What is famotidine used for. How does famotidine work to reduce stomach acid. What are the common and serious side effects of famotidine. How can famotidine interact with other medications.

What is Famotidine and How Does It Work?

Famotidine is a medication that belongs to a class of drugs called histamine-2 receptor blockers. It works by blocking the histamine 2 (H2) receptor in the stomach, which helps reduce the amount of acid produced. This makes famotidine effective for treating conditions related to excess stomach acid.

The drug is available in both prescription and over-the-counter (OTC) forms. Prescription famotidine comes as an oral tablet, oral suspension, and injectable form. The OTC versions include oral tablets and chewable tablets.

How does famotidine reduce stomach acid?

Famotidine works by targeting the H2 receptors in the stomach. These receptors play a crucial role in stimulating acid production. By blocking these receptors, famotidine effectively lowers the amount of acid released in the stomach, providing relief from acid-related symptoms and conditions.

Medical Conditions Treated with Famotidine

Famotidine is primarily used to alleviate symptoms associated with excess stomach acid. Some of the main conditions it treats include:

• Gastroesophageal reflux disease (GERD)
• Acid-related damage to the esophageal lining
• Duodenal ulcers
• Stomach ulcers (gastric ulcers)
• Conditions causing excessive stomach acid production, such as Zollinger-Ellison syndrome

Can famotidine be used for GERD?

Yes, famotidine is commonly prescribed for GERD. It helps reduce the backflow of stomach acid into the esophagus, alleviating symptoms like heartburn, chest pain, and regurgitation. By decreasing acid production, famotidine can provide relief and help prevent further damage to the esophageal lining.

Famotidine Dosage and Administration

The dosage of famotidine can vary depending on the condition being treated, the severity of symptoms, and whether it’s being used for prevention or treatment. It’s crucial to follow your healthcare provider’s instructions or the directions on the OTC package carefully.

Is there a difference between prescription and OTC famotidine?

While both prescription and OTC famotidine contain the same active ingredient, there are differences in strength and intended use. Prescription famotidine is typically available in higher doses and may be prescribed for longer-term use or more severe conditions. OTC famotidine is generally used for short-term relief of heartburn and acid indigestion.

Common Side Effects of Famotidine

Like all medications, famotidine can cause side effects. Most side effects are mild and may resolve on their own as your body adjusts to the medication. Common side effects in adults include:

• Headache
• Dizziness
• Constipation
• Diarrhea

In children under one year of age, additional side effects may include agitation, unusual restlessness, or crying without apparent reason.

Are famotidine side effects usually severe?

Most side effects of famotidine are mild and temporary. However, if side effects persist or worsen, it’s important to consult with a healthcare provider. Severe side effects are rare but can occur, and any unusual or concerning symptoms should be reported to a doctor immediately.

Serious Side Effects and Precautions

While rare, famotidine can cause serious side effects in some individuals. It’s important to be aware of these potential reactions and seek immediate medical attention if they occur. Serious side effects may include:

1. Heart rate and rhythm problems
2. Severe muscle problems
3. Neurological issues
4. Liver problems
5. Skin reactions

When should you seek medical help for famotidine side effects?

Seek immediate medical attention if you experience symptoms such as irregular heartbeat, severe muscle pain or weakness, seizures, yellowing of the skin or eyes, or severe skin reactions like blistering or rash. These could indicate a serious adverse reaction to the medication.

Famotidine Interactions with Other Medications

Famotidine can interact with various medications, potentially affecting their efficacy or increasing the risk of side effects. It’s crucial to inform your healthcare provider about all medications, supplements, and herbal products you’re taking before starting famotidine.

Which medications can interact with famotidine?

Famotidine may interact with several types of medications, including certain antibiotics, antifungals, and drugs used to treat HIV. It can also affect the absorption of medications that require stomach acid for proper dissolution. Always consult with a healthcare professional or pharmacist about potential drug interactions.

Special Considerations for Famotidine Use

Certain groups of people may need to use famotidine with caution or avoid it altogether. These include:

• Individuals with kidney problems
• Pregnant or breastfeeding women
• Elderly patients
• People with a history of certain medical conditions

Is famotidine safe during pregnancy?

While famotidine is generally considered safe during pregnancy, it’s important to consult with a healthcare provider before using any medication while pregnant. They can assess the potential risks and benefits based on your individual situation and medical history.

Comparing Famotidine to Other Acid-Reducing Medications

Famotidine is one of several medications used to treat acid-related conditions. Other common options include:

• Proton pump inhibitors (PPIs) like omeprazole
• Other H2 blockers like ranitidine
• Antacids

How does famotidine compare to proton pump inhibitors?

While both famotidine and PPIs reduce stomach acid, they work differently. Famotidine blocks histamine receptors, while PPIs block the proton pumps responsible for acid production. PPIs are generally more potent and long-lasting, but may have different side effect profiles. The choice between these medications depends on the specific condition being treated and individual patient factors.

Famotidine plays a crucial role in managing acid-related disorders, providing relief for millions of people worldwide. Its mechanism of action, by blocking histamine receptors in the stomach, effectively reduces acid production and alleviates symptoms associated with conditions like GERD, ulcers, and other gastrointestinal issues. While generally well-tolerated, it’s important to be aware of potential side effects and drug interactions.

The availability of famotidine in both prescription and over-the-counter forms offers flexibility in treatment options. However, it’s always advisable to consult with a healthcare provider before starting any new medication regimen, especially for chronic or severe symptoms. They can provide personalized advice based on your medical history, current medications, and specific symptoms.

As with any medication, the benefits of famotidine should be weighed against potential risks. Regular follow-ups with a healthcare provider can help monitor the effectiveness of the treatment and address any concerns that may arise during use. By understanding how famotidine works, its proper use, and potential side effects, patients can make informed decisions about their acid reflux treatment and overall digestive health.

Remember, while famotidine can be highly effective in managing acid-related symptoms, it’s also important to consider lifestyle modifications that can complement medical treatment. These may include dietary changes, weight management, and avoiding triggers that exacerbate acid reflux. A comprehensive approach that combines medication with lifestyle adjustments often yields the best results in managing acid-related disorders.

As research in gastroenterology continues to advance, our understanding of acid-related disorders and their treatments evolves. Staying informed about the latest developments in medications like famotidine can help patients and healthcare providers make the most appropriate treatment decisions. Whether used for short-term relief or as part of a long-term management plan, famotidine remains an important tool in the treatment of acid-related gastrointestinal conditions.

Side effects, dosage, uses, and more

1. Prescription famotidine oral tablet is available as a generic drug and as a brand-name drug. Brand name: Pepcid.
2. Prescription famotidine also comes as a liquid suspension you take by mouth, and in an injectable form that’s only given by a healthcare provider. Famotidine also comes in over-the-counter forms.
3. Famotidine oral tablet is used to relieve symptoms of acid reflux and heartburn. It does this by reducing the amount of acid in your stomach.

Prescription famotidine oral tablet is available as a generic drug and as a brand-name drug. The brand name is Pepcid. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

Prescription famotidine is also available as an oral suspension and an injectable form, which is only given by a healthcare provider. Famotidine also comes as an over-the-counter (OTC) drug. It comes as an OTC oral tablet and an OTC chewable oral tablet. This article focuses on the prescription oral tablet.

Why it’s used

Famotidine is used to relieve symptoms of acid reflux and heartburn. It does this by reducing the amount of acid in your stomach. It treats the following conditions:

• Gastroesophageal reflux disease (GERD). GERD happens when acid in your stomach backs up into your esophagus (the tube that connects your mouth to your stomach). This may cause a burning feeling in your chest or throat, a sour taste in your mouth, or burping.
• Acid-related damage to the lining of your esophagus. When stomach acid splashes up and into the lower portion of your esophagus, it can cause damage to the tissue cells in your esophagus.
• Duodenal ulcers. The duodenal area is the part of your intestine where food passes when it leaves the stomach.
• Stomach ulcers. Also known as gastric ulcers, these are painful sores in the stomach lining.
• Conditions where your stomach makes too much acid. These conditions include Zollinger-Ellison syndrome.

This drug may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

Famotidine belongs to a class of drugs called histamine-2 receptor blockers. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Famotidine works by blocking the histamine 2 (h3) receptor in your stomach. This receptor helps release acid in your stomach. By blocking this receptor, this drug lowers the amount of acid released in your stomach.

Famotidine oral tablet can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking famotidine. This list does not include all possible side effects.

For more information on the possible side effects of famotidine, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common adult side effects for this drug are slightly different from the more common side effects for children.

• Adult side effects can include:
  • headache
  • dizziness
  • constipation
  • diarrhea
• Children under one year of age may also experience:
  • agitation, unusual restlessness, or crying for no clear reason

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Heart rate and rhythm problems. Symptoms can include:
  • dizziness
  • fainting
  • shortness of breath
  • irregular heart rate and rhythm
• Severe muscle problems. Symptoms can include:
  • unusual muscle pain that you cannot explain
  • weakness
  • fever
• Neurological problems. Symptoms can include:
  • agitation
  • anxiety
  • depression
  • trouble sleeping
  • seizures
  • sexual problems, such as decreased sex drive
• Liver problems. Symptoms can include:
  • unexplained or unusual weakness
  • decrease in appetite
  • pain in your abdomen (stomach area)
  • change in the color of your urine
  • yellowing of your skin or the whites of your eyes
• Skin problems. Symptoms can include:
  • blisters
  • rash
  • mouth sores or ulcers

Famotidine oral tablet can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Before taking famotidine, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

The famotidine dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using famotidine to treat
• your age
• the form of famotidine you take
• other medical conditions you may have

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Forms and strengths

Generic: Famotidine

• Form: oral tablet
• Strengths: 20 mg, 40 mg

Brand: Pepcid

• Form: oral tablet
• Strengths: 20 mg, 40 mg

Dosage for duodenal ulcer

Adult dosage (ages 18 years and older)

• Short-term dosage: 40 mg taken once per day at bedtime for up to eight weeks. Your doctor may divide your dose into 20 mg taken two times per day.
• Long-term dosage: 20 mg taken once per day at bedtime.

Child dosage (ages 0–17 years, 40 kg [88 lbs.] or greater)

• Short-term dosage: 40 mg taken once per day at bedtime for up to eight weeks. Your doctor may divide your dose into 20 mg taken two times per day.
• Long-term dosage: 20 mg taken once per day at bedtime.
• Dosage changes: Your doctor may adjust your dosage and length of treatment based on how well you respond to the drug.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

People with moderate or severe kidney disease: Your doctor may decrease your dose of this drug by half or they may have you take one dose every 48 hours instead of every day.

Dosage for gastric ulcer

Adult dosage (ages 18 years and older)

• Short-term dosage: 40 mg taken once per day at bedtime for up to eight weeks.

Child dosage (ages 0–17 years, 40 kg [88 lbs.] or greater)

• Short-term dosage: 40 mg taken once per day at bedtime for up to eight weeks.
• Dosage changes: Your doctor may adjust your dosage and length of treatment based on how well you respond to the drug.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

People with moderate or severe kidney disease: Your doctor may decrease your dose of this drug by half. Or they may have you take one dose 48 hours instead of every day.

Dosage for gastroesophageal reflux disease

Adult dosage (ages 18 years and older)

• Gastroesophageal reflux disease (GERD) symptoms: 20 mg taken two times per day for up to six weeks.
• Esophagitis (irritated esophagus with sores) with GERD symptoms: 20 to 40 mg taken two times per day for up to 12 weeks.

Child dosage (ages 0–17 years, 40 kg [88 lbs. ] or greater)

• Gastroesophageal reflux disease (GERD) symptoms: 20 mg taken two times per day for up to six weeks.
• Esophagitis (irritated esophagus with sores) with GERD symptoms: 20 to 40 mg taken two times per day for up to 12 weeks.
• Dosage changes: Your doctor may adjust your dosage and length of treatment based on how well you respond to the drug.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

People with moderate or severe kidney disease: Your doctor may decrease your dose of this drug by half. Or they may have you take one dose every 48 hours instead of every day.

Dosage for pathological hypersecretory conditions

Adult dosage (ages 18 years and older)

• Typical starting dose: 20 mg taken every 6 hours.
• Dose increases: Your doctor may increase your dose based on your symptoms.
• Maximum dose: People with severe disease may need 160 mg taken every 6 hours.

Child dosage (under 0–17 years)

This drug hasn’t been studied in children under 18 years of age for the treatment of this condition.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

People with moderate or severe kidney disease: Avoid using famotidine tablets for treating pathological hypersecretory conditions. The doses required for treating this condition may be higher than the maximum doses recommended in people with kidney disease.

Famotidine oral tablet comes with several warnings.

Allergy warning

Famotidine can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling in your eye(s) or face
• swelling of your throat or tongue
• rash
• hives

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it or other histamine receptor blockers (such as cimetidine, ranitidine, or nizatidine). Taking it again could be fatal (cause death).

Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.

Warnings for people with certain health conditions

For people with moderate or severe kidney disease: If you have kidney problems, you may not be able to clear this drug from your body. This may increase the levels of this drug in your body. The increased levels may cause more side effects, such as confusion and an irregular heart rhythm called QT prolongation.

Warnings for other groups

For pregnant women: There haven’t been enough studies done in humans to show if famotidine poses a risk to a human fetus. Research in animals has not shown a risk to the fetus when the mother takes the drug. However, animal studies don’t always predict the way humans would respond.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used in pregnancy if clearly needed.

For women who are breastfeeding: Famotidine may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

For children:

• Famotidine may be used in children with peptic ulcer disease (such as duodenal or gastric ulcer) and gastroesophageal reflux disease (GERD).
• This drug hasn’t been studied in children under 18 years of age for the treatment of pathological hypersecretory conditions or reducing the risk of duodenal ulcer recurrence.
• Famotidine tablets are not recommended for use in children weighing less than 40 kg (88 lbs.). This is because the strengths of these tablets are greater than the recommended dose for these children. For these children, consider using another form of famotidine (such as the oral suspension).

Famotidine oral tablet is used for long-term treatment of Zollinger-Ellison syndrome and maintaining healing of ulcers. Famotidine oral tablet is used for short-term treatment of gastroesophageal reflux disease (GERD) and duodenal and gastric ulcers. Famotidine comes with risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: Your acid reflux, heartburn, or ulcer symptoms may not get better or may get worse.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

• agitation
• confusion
• seizures
• severe muscle pain

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: You should have less pain and your symptoms should improve.

Keep these considerations in mind if your doctor prescribes famotidine oral tablet for you.

General

• You can take famotidine with or without food.
• Take this drug at the time(s) recommended by your doctor.
• You can cut or crush the tablet.
• Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Storage

Store the oral tablets at 77°F (25°C). They may be stored for a short time from 59°F to 86°F (15°C to 30°C). Keep them away from light.Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Your diet

Certain foods and beverages may irritate your stomach. This irritation could make your symptoms worse. Your doctor may suggest that you avoid spicy, acidic, and fatty foods while you take this drug. (Acidic foods include tomatoes and citrus fruits.) They may also ask you to avoid beverages with caffeine.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Top famotidine alternatives and how to switch your Rx

Famotidine doesn’t work for everyone. OTC antacids, h3 blockers, and proton pump inhibitors are some famotidine alternatives. Get the full list here.

Compare famotidine alternatives | OTC antacids | h3 blockers | PPIs | Natural alternatives | How to switch meds

Most people have heard of the brand-name stomach medications Pepcid or Pepcid AC. The generic form of Pepcid is famotidine. Famotidine is an FDA-approved over-the-counter (OTC) medication that is used to treat heartburn, indigestion, and stomach pain. It is specifically indicated for gastroesophageal reflux disease (GERD) and gastric or duodenal ulcer.

The cells in the stomach that are responsible for producing acid are called parietal cells. These cells produce acid when stimulated by three things: the vagus nerve, gastrin, and histamine. Famotidine blocks the histamine receptor; specifically histamine type 2 receptors. By doing this, it decreases the amount of acid these cells can secrete into the stomach. 

There are several heartburn medications available. Some are more effective than others and some cause side effects and drug interactions that may make an alternative necessary.

What can I take instead of famotidine?

If looking to switch from famotidine to another drug within the same class of medications (h3 blockers or h3 receptor antagonists), there is Tagamet (cimetidine) and Axid (nizatidine). Zantac (ranitidine) had been a viable alternative for years, however, a couple years ago this was removed from the market due to a potential carcinogen being discovered in the manufacturing process (this has not been found with famotidine). Cimetidine and nizatidine are fairly equivalent in their efficacy with acid reflux and stomach ulcer healing as compared to famotidine. However, nizatidine is often not as readily available as the others.

If the issue is that famotidine is not working as well as you would have liked, it may be time to jump up to a more potent class of acid reducers, which would be the proton pump inhibitors (or PPIs). These include Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole), Aciphex (rabeprazole), Prevacid (lansoprazole), Dexilant (dexlansoprazole), and Zegerid (omeprazole-sodium bicarbonate). These medications are stronger acid reducers, and usually work better to treat stubborn acid reflux symptoms. PPIs also will be better at healing duodenal or gastric ulcers. They work by inhibiting the final common pathway in the production of stomach acid by the parietal cell, the proton pump (hence their name). The h3 blockers just stop one step on the way to the acid production.

If it is just a quick fix you are looking for mild, occasional heartburn symptoms, try one of the fast-acting antacids, such as Tums (calcium carbonate), Rolaids (calcium carbonate-magnesium hydroxide), or Gaviscon (aluminum hydroxide-magnesium carbonate). These medications are fairly inexpensive and work faster than the h3 blockers or the PPIs to curb heartburn symptoms. However, they are not indicated to heal ulcers.

Top 3 famotidine alternatives

1. Over-the-counter antacids

These include Tums, Rolaids, Alka Seltzer, Maalox, and Gaviscon. These medications are safe, inexpensive, act fast, and can be taken several times a day if needed. The downside is that their effects often don’t last that long, and they are not indicated for erosive esophagitis or peptic ulcer disease.

RELATED: Pepto Bismol vs. Tums

2. h3 blockers

These are the same class as famotidine, and include alternatives cimetidine and nizatidine. These alternatives are equally effective as famotidine for the most part, are available OTC, and are usually inexpensive. The potential downside is they will likely present the same issues as your original reasons for switching medications in the first place.

3. Proton pump inhibitors

The proton pump inhibitors include Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole), Aciphex (rabeprazole), Prevacid (lansoprazole), Dexilant (dexlansoprazole), and Zegerid (omeprazole-sodium bicarbonate). These medications are stronger acid reducers, and usually work better to treat stubborn acid reflux symptoms, and also will be better at healing gastric or duodenal ulcers. The downside is that they can be more expensive OTC alternatives compared to the other medications discussed. 

RELATED: Famotidine vs. omeprazole

Natural alternatives to famotidine

GERD is a condition where there are probably more natural remedies than any other gastrointestinal condition (save constipation perhaps). I tell my patients with mild reflux symptoms that I am fine with using natural remedies and lifestyle changes, so long as they have no condition that requires a prescription medication. This would include Barrett’s esophagus and reflux induced esophagitis. These conditions would require PPIs, usually long term.

Baking soda, which is sodium bicarbonate, a basic compound, can neutralize the acid in the stomach. A tablespoon in a glass of water when heartburn occurs, can be very effective as a fast-acting antacid.

Aloe vera juice can also help to coat the esophagus and stomach. This is sold in many super markets. It can be purchased as a juice in a bottle, or as a capsule. About 4 ounces twice a day is usually sufficient. 

Many of my patients with reflux or indigestion have had a good response to apple cider vinegar. A teaspoon or tablespoon as needed when symptoms occur, or on a daily basis can help relieve indigestion symptoms quickly. This likely works by a negative feedback to tell the stomach to stop producing acid.

Always ask your healthcare provider before using supplements to treat heartburn or any other condition as supplements can affect your other medications or health conditions, causing potential for serious side effects.

RELATED: The best diet for acid reflux

How to switch to a famotidine alternative

It’s always a good idea to taper any long-term medication prior to discontinuing. Although it may not be necessary, it certainly won’t hurt. The same is true with famotidine. Even though it does not necessarily require a taper for safety reasons, tapering famotidine will prevent any rebound acid reflux from occurring (although this is less necessary than with the PPIs, where tapering is strongly recommended). As you are tapering off the famotidine, you can try the alternative medication, whether it is another h3 blocker, a stronger PPI medication, or a fast-acting antacid. Remember, if you have any questions about switching medications, or if you experience worsening symptoms despite switching, contact your healthcare provider for medical advice.

What is happening with two classes of acid-lowering drugs » Pharmvestnik

The Ministry of Health suspended the use of ranitidine in Russia, after which only famotidine remained among the available representatives of the group. The situation with the assessment of the risks of long-term use of the second class of acid-lowering drugs also raises questions.

It all started with Bourget

The opportunity to treat acid-related diseases appeared in the 80s, when two new classes of drugs, h3-histamine receptor blockers and proton pump inhibitors (PPIs), were approved about 10 years apart.

The first type of blocker, cimetidine, was approved in 1977, but was not used for long due to interactions with a large number of drugs. Later, ranitidine and famotidine entered the market.

In some countries, but not in Russia, nizatidine is approved.

Proton pump inhibitors were first in their class with omeprazole.

Next came the processes inherent in all drugs after entering the market: pharmacovigilance, post-registration studies and meta-analyses. Already at 19In 1990, meta-analysis helped to formulate the famous “Bourget’s rule”. For scarring of an ulcer, the pH of the stomach must be within certain values ​​for about 18 hours a day.

Proton pump inhibitors “fit” this condition, making them first-line drugs after evidence of efficacy in acid-related diseases. However, no one was going to give up H2-blockers.

What happened to h3-blockers

The situation has changed quite recently. In 2019ranitidine was found to be a potential carcinogen. And the number of studies with potential risks in long-term PPI use has not reached critical mass.

Impurities of potential carcinogens over the past four years have “hooked” sartans, quinapril, metformin, varenicline, and finally ranitidine, but only for h3-blockers the consequences were the most severe. In 2020, the U.S. regulator demanded that ranitidine be withdrawn from the market due to the findings of an increase in the level of potential carcinogens during drug storage.

In Russia, the Ministry of Health in 2021 suspended the use of all approved ranitidine. The commission of the department decided to exclude it from the minimum assortment and the list of vital and essential drugs.

After the “rantitidine” storm, only famotidine remained on the Russian market among H2-blockers. The drugs of the group are not included in the first line of therapy, but the Russian Gastroenterological Association recommends them, for example, for peptic ulcer disease, when PPIs are ineffective or there are contraindications to taking them, and for dysphagia.

However, out of 10 manufacturers of oral famotidine, only three meet the needs of the market in 2022, follows from the register of Roszdravnadzor.

What happened to the IPP

The situation with the IPP developed less dramatically, but it required the participation of experts from specialized communities. Clinical studies in recent years have raised increasing concerns about the risks of PPI use. As a rule, they were associated with long-term use of the drugs of the group.

A recent evaluation of a cohort of 75,000 people showed an increased risk of infections, decompensation with cirrhosis of the liver, and death associated with liver damage when taking PPIs. The exception was patients with gastrointestinal bleeding – their mortality rate decreased.

In addition, proton pump inhibitors doubled the risk of COVID-19 (unlike h3-blockers), and administration during hospitalization increased the risk of severe clostridial infection.

One of the explanations of the phenomenon was given by prof. Andrey Karateev – increased acidity of the stomach is a barrier to the penetration of pathogenic microorganisms. Long-term antisecretory therapy inevitably increases the risk of infections. This also affects the exchange of calcium due to a decrease in its solubility, leads to a decrease in bone density and the risk of fractures.

A recent meta-analysis has proven the latter suggestion. When assessing the data of 900 thousand people, the risk of fractures increased even in children and young people when taking PPIs, but not h3-blockers.

Expert response

A critical mass of evidence prompted the American Gastroenterological Association (AGA) to issue a statement in 2022. Among the reasons for this situation, experts noted the widespread use of PPIs for indications where their benefits are not obvious.

Withdrawal of drugs (when they are no longer indicated) is an important strategy to reduce theoretical risks. PPIs are generally safe, experts say, but should not be used without the expected benefit. In the absence of clear indications, drugs should be canceled. The physician is responsible for assessing the need for PPIs.

Some proton pump inhibitors are available without a prescription. The expansion of indications and the emergence of generics have made drugs one of the most prescribed groups.