sure to monitor for hypotension or bradycardia. Refer to the full prescribing information on tizanidine.

Pepcid Use during Pregnancy and lactation

Pregnancy

The data available in pregnant women is insufficient to establish a drug-associated risk of major birth defects, miscarriage, or adverse maternal and fetal outcomes.

Lactation

Limited data are available about famotidine’s presence in human milk. There were no adverse effects on infants breastfed; no evidence on famotidine’s effects on milk production.

Drugs reported in the milk of lactating rats are not known to be present in human milk. The developmental and health benefits that breastfeeding can have on infants and mothers should be considered.

Pharmacology of Pepcid (Famotidine):

Mechanism of Action (MOA) of Famotidine:

  • It blocks the H2 receptors in gastric parietal cell cells. This results in inhibition of gastric secretions

Absorption:

  • Bioavailability: 40 to 45% (PO; minimal 1st pass metabolism).
  • Duration of action: 10-12 hours
  • Peak plasma time:
    • IV 20 minutes;
    • PO 1-4 hours

Distribution

  • Protein-bound: 15-20%

Metabolism

  • Metabolized in the liver
  • Metabolites: Famotidine S-oxide (inactive)

Elimination

  • Half-life: 2.5-4 hours (adults); increases with renal impairment (eg, 20 hr CrCl10 mL/min); 3-4-5 hr for children; 4.5 hr for infants 3-12 months; 8-10.5 Hr for infants 3 months).
  • Dialyzable No
  • Clearance of the renal system: 250-450mL/min
  • Total body clearance: 381-483mL/min

Excretion:

  • Urine (25-30% unchanged drug when administered PO, 70% when administered IV).

Classes: Histamine H2 Antagonists

How to Administer Pepcid (Famotidine):

IV Incompatibilities

  • Additive: Piperacillin-tazobactam
  • Y-site: Cefepime, piperacillin-tazobactam, amphotericin B, azithromycin, furosemide (at 2 mg/mL famotidine; compatible at 0.2 mg/mL)

IV Compatibilities

  • Additive: Aztreonam. Ceftazidime. Dobutamine. Furosemide. Gentamicin. Imipenem. Thiamine.
  • Y-site: Atropine. Cefazolin. Furosemide. Gentamicin.

IV Preparation

  • Mix 20 mg with D5W, NS, or LR to make 5-10 mL.
  • Available in premixed bags containing 20mg in 50mL NS

IV Administration

  • Do not infuse faster than 10 mg/min

How to Store Pepcid (Famotidine):

Premixed: Keep at room temperature

Unmixed: Keep in the refrigerator at 2-8 degrees Celsius (36-46degF).

Patient Handout

Famotidine intravenous

FAMOTIDINE – INJECTION

(fam-OH-tih-dine)

COMMON BRAND NAME(S): Pepcid

Pepcid Uses:

Famotidine is used to treat ulcers. It is also used to prevent intestinal ulcers from coming back after they have healed.

It is used to treat certain problems in the stomach and throat (esophagus), such as erosive esophagitis or gastroesophageal acid disease-GERD, Zollinger Ellison syndrome, and gastroesophageal recurrent ulcers.

It reduces the acidity of your stomach. It can relieve symptoms like a persistent cough, stomach pain, heartburn, and difficulty swallowing.

Famotidine belongs in the H2 blocker class. It is administered by vein to relieve symptoms such as a persistent cough, stomach pain, heartburn, and difficulty swallowing. If possible, your doctor will switch you to using this medication by mouth.

How to use Pepcid (Famotidine)?

The medication is injected into the vein according to your doctor’s instructions. Your medical condition and your response to treatment will determine the dosage and duration of treatment.

Children may have a different dosage depending on their medical condition and response to treatment. Clean the injection site with alcohol before you inject each dose.

Check the product for any discoloration or particles before you use it. Do not use any liquid if they are present. If you have any questions about how to safely store or dispose of medical supplies, please consult your doctor.

Side effects of Pepcid:

It is possible to experience headaches, constipation, or diarrhea as well as pain/redness at injection sites. These side effects may persist or get worse.

Most people don’t experience serious side effects from this medication. Side effects of serious allergic reactions include rash, swelling, especially of the face/tongue/throat, severe dizziness, and trouble breathing. You can contact your pharmacist or doctor if you experience any other side effects.

Precautions when using Pepcid (Famotidine):

Before using famotidine, tell your doctor or pharmacist if you are allergic to it; or to other H2 blockers (e.g., cimetidine, ranitidine); or if you have any other allergies.

Inactive ingredients can cause allergic reactions and other problems. You should consult your pharmacist if you have any concerns about this product.

Get medical help right away if you have:

  • heartburn with lightheadedness, sweating, or dizziness,
  • Chest, jaw, arm, or shoulder pain
  • Unexplained weight loss,
  • Shortness of breath,
  • Unusual sweating (especially if it is accompanied by shortness or unusual sweating).

Side effects may be more noticeable in older adults, particularly if they are experiencing mental/mood changes, seizures, or unusual tiredness.

Famotidine should be used only when clearly needed during pregnancy. This drug can pass into breast milk. Before breastfeeding, consult your doctor.

Pepcid Drug Interactions:

Drug interactions may change how your medications work or increase your risk for serious side effects. This document doesn’t cover all drug interactions.

Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist.

Your doctor may not approve of you changing the dose or starting a new medication. Some products require stomach acid to be absorbed properly.

Famotidine can cause stomach acid to be decreased, which could affect the effectiveness of these products. Atazanavir and dasatinib are some of the affected products.

What should you do in case of Pepcid Overdose?

If someone has overdosed and has serious symptoms such as passing out or trouble breathing. If you have any other concerns, contact a poison control center immediately.

Other things of note:

Do not share this medication with others. Lifestyle changes such as stress reduction programs, stopping smoking, limiting alcohol, and diet changes (such as avoiding caffeine and certain spices) may help this medication work better.

To monitor your progress and check for side effects, your pharmacist may recommend lifestyle changes. Consult your doctor for more details.

What to do if you miss your dose?

It is important to get each dose of this medication as scheduled. Ask your pharmacist or doctor immediately if you have missed a dose. To catch up, do not double the dose.

How to store pepcid?

Consult the product instructions and your pharmacist for storage details. All medications should be kept away from pets and children. When the product is no longer required or expired, dispose of it properly. Talk to your pharmacist or the local waste disposal company.