Famotidine

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Generic Name of Famotidine - Learn More

Famotidine

Famotidine Precaution - What You Need to Know

- Pregnancy and Breastfeeding: Famotidine is classified as Pregnancy Category B by the FDA, meaning that studies in animals have shown no evidence of harm to the fetus, but there are no well-controlled studies in pregnant women. It should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. It is excreted into breast milk in small amounts, so caution is advised when using it in breastfeeding women. If the benefits outweigh the risks, use in lactating women may be considered.
- Renal Impairment: Famotidine is primarily excreted by the kidneys. In patients with renal impairment, particularly those with creatinine clearance (CrCl) less than 30 mL/min, the dose should be reduced to avoid drug accumulation and potential toxicity. Patients with severe renal dysfunction should be closely monitored for adverse effects, especially in prolonged therapy.
- Hepatic Impairment: Though famotidine is not extensively metabolized by the liver, caution is still needed in patients with significant hepatic impairment, especially for long-term use or high doses. Liver function should be monitored periodically during treatment.
- Gastrointestinal Disorders: Use with caution in patients with a history of gastrointestinal bleeding or gastric ulcer, as famotidine reduces gastric acidity and could mask symptoms of bleeding or ulcer-related complications. Famotidine should be used judiciously in patients with a history of recurrent peptic ulcers or gastritis.
- Elderly Patients: Elderly patients may have altered renal function, so dose adjustments may be necessary to avoid drug accumulation. They are also at a higher risk for potential drug interactions, especially if they are on multiple medications.

Famotidine Indication - Uses and Benefits

- Peptic Ulcer Disease (PUD): Famotidine is commonly prescribed for the treatment of duodenal ulcers and gastric ulcers. It works by inhibiting gastric acid secretion, thus allowing ulcers to heal. For duodenal ulcers, the typical course of therapy lasts up to 4 to 8 weeks.
- Gastroesophageal Reflux Disease (GERD): Famotidine is used for GERD to reduce gastric acid secretion, which helps alleviate the symptoms of heartburn, acid regurgitation, and discomfort associated with reflux disease. It is effective in managing both the acute symptoms and long-term management of GERD.
- Zollinger-Ellison Syndrome: Famotidine is used in the treatment of Zollinger-Ellison syndrome, a rare condition characterized by gastrinoma and excessive gastric acid secretion. The drug helps to reduce acid output and manage symptoms related to this syndrome.
- Off-Label Uses: Famotidine has been used off-label for prevention of stress ulcers in critically ill patients, although this is not its primary indication. It has also been explored in the context of drug-induced gastrointestinal distress or preoperative use for reducing gastric acidity prior to surgery, particularly in patients at high risk for aspiration.
- Evidence-Based Context: Famotidine's efficacy in reducing gastric acid secretion and promoting ulcer healing has been demonstrated in multiple clinical trials, making it a first-line treatment for PUD and GERD. It is often preferred over older H2 blockers due to its higher potency and fewer side effects.

Famotidine Contraindications - Important Warnings

- Hypersensitivity: Famotidine is contraindicated in patients who have a known hypersensitivity to the drug or any of its components, including reactions such as angioedema or rash.
- Severe Renal Impairment: In patients with severe renal impairment (CrCl less than 10 mL/min), famotidine should be avoided, or used with extreme caution, due to the potential for drug accumulation and increased risk of adverse effects. In these cases, dose reduction or alternative therapies may be considered.
- Liver Disease: Although famotidine is not extensively metabolized by the liver, caution is still advised for patients with severe liver disease. Use should be closely monitored, especially for those on prolonged therapy.
- Pregnancy and Breastfeeding: Famotidine should be used in pregnant or breastfeeding women only if the potential benefits outweigh the potential risks. It is classified as Category B for pregnancy, and while it is generally considered safe for breastfeeding, it is always best to use it with caution during lactation.

Famotidine Side Effects - What to Expect

- Common Side Effects:
- Headache: A mild and common side effect of famotidine, often transient and manageable.
- Dizziness: Some patients may experience dizziness or lightheadedness, particularly in elderly patients.
- Constipation: Famotidine may cause mild constipation in some individuals, although this is less common.
- Diarrhea: Diarrhea is another gastrointestinal side effect, though it is generally mild and resolves with continued use.
- Serious Side Effects:
- Severe Allergic Reactions: Rare but serious allergic reactions, including angioedema (swelling of the face, lips, or throat), urticaria (hives), and difficulty breathing, may occur. Immediate medical attention is required.
- Arrhythmias: Famotidine has been rarely associated with arrhythmias, including bradycardia and tachycardia. Monitoring heart function is recommended, especially in patients with underlying heart conditions.
- Liver Enzyme Elevation: Some patients may experience elevations in liver enzymes, especially with prolonged use, requiring liver function monitoring.
- CNS Effects: Confusion, hallucinations, or agitation, particularly in elderly patients or those with renal impairment, have been reported but are rare.
- Long-Term Side Effects: Chronic use of famotidine at high doses may lead to vitamin B12 deficiency and potential bone fractures due to prolonged acid suppression, although this is not a common occurrence.

Famotidine Pregnancy Category ID - Safety Information

2

Famotidine Mode of Action - How It Works

Famotidine is a histamine H2-receptor antagonist, meaning it blocks the action of histamine on the H2 receptors located on the parietal cells in the stomach lining. Histamine normally stimulates the H2 receptors, leading to an increase in gastric acid secretion. By inhibiting this receptor, famotidine effectively reduces gastric acid production, which aids in the healing of ulcers and alleviates symptoms associated with GERD and other acid-related conditions.
- Pharmacodynamics: The primary effect of famotidine is a decrease in gastric acid secretion, resulting in a lower pH in the stomach. This promotes the healing of gastric and duodenal ulcers, reduces acid reflux, and relieves discomfort associated with acid indigestion.
- Pharmacokinetics: Famotidine is rapidly absorbed after oral administration, with peak plasma concentrations occurring within 1-3 hours. It has a half-life of 2.5 to 3.5 hours, which allows for twice-daily dosing. Famotidine is excreted primarily by the kidneys, and its clearance may be reduced in patients with renal impairment.

Famotidine Drug Interactions - What to Avoid

- Antacids: The coadministration of famotidine with antacids can alter the absorption of the drug, as antacids can increase the pH of the stomach, affecting the bioavailability of famotidine. To minimize this interaction, it is advised to take famotidine at least 1 hour before or after an antacid.
- Warfarin: There is a potential interaction between famotidine and warfarin, as famotidine may enhance the anticoagulant effect of warfarin, increasing the risk of bleeding. Frequent monitoring of INR (International Normalized Ratio) is recommended for patients taking both medications.
- Ketoconazole: Famotidine can decrease the absorption of ketoconazole by raising gastric pH. This can reduce the effectiveness of ketoconazole, particularly in patients who are using it to treat fungal infections. The administration of ketoconazole should be done at least 2 hours before famotidine.
- Theophylline: There is a potential interaction between famotidine and theophylline in which famotidine may increase the serum concentration of theophylline. Monitoring for toxicity is recommended when these drugs are used together.
- Alcohol: Alcohol may exacerbate the gastrointestinal side effects of famotidine, such as gastric irritation or nausea. While there is no direct contraindication, it is advised to limit alcohol consumption during therapy.
- Cimetidine and Ranitidine: Combining famotidine with other H2 receptor antagonists like cimetidine or ranitidine is generally unnecessary and not recommended, as it may lead to increased risk of adverse effects due to additive pharmacologic actions.

Famotidine Adult Dose - Recommended Dosage

- Peptic Ulcer Disease (PUD): The typical dose for adults is 20 mg twice daily for duodenal ulcers or 40 mg once daily at bedtime for gastric ulcers. The duration of therapy usually lasts between 4 to 8 weeks.
- Gastroesophageal Reflux Disease (GERD): For GERD, 20 mg twice daily is often prescribed, though some patients may require higher doses depending on the severity of symptoms.
- Zollinger-Ellison Syndrome: For this condition, higher doses of 40 mg every 6 hours may be required. Treatment should be adjusted based on symptom relief and acid output monitoring.
- Prevention of Stress Ulcers: 20 to 40 mg once daily is typically used for ulcer prevention in critically ill patients.

Famotidine Child Dose - Dosage for Children

- Pediatrics (Children 1-16 years): The typical dose for pediatric patients with peptic ulcers or GERD is 0.5 mg/kg given twice daily, with a maximum dose of 40 mg/day. Dosing adjustments may be required for children with renal impairment. The safety and efficacy of famotidine in children younger than 1 year have not been established.

Famotidine Renal Dose - Dosage for Kidney Conditions

- Mild Renal Impairment (CrCl 30-60 mL/min): No adjustment is necessary, but patients should be monitored.
- Moderate Renal Impairment (CrCl 10-30 mL/min): The dose should be reduced to 20 mg once daily.
- Severe Renal Impairment (CrCl <10 mL/min): In this population, famotidine should be used with caution, and the dose should be reduced to 20 mg once daily, or alternative therapies may be considered.