What are the best alternatives to famotidine for treating heartburn and acid reflux. How do over-the-counter antacids compare to h3 blockers and proton pump inhibitors. Which natural remedies can provide relief from GERD symptoms.

Understanding Famotidine and Its Uses

Famotidine, the generic form of Pepcid, is an FDA-approved over-the-counter (OTC) medication used to treat various gastrointestinal issues. Its primary indications include:

• Heartburn
• Indigestion
• Stomach pain
• Gastroesophageal reflux disease (GERD)
• Gastric or duodenal ulcers

Famotidine belongs to a class of drugs called h3 blockers or h3 receptor antagonists. It works by blocking histamine type 2 receptors in the stomach, which reduces acid production by parietal cells. This mechanism of action helps alleviate symptoms associated with excess stomach acid.

Top 3 Famotidine Alternatives: A Comprehensive Overview

When famotidine doesn’t provide the desired relief, several alternatives are available. Here are the top three options:

1. Over-the-Counter Antacids

OTC antacids are a popular first-line treatment for mild, occasional heartburn. Some common brands include:

• Tums (calcium carbonate)
• Rolaids (calcium carbonate-magnesium hydroxide)
• Alka Seltzer
• Maalox
• Gaviscon (aluminum hydroxide-magnesium carbonate)

These medications offer several advantages:

• Safe for most people
• Inexpensive
• Fast-acting
• Can be taken multiple times daily

However, they also have limitations:

• Effects may not last long
• Not indicated for erosive esophagitis or peptic ulcer disease

2. h3 Blockers

Other h3 blockers in the same class as famotidine include:

• Tagamet (cimetidine)
• Axid (nizatidine)

These alternatives offer similar benefits to famotidine:

• Comparable efficacy for acid reflux and stomach ulcer healing
• Available over-the-counter
• Generally inexpensive

The main drawback is that they may present similar issues as famotidine, potentially necessitating the switch in the first place.

3. Proton Pump Inhibitors (PPIs)

PPIs are a more potent class of acid reducers, often recommended when h3 blockers prove ineffective. Common PPIs include:

• Prilosec (omeprazole)
• Nexium (esomeprazole)
• Protonix (pantoprazole)
• Aciphex (rabeprazole)
• Prevacid (lansoprazole)
• Dexilant (dexlansoprazole)
• Zegerid (omeprazole-sodium bicarbonate)

Advantages of PPIs:

• Stronger acid reduction
• More effective for stubborn acid reflux symptoms
• Better at healing duodenal or gastric ulcers

The primary disadvantage is that OTC PPIs can be more expensive than other alternatives.

Natural Alternatives to Famotidine: Exploring Non-Medicinal Options

For individuals with mild reflux symptoms and no conditions requiring prescription medication, natural remedies and lifestyle changes can be effective alternatives to famotidine. Some popular natural approaches include:

1. Dietary modifications:
   • Avoiding trigger foods (e.g., spicy, acidic, or fatty foods)
   • Eating smaller, more frequent meals
   • Avoiding late-night snacking
2. Lifestyle adjustments:
   • Elevating the head of the bed
   • Maintaining a healthy weight
   • Quitting smoking
   • Limiting alcohol consumption
3. Herbal remedies:
   • Chamomile tea
   • Ginger
   • Licorice root
   • Slippery elm
4. Supplements:
   • Probiotics
   • Digestive enzymes
   • Deglycyrrhizinated licorice (DGL)

It’s important to note that while these natural alternatives may provide relief for some individuals, they may not be suitable for everyone, especially those with severe GERD or complications such as Barrett’s esophagus.

Comparing Famotidine to Other Acid-Reducing Medications

Understanding the differences between famotidine and other acid-reducing medications can help in making an informed decision about alternative treatments.

Famotidine vs. Omeprazole

Famotidine (Pepcid) and omeprazole (Prilosec) are both used to treat acid-related conditions, but they belong to different drug classes and have distinct mechanisms of action:

• Famotidine: h3 blocker, works by reducing acid production
• Omeprazole: Proton pump inhibitor, blocks the final step in acid production

Generally, omeprazole is considered more potent and longer-lasting than famotidine. It may be more effective for severe GERD symptoms and healing of erosive esophagitis.

Famotidine vs. Other h3 Blockers

When comparing famotidine to other h3 blockers like cimetidine and nizatidine, the differences are less pronounced:

• Efficacy: Generally similar for treating acid reflux and ulcers
• Side effects: May vary slightly between medications
• Drug interactions: Cimetidine has more potential drug interactions than famotidine or nizatidine

The choice between these medications often depends on individual patient factors and potential side effects.

How to Switch from Famotidine to an Alternative Medication

When considering a switch from famotidine to another medication, it’s crucial to follow these steps:

1. Consult your healthcare provider:
   • Discuss your reasons for wanting to switch
   • Review your medical history and current symptoms
   • Evaluate potential drug interactions or contraindications
2. Choose an appropriate alternative:
   • Consider the severity of your symptoms
   • Factor in cost and availability
   • Weigh the potential benefits and risks of each option
3. Follow the recommended transition plan:
   • Some medications may require a gradual transition
   • Others can be switched immediately
4. Monitor your symptoms:
   • Keep track of any changes in symptom severity or frequency
   • Note any new side effects
5. Follow up with your healthcare provider:
   • Discuss the effectiveness of the new medication
   • Address any concerns or side effects
   • Adjust the treatment plan if necessary

Remember that finding the right medication may require some trial and error. Be patient and work closely with your healthcare provider to find the most effective treatment for your specific needs.

Potential Side Effects and Precautions When Switching Medications

When transitioning from famotidine to an alternative medication, it’s essential to be aware of potential side effects and take necessary precautions:

Common Side Effects

Each class of acid-reducing medications can have different side effects:

• Antacids:
  • Constipation or diarrhea
  • Chalky taste
  • Nausea
• h3 Blockers:
  • Headache
  • Dizziness
  • Constipation or diarrhea
• Proton Pump Inhibitors:
  • Headache
  • Nausea
  • Abdominal pain
  • Increased risk of certain infections

Precautions

When switching medications, consider the following precautions:

1. Drug interactions: Some acid-reducing medications may interact with other drugs you’re taking. Always inform your healthcare provider about all medications and supplements you use.
2. Underlying conditions: Certain medical conditions may affect your ability to take specific acid-reducing medications. Discuss your full medical history with your healthcare provider.
3. Pregnancy and breastfeeding: If you’re pregnant or breastfeeding, some medications may be safer than others. Consult your healthcare provider for guidance.
4. Long-term use: Some medications, particularly PPIs, may have risks associated with long-term use. Discuss the appropriate duration of treatment with your healthcare provider.
5. Rebound acid hypersecretion: When stopping certain acid-reducing medications, especially PPIs, you may experience a temporary increase in acid production. This can usually be managed by tapering the medication or using other treatments temporarily.

By being aware of these potential side effects and taking necessary precautions, you can help ensure a smoother transition when switching from famotidine to an alternative medication.

When to Seek Medical Advice: Red Flags and Warning Signs

While many cases of heartburn and acid reflux can be managed with over-the-counter medications or natural remedies, certain symptoms warrant immediate medical attention. Be aware of these red flags:

• Difficulty swallowing or painful swallowing
• Unexplained weight loss
• Persistent vomiting
• Blood in vomit or stools
• Severe or persistent abdominal pain
• Chest pain that radiates to the jaw, arm, or back
• Shortness of breath or wheezing
• Symptoms that persist or worsen despite treatment

If you experience any of these symptoms, it’s crucial to consult a healthcare provider promptly. These could indicate more serious conditions that require medical evaluation and treatment.

Additionally, if you find that you’re relying on acid-reducing medications frequently or for extended periods, it’s important to discuss this with your healthcare provider. They can help determine if there’s an underlying condition that needs addressing and ensure you’re using the most appropriate treatment strategy.

Remember, while switching medications can be helpful, it’s always best to do so under medical supervision, especially if you have chronic or severe symptoms. Your healthcare provider can offer personalized advice based on your specific situation and help you navigate the process of finding the most effective treatment for your acid-related symptoms.

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.

Famotidine (Pepcid®) for Dogs – PetPlace.com

Table of Contents:

1. Fast Facts: What Is Famotidine (Pepcid)?
2. Brand Names for Famotidine
3. Is Pepcid Routinely Prescribed to Pets?
4. Uses of Famotidine for Dogs
5. How Is Famotidine Supplied?
6. Pepcid Dosage for Dogs
7. Potential Side Effects of Pepcid
8. How to Prevent Unintended Pepcid Exposure
9. More Pet Emergency Resources
10. FAQs About Famotidine for Dogs
11. Drug Library for Pets

Famotidine, also known as famotidine hydrochloride or famotidine HCl, is the generic name for a medication used to treat excessive stomach acid production, esophagitis, and gastroesophageal reflux disease (GERD). It is currently one of the most commonly-prescribed drugs in the United States and is available as both a prescription drug and over-the counter. It is typically known by the brand names “Pepcid®” and “Pepcid AC®.”

Fast Facts: What Is Famotidine (Pepcid)?

• Famotidine is an anti-ulcer drug of the histamine receptor-2 (H-2) antagonist class. Stimulation of H-2 receptors (targets) located on the cell membranes of stomach cells leads to secretion of gastric acid. The drug slows stomach acid production, allowing the ulcer time to heal. Other drugs with similar actions include ranitidine (Zantac®), nizatidine (Axid®) and cimetidine (Tagamet®).
• Use of famotidine can decrease nausea in dogs by its action on the chemoreceptor trigger zone.
• Pepcid is used to treat pets with stomach ulcers, esophagitis, gastric reflux, esophageal reflux, Helicobacter infections, and/or vomiting.
• Studies suggest that there is a diminished effect of famotidine when given on a consistent long-term basis (more than 14 days). For this reason, twice daily dosing may be recommended.

Brand Names for Famotidine

• This drug is registered and FDA approved for human use only.
• Human formulations: Pepcid (Merck), Pepcid AC, and other brand names including Act, Dyspep HB, Pepzan, Arfam, Pamacid, Peptris, Famotren, Famistine, and Fluxid.
• Veterinary formulations: None

Is Pepcid Routinely Prescribed to Pets?

This drug is not FDA approved for use in animals, but it is legally prescribed by veterinarians as an extra-label drug. Famotidine is available over-the-counter, but should not be administered unless under the supervision and guidance of a veterinarian. Pepcid is one of 15 human over-the-counter drugs considered safe for dogs.

Uses of Famotidine for Dogs

Famotidine has a number of purposes for humans, dogs, cats, and other pets:

• Famotidine is used in the treatment and prevention of stomach (gastric) and intestinal ulcers or erosions (shallow depressions in the stomach lining).
• Drugs like Pepcid are used to manage gastric reflux, also known as acid-reflux disease, a condition similar to “heartburn” in people and caused by movement of stomach acid into the lower part of the esophagus. It can help to reduce injury to the esophagus (food tube), making it a good medication for dogs with megaesophagus.
• Famotidine may be useful in the treatment of stomach inflammation caused by kidney disease or kidney failure.
• Dogs with mast cell tumors may be treated with famotidine or a related drug, since these tumors can produce large amounts of histamine.
• Famotidine is used to treat a variety of causes of nausea in dogs and sometimes prescribed to pets that have a decreased appetite. Click here to learn more about caring for a dog that won’t eat.
• Because famotidine blocks histamine, it is sometimes used in addition to other medications, such as steroids or diphenhydramine (Benadryl®), to treat an allergic reaction.
• Famotidine is used in many situations that result in stomach problems, ulcers, or diseases that cause nausea and vomiting. Examples include inflammatory bowel disease, acute pancreatitis, or infections such as canine parvoviral enteritis or helicobacter.

How Is Famotidine Supplied?

Famotidine is available in both prescription and over-the-counter formulations.

• 10 mg, 20 mg, and 40 mg tablets.
• Oral powder for suspension is supplied at 50 mg/5 ml.
• An injectable at the concentration of 20 mg/50 mL or 20 mg (2 mg/mL).

Pepcid Dosage for Dogs

Medication should never be administered without first consulting your veterinarian. Make sure to discuss proper dosage and other precautions with your veterinarian before using Pepcid for dogs. The typical dose of famotidine administered is 0.25 to 0.5 mg per pound (0.5 to 1.0 mg/kg) every 12 to 24 hours. There is a diminished effect when given for more than 14 consecutive days. For this reason, twice daily dosing may be recommended.

The duration of administration depends on the condition being treated, response to the medication, and the development of any adverse side effects. Be certain to complete the prescription unless specifically directed by your veterinarian. Even if your pet feels better, complete the entire treatment plan to avoid a sudden relapse.

Tablets should be stored away from light and at room temperature. Liquid formulations should be refrigerated.

Potential Side Effects of Pepcid

Call your vet if you are concerned about your pet ingesting a toxic dose of medication and if you observe any of the following side effects:

• Diarrhea
• Difficulty breathing
• Difficulty walking
• Lack of appetite
• Lethargy
• Pale gums
• Vomiting

Make sure to monitor your pet closely and observe their behavior, urination, and bowel movements to ensure they are not suffering from any of these symptoms. Contact your veterinarian immediately if you believe your pet has ingested a potentially-toxic dose of famotidine.

How to Prevent Unintended Pepcid Exposure

Curious pets are good at getting into things, and it’s always better to prevent poisoning than to treat it after the fact. Take these precautions to keep your pets from unwittingly ingesting a dangerous amount of famotidine:

• Store all medications out of the reach of pets.
• Take extra special care with pill bottles and weekly pill holders. The shape of the containers and the sounds they make when shaken can mimic toys, tempting pets into playing with them or chewing on them.
• Avoid using plastic bags to store pills. If you are traveling with medications, keep them secure. Bags can be easily chewed through and ingested.
• If you keep medications in your purse, make sure you close it, hang it up, or secure it in an area that is inaccessible to your pet.
• Encourage house guests to keep their belongings closed and medications away from your pets.

More Pet Emergency Resources

If your pet ingests Pepcid and you can’t get in touch with your vet, call your closest emergency clinic. Another option is to call a poison control hotline for pets.

The two most common are:

• Pet Poison Helpline
• ASPCA Animal Poison Control Center

FAQs About Famotidine for Dogs

What should I do if I miss giving a dose of famotidine?

If you miss giving a dose of famotidine to your dog, you can give the missed dose as soon as possible. However, if the next dose is due soon, don’t double the dose, just give the regularly scheduled dose.

What is the most important thing I should know about famotidine?

Pepcid is in a class of drugs referred to as “h3 blockers” and related to medications like cimetidine (Tagamet) and ranitidine (Zantac). Famotidine decreases the production of stomach acid. It is a fairly safe drug and overdoses are uncommon. Pepcid is commonly prescribed to dogs, cats, and other animals.

What should I discuss with my veterinarian before giving famotidine to my pet?

You should discuss the underlying issue with your veterinarian before giving your pet any medication. For example, if your dog is not eating, you should discuss potential causes and create a plan of action. It’s important to look for additional symptoms, such as vomiting, diarrhea, lethargy, blood in the vomit or stool, and any other abnormalities.

Are there alternatives to famotidine?

Famotidine belongs to a class of medications called “h3 blockers. ” Other drugs in this class include cimetidine and ranitidine, which can also be used in dogs. Alternative drugs such as omeprazole, commonly known as Prilosec®, may have superior gastric acid suppression. Depending on your dog’s clinical symptoms, alternatives like cerenia may be recommended to treat vomiting.

Can you buy famotidine over-the-counter?

Yes, you can buy famotidine over-the-counter in some sizes (10 mg is the most common).

What are contraindications to giving famotidine?

Famotidine should be used with caution in dogs with kidney and liver disease. Because it is metabolized by these organs, toxicity is possible. With that being said, famotidine is very commonly recommended, but a lower dose or frequency may be used in some dogs.

Does famotidine need to be given with food?

Ideally, famotidine should be given on an empty stomach and not with food.

What drugs interact with famotidine?

Famotidine has minimal drug interactions. However, because the primary effect of famotidine is to decrease gastric acid, the pH alteration can impact the absorption of other orally administered medications. These drugs include iron supplements and antifungal drugs such as itraconazole, ketoconazole, and fluconazole. Cephalosporin antibiotics, such as cephalexin or cefpodoxime, should ideally be given two hours before or after administering famotidine to optimize its absorption. Separating oral administration between other drugs by one hour is generally recommended. Some antacids can diminish the absorption of famotidine.

What is the difference between famotidine (Pepcid) and ranitidine (Zantac)?

Famotidine (Pepcid) and ranitidine (Zantac) are both in the class of drugs called h3 receptor antagonists, which block histamine.

There are some physiologic differences between famotidine and ranitidine that include:

• Famotidine is given one to two times per day and ranitidine is given two to three times per day
• Famotidine is eight to nine times more effective at suppression of gastric acid secretion
• Ranitidine has some effect on gastric motility and hepatic microsomal enzyme systems, while famotidine does not

Is Pepcid AC the same as Pepcid?

Both Pepcid and Pepcid AC are composed of the same active ingredient (famotidine). Pepcid AC refers to the over-the-counter, lower-strength version, while Pepcid often refers to the prescription strength versions.

What is Pepcid Complete?

Pepcid Complete® is a chewable tablet that consists of famotidine combined with an antacid. The antacid component provides faster relief (minutes) for symptoms of heartburn, while the famotidine takes longer (peak effect 2 hours).

When is the best time to give famotidine to my dog?

The best time to give famotidine is in the morning before feeding breakfast.

Can you crush Pepcid and give it to your dog?

Ideally, Pepcid should not be crushed. Many tablets are formulated to be ingested and broken down in the gastrointestinal tract over time. When crushed, more of the medication is absorbed quickly.

If you are having difficulty medicating your dog, a better alternative is to use the oral liquid formulation (liquid famotidine oral powder for suspension supplied at 50 mg/5 ml), which is available at most pharmacies. Check with your veterinarian for a prescription.

As an alternative to crushing pills, a better approach is to hide the pill in a small amount of food, such as canned dog food, chicken, cheese, or peanut butter. If that is not possible, you can open your dog’s mouth and place it near the back. Here are tips on how to give your dog a pill and how to hide a pill in food.

What human medications or over-the-counter (OTC) medications are safe to give my dog?

There are several human OTC medications safe to use in dogs. Here is a list for your reference.

Drug Library for Pets

Want to learn more about safely administering medication to your dog? Check out PetPlace’s Drug Library.

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Famotidine tablets 20 mg Kievmedpreparat

• Indications
• Contraindications
• Dosage and Administration
• Adverse reactions
• Overdose
• Interaction with other medicinal products and other forms of interaction
• Pharmacological properties
• Expiry date
• Storage conditions
• Diagnosis
• Recommended alternatives
• Trade names

Composition:

active ingredient: 1 tablet contains famotidine in terms of 100% substance 20 mg;

excipients: lactose, monohydrate; potato starch; povidone; calcium stearate; silicon dioxide colloidal anhydrous.

Dosage form

Tablets.

Pharmacotherapeutic group

Agents for the treatment of peptic ulcer and gastroesophageal reflux disease. H2 receptor antagonists. ATC code A02B A03.

Clinical characteristics

Indications

• Benign gastric ulcer.
• Peptic ulcer of the duodenum (treatment and prevention of recurrence).
• Hypersecretory conditions such as Zollinger-Ellison syndrome.
• Treatment of gastroesophageal reflux disease (reflux esophagitis).
• Prevention of the development of symptoms and erosions or ulceration associated with gastroesophageal reflux disease.

Contraindications

Hypersensitivity to any component of the drug and other histamine H2 receptor antagonists.

Childhood, pregnancy or lactation (due to lack of necessary clinical experience).

Dosage and administration

The drug is most effective in the evening before bedtime. When taking famotidine twice a day, one dose should be taken in the morning, the other in the evening before bedtime.

Peptic ulcer of the duodenum and stomach (benign)

40 mg in the evening before bed for 4-8 weeks.

Prevention of recurrence of duodenal ulcer

To prevent recurrence after achieving a therapeutic effect, administer at a maintenance dose: 20 mg once a night for 1-4 weeks.

Gastroesophageal reflux disease (reflux esophagitis)

20 mg or 40 mg (depending on the severity of the disease) 2 times a day. Treatment lasts for 6-12 weeks.

For gastroesophageal reflux disease associated with erosive esophagitis or ulcers, 40 mg twice a day for 6-12 weeks.

For the prevention of recurrence of symptoms and erosions or ulceration associated with gastroesophageal reflux disease (maintenance therapy). Assign 20 mg 2 times a day.

Zollinger-Ellison syndrome

Select the dose of the drug individually. Patients who have not previously been prescribed antisecretory drugs should be given an initial dose of 20 mg 4 times a day (every 6 hours). For patients who have previously used other histamine H2 receptor antagonists, a higher initial dose of 40 mg every 6 hours can be immediately prescribed. Then the dose is adjusted depending on the level of secretion of gastric juice, as well as the clinical condition of the patient. Treatment should be carried out as long as clinical symptoms of the disease are observed.

If necessary, increase the daily dose gradually, depending on the individual, until the optimal dose is reached.

According to the literature, the highest doses of famotidine taken by patients with severe forms of the disease were up to 160 mg every 6 hours.

Dosing in renal failure

If creatinine clearance is less than 30 ml/min, serum creatinine level is more than 3 mg/100 ml, the daily dose of the drug should be reduced to 20 mg or the interval between doses should be increased to 36-48 hours .

Discontinue treatment with the drug gradually due to the risk of rebound syndrome with abrupt withdrawal.

Dosage for the Elderly

Dosage adjustment is not necessary for the elderly, except in patients with renal insufficiency.

Adverse reactions

Adverse events are listed below and classified by organ system. However, their causal relationship with famotidine therapy has not been established.

* Gynecomastia is extremely rare and is reversible if treatment is stopped. If any serious adverse reactions develop, treatment with Famotidine should be discontinued.

Overdose

Symptoms: Vomiting, restlessness, tremors, hypotension, tachycardia and collapse may occur.

Treatment: stop the drug, induce vomiting and/or gastric lavage. If necessary, appropriate symptomatic and supportive treatment can be used: intravenous diazepam in case of convulsions, atropine in case of bradycardia and lidocaine in case of ventricular arrhythmia. effective hemodialysis.

Use during pregnancy or lactation.

Pregnancy.

Famotidine crosses the placenta. Adequate and well-controlled studies involving pregnant women have not been conducted.

Famotidine is not recommended during pregnancy.

Breastfeeding.

Famotidine passes into human breast milk, therefore breast-feeding should be discontinued while using Famotidine.

Children.

This drug should not be prescribed to children due to the lack of experience with its use in this category of patients.

Application features

Prior to treatment with famotidine, it is necessary to exclude the presence of malignant neoplasms in the stomach and duodenum. Treatment with this drug may mask the symptoms of gastric carcinoma.

In case of hepatic insufficiency, famotidine should be used with caution and at low doses.

Since cross-sensitivity between H2 receptor antagonists has been reported, the use of Famotidine in patients with hypersensitivity to other H2 receptor antagonists is contraindicated.

Treatment with Famotidine cannot be carried out without a doctor’s prescription or without proper medical examination if:

• the patient suffers from kidney or liver disease. In elderly patients or in patients with impaired liver or kidney function, mental disorders (confusion) may occur that require a dose reduction;
• the patient suffers from concomitant diseases or uses other drugs at the same time;
• in a middle-aged or elderly patient, complaints of digestive disorders first appeared or previous complaints changed;
• the patient has stomach complaints and has lost weight;
• black patient stool;
• the patient has swallowing disorders or chronic abdominal pain.

The drug should be used with caution in case of acute porphyria (including history) and immunodeficiency.

Symptoms of duodenal ulcer may disappear within 1-2 weeks; however, treatment should be continued until scarring is confirmed by endoscopic or x-ray findings.

It is necessary to regularly monitor the condition of patients (especially elderly patients and patients with a history of gastric and / or duodenal ulcers) who use the drug in combination with non-steroidal anti-inflammatory drugs.

In the case of complex treatment with antacids, the interval between the use of the drug and antacids should be at least 1-2 hours.

If a dose is missed, it should be taken as soon as possible; do not double the dose if it is time for the next dose.

Treatment with the drug should not be started without prior proper medical examination in the presence of heartburn, manifestations of a hyperacid state, stomach pain or a hyperacid state after eating in elderly patients.

Patients should be warned that each Famotidine 20 mg tablet contains lactose and should not be used in patients with galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.

The ability to influence the reaction rate when driving vehicles or operating other mechanisms.

Patients should be careful when performing potentially hazardous activities that require increased attention and speed of psychomotor reactions, since the drug can cause dizziness.

Interaction with other drugs and other types of interactions

The absorption of some drugs (eg ketoconazole, amoxicillin, iron preparations) depends on the acidity of gastric juice. Therefore, famotidine must be used at least 2 hours after taking such medicines. Simultaneous use with other H2 receptor antagonists can significantly reduce the effectiveness of tolazoline. Although there are no confirmed interactions between famotidine and tolazoline, the likelihood of their existence is high enough that the effect of tolazoline should be checked at the beginning and after completion of concomitant treatment. In the event of a decrease in the effect of tolazoline, its dose should be gradually increased or treatment with famotidine should be discontinued.

Food and antacids have no significant effect on famotidine treatment.

Famotidine does not affect the hepatic cytochrome P450 oxidase system, so the metabolism of oral anticoagulants, antipyrine, aminopyrine, theophylline, phenytoin, diazepam, ethanol and propranolol remains unchanged.

Probenecid may delay the release of famotidine.

Pharmacological properties

Pharmacodynamics.

Famotidine is a potent competitive inhibitor of the histamine H2 receptor. The main clinically significant pharmacological action of famotidine is the inhibition of gastric secretion. Famotidine reduces both the concentration of acid and the volume of gastric secretion, while the production of pepsin remains proportional to the volume of secreted gastric juice.

Famotidine inhibits basal and nocturnal gastric secretion, as well as secretion stimulated by the administration of pentagastrin, betazol, caffeine, insulin and the physiological vagus nerve reflex.

The duration of inhibition of secretion when using doses of 20 mg and 40 mg is from 10 to 12 hours. Single oral doses of 20 mg and 40 mg in the evening provide inhibition of basal and nocturnal acid secretion.

Nocturnal secretion of hydrochloric acid is inhibited by 86-94% for at least 10 hours. The same doses taken in the morning reduce the acid secretion stimulated by food. This inhibition is respectively 76-84% of the initial secretion 3-5 hours after ingestion, and 25% and 30% 8 and 10 hours after ingestion, respectively.

Famotidine has virtually no effect on fasting or postprandial gastrin levels. Famotidine has no effect on gastric emptying, exocrine pancreatic function, blood flow in the liver and in the portal system.

Pharmacokinetics.

The kinetics of famotidine is linear.

Suction. Famotidine is rapidly absorbed. Bioavailability when taken orally is 40-45%. Bioavailability does not change depending on the contents of the stomach, but slightly decreases when taking antacids.

In elderly patients, no clinically significant, age-related change in the bioavailability of famotidine has been identified.

First-pass biotransformation has little effect on drug bioavailability.

Distribution. After oral administration, peak plasma concentrations are reached within 1-3 hours. With repeated administration of the cumulative effect does not occur. Plasma protein binding is relatively low, amounting to 15-20%.

Half-life – 2.3-3.5 hours. In patients with severe renal insufficiency, the half-life of famotidine may exceed 20 hours.

Metabolism of the drug occurs in the liver. The only metabolite identified in humans is the sulfoxide.

Famotidine is excreted by the kidneys (65-70%) and by metabolism of 30-35% of the administered drug. Renal clearance is 250-450 ml/min, indicating some degree of tubular excretion. 25-30% of the dose taken orally and 65-70% of the intravenously administered dose is determined in the urine unchanged. A small part of the administered dose may be excreted in the form of sulfoxide.

Pharmaceutical characteristics

Basic physical and chemical properties: white or white with a creamy tint tablets, round shape, with a flat surface, with a bevel.

Shelf life

4 years.

Storage conditions

Store in the original container at a temperature not exceeding 25 °C. Keep out of the reach of children.

Packaging

10 tablets in a blister, 2 blisters in a pack.

Dispensing category

Prescription.

Producer

PJSC “Kyivmedpreparat”.

Location

Ukraine, 01032, Kyiv, st. Saksaganskogo, 139.

Diseases of the stomach and duodenum	ICD K29.9
Other acute gastritis	ICD K29.1
Other chronic pancreatitis	ICD K86. 1
Urticaria	ICD L50.9

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 were approved about 10 years apart – h3-histamine receptor blockers and proton pump inhibitors (PPIs).

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.

Then followed the processes inherent in all drugs after entering the market: pharmacovigilance, post-registration studies and meta-analyses. As early as 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 into 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 2019, potential carcinogens were found in ranitidine. 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 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.