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Famotidine

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Nov.03.2023

Famotidine

Indications/Dosage

Labeled

  • duodenal ulcer
  • dyspepsia
  • gastric ulcer
  • gastroesophageal reflux disease (GERD)
  • multiple endocrine adenoma syndrome
  • pyrosis (heartburn)
  • systemic mastocytosis
  • Zollinger-Ellison syndrome

Off-Label

  • anaphylaxis
  • aspiration prophylaxis
  • NSAID-induced ulcer prophylaxis
  • short bowel syndrome
  • stress gastritis prophylaxis
† Off-label indication

For self-medication of pyrosis (heartburn), acid dyspepsia (acid indigestion), or sour stomach, either for prophylaxis or for symptomatic relief

Oral dosage (tablets)

Adults

10 to 20 mg PO twice daily as needed. Max: 40 mg/day.[51488] [51490]

Children and Adolescents 12 to 17 years

10 to 20 mg PO twice daily as needed. Max: 40 mg/day.[51488] [51490]

For the treatment of non-erosive gastroesophageal reflux disease (GERD)

for the treatment of non-erosive gastroesophagel reflux disease (GERD)

Oral dosage

Adults

20 mg PO twice daily for up to 6 weeks.[51477]

Children and Adolescents

0.5 mg/kg/dose PO twice daily (Max: 40 mg PO twice daily).[44392] [55232] Treat for 6 to 12 weeks.[51477] While famotidine may be effective in patients with less severe GERD, proton pump inhibitors (PPIs) offer more rapid symptom relief and better healing.[26115]

Infants 3 to 11 months

0.5 mg/kg/dose PO twice daily initially, in addition to conservative measures such as thickened feedings. May increase the dose to 1 mg/kg/dose PO twice daily if needed. Treat for up to 8 weeks.[51477] While famotidine may be effective in patients with less severe GERD, proton pump inhibitors (PPIs) offer more rapid symptom relief and better healing.[26115]

Infants 1 to 2 months

0.5 mg/kg/dose PO once daily initially, in addition to conservative measures such as thickened feedings. May increase the dose to 1 mg/kg/dose PO once daily if needed. Treat for up to 8 weeks.[51477] While famotidine may be effective in patients with less severe GERD, proton pump inhibitors (PPIs) offer more rapid symptom relief and better healing.[26115]

Neonates

0.5 mg/kg/dose PO once daily initially, in addition to conservative measures such as thickened feedings. May increase the dose to 1 mg/kg/dose PO once daily if needed. Treat for up to 8 weeks.[51477] While famotidine may be effective in patients with less severe GERD, proton pump inhibitors (PPIs) offer more rapid symptom relief and better healing.[26115]

Intravenous dosage

Children and Adolescents

0.25 mg/kg/dose IV every 12 hours (Max: 40 mg/day) is the FDA-approved dose; doses up to 0.5 mg/kg/dose IV every 12 hours have been used.[51456] A dose of 0.5 mg/kg/dose IV every 8 to 12 hours is supported by pharmacokinetic and pharmacodynamic data.[25030]

Infants 4 to 11 months†

Safety and efficacy have not been established; however, doses of 0.25 to 0.5 mg/kg/dose IV twice daily have been used in 1 small study.[51494]

Infants 1 to 3 months†

Safety and efficacy have not been established; however, doses of 0.25 to 0.5 mg/kg/dose IV once daily have been used in 1 small study.[51494]

Neonates†

Safety and efficacy have not been established; however, doses of 0.25 to 0.5 mg/kg/dose IV once daily have been used in 1 small study.[51494]

for the treatment of erosive esophagitis due to gastroesophagel reflux disease (GERD)

Oral dosage

Adults

20 or 40 mg PO twice daily for up to 12 weeks.[51477]

Children and Adolescents

0.5 mg/kg/dose PO twice daily (Max: 40 mg PO twice daily).[44392] [55232] Treat for 6 to 12 weeks.[51477] While famotidine may be effective in patients with less severe GERD, proton pump inhibitors (PPIs) offer more rapid symptom relief and better healing.[26115]

Infants 3 to 11 months

0.5 mg/kg/dose PO twice daily initially, in addition to conservative measures such as thickened feedings. May increase the dose to 1 mg/kg/dose PO twice daily if needed. Treat for up to 8 weeks.[51477] While famotidine may be effective in patients with less severe GERD, proton pump inhibitors (PPIs) offer more rapid symptom relief and better healing.[26115]

Infants 1 to 2 months

0.5 mg/kg/dose PO once daily initially, in addition to conservative measures such as thickened feedings. May increase the dose to 1 mg/kg/dose PO once daily if needed. Treat for up to 8 weeks.[51477] While famotidine may be effective in patients with less severe GERD, proton pump inhibitors (PPIs) offer more rapid symptom relief and better healing.[26115]

Neonates

0.5 mg/kg/dose PO once daily initially, in addition to conservative measures such as thickened feedings. May increase the dose to 1 mg/kg/dose PO once daily if needed. Treat for up to 8 weeks.[51477] While famotidine may be effective in patients with less severe GERD, proton pump inhibitors (PPIs) offer more rapid symptom relief and better healing.[26115]

Intravenous dosage

Children and Adolescents

0.25 mg/kg/dose IV every 12 hours (Max: 40 mg/day) is the FDA-approved dose; doses up to 0.5 mg/kg/dose IV every 12 hours have been used.[51456] A dose of 0.5 mg/kg/dose IV every 8 to 12 hours is supported by pharmacokinetic and pharmacodynamic data.[25030]

Infants 4 to 11 months†

Safety and efficacy have not been established; however, doses of 0.25 to 0.5 mg/kg/dose IV twice daily have been used in 1 small study.[51494]

Infants 1 to 3 months†

Safety and efficacy have not been established; however, doses of 0.25 to 0.5 mg/kg/dose IV once daily have been used in 1 small study.[51494]

Neonates†

Safety and efficacy have not been established; however, doses of 0.25 to 0.5 mg/kg/dose IV once daily have been used in 1 small study.[51494]

For the treatment of peptic ulcer disease (duodenal ulcer or gastric ulcer)

NOTE: For dosing in patients with gastric or duodenal ulcers due to H. pylori, see H. pylori eradication indication.

for acute treatment

Oral dosage

Adults

40 mg PO once daily at bedtime. Most duodenal ulcer patients heal within 4 weeks and full-dose therapy is rarely needed for longer than 6 to 8 weeks.

Adolescents and Children

0.5 mg/kg/day PO at bedtime or 0.25 mg/kg/dose PO twice daily initially (Max: 40 mg/day). Doses up to 1 mg/kg/day (Max: 40 mg/day) PO have been used. Individualize treatment duration and dose based on clinical response and/or pH determination (gastric or esophageal) and endoscopy.[44392] In one small study, a treatment duration of 8 weeks was effective for the treatment of gastric or duodenal ulcer.[25029]

Intravenous dosage

Adults

20 mg IV every 12 hours.

Adolescents and Children

0.25 mg/kg/dose IV every 12 hours (Max: 40 mg/day) is recommended by the manufacturer.[51456] An initial dose of 0.5 mg/kg/dose IV every 8 to 12 hours is supported by pharmacokinetic and pharmacodynamic data.[25030]

for maintenance therapy of duodenal ulcer after the initial treatment phase has been completed

Oral dosage

Adults

20 mg PO once daily at bedtime.

For pathologic GI hypersecretory conditions such as Zollinger-Ellison syndrome, systemic mastocytosis, or multiple endocrine adenoma syndrome

Oral dosage

Adults

20 mg PO every 6 hours, initially. May titrate. Maximum: 160 mg PO every 6 hours per the manufacturer. Clinically, adjust to patient response. Doses as high as 200 mg PO every 6 hours have been reported.[44392]

Intravenous dosage

Adults

20 mg IV every 6 hours when oral therapy is not feasible; higher doses may be needed and therapy should be individualized based on patient response.[51456]

For NSAID-induced ulcer prophylaxis†

Oral dosage

Adults

40 mg PO twice daily. Data from clinical trials note that only higher doses of H2-blockers are effective at reducing risk for gastric ulceration from NSAIDs.[60443] [60444] In one trial, patients receiving a NSAID for either rheumatoid arthritis or osteoarthritis were given famotidine 20 mg PO twice daily, famotidine 40 mg PO twice daily, or placebo for 24 weeks. The cumulative incidence of gastric ulcer was significantly reduced by famotidine 40 mg but not the lower dose compared to placebo. The cumulative incidence of duodenal ulcer was significantly reduced by both famotidine doses relative to placebo.[24596]

For stress gastritis prophylaxis† in critically ill patients

Oral dosage

Adults

20 mg PO every 12 hours.[67626]

Intravenous dosage

Adults

20 mg IV every 12 hours.[26015] [67626]

Infants, Children, and Adolescents

1 to 2 mg/kg/day IV divided every 8 to 12 hours (Max: 40 mg/day).[51510] [51511] [51981]

Continuous Intravenous Infusion dosage

Adults

10 mg IV bolus, followed by 1.7 mg/hour (40 mg/day) continuous IV infusion.[26015] [67626]

For acid aspiration prophylaxis† prior to anesthesia

Oral dosage

Adults

20 mg PO as a single dose given 3 hours prior to the time of surgery, before induction of anesthesia. Alternatively, 40 mg PO the night prior to elective surgery. According to guidelines of the American Society of Anesthesiologists, routine preoperative use is NOT recommended in patients who have no apparent increased risk for pulmonary aspiration.[60445] However, some guidelines recommend an H2-receptor antagonist (PO or IV) for all women presenting for cesarean delivery.[66408]

Intravenous dosage

Adults

20 mg IV in the morning prior to surgery, before induction of anesthesia. According to guidelines of the American Society of Anesthesiologists, routine preoperative use is NOT recommended in patients who have no apparent increased risk for pulmonary aspiration.[60445] However, some guidelines recommend an H2-receptor antagonist (PO or IV) for all women presenting for cesarean delivery.[66408]

For the treatment of anaphylaxis†

Intravenous dosage

Adults

20 mg IV as a single dose.[69080]

Infants, Children, and Adolescents

0.25 mg/kg/dose (Max: 20 mg/dose) IV as a single dose.[69080]

Oral dosage

Adults

20 mg PO as a single dose.[69080]

Infants, Children, and Adolescents

0.25 mg/kg/dose (Max: 20 mg/dose) PO as a single dose.[69080]

For the treatment of short bowel syndrome†

Oral dosage

Adults

20 to 40 mg PO twice daily for at least 6 months.[69771] [69772]

Intravenous dosage

Adults

20 to 40 mg IV twice daily for at least 6 months.[69771] [69772]

Therapeutic Drug Monitoring

Maximum Dosage Limits

  • Adults

    40 mg/day PO or IV for active duodenal or benign gastric ulcer; 20 mg/day PO for ulcer maintenance; 40 mg/day PO for GERD; 80 mg/day PO for esophagitis; doses may go as high as 640 mg/day or 800 mg/day (rare) PO or 80 mg/day IV for hypersecretory conditions such as Zollinger-Ellison; 40 mg/day PO for self-medication (OTC).

  • Geriatric

    40 mg/day PO or IV for active duodenal or benign gastric ulcer healing; 20 mg/day PO for ulcer maintenance; 40 mg/day PO for GERD; 80 mg/day PO for esophagitis; doses may go as high as 640 mg/day or 800 mg/day (rare) PO or 80 mg/day IV for hypersecretory conditions such as Zollinger-Ellison; 40 mg/day PO for self-medication (OTC).

  • Adolescents

    1 mg/kg/day PO (Max: 80 mg/day); 1 mg/kg/day IV (Max: 40 mg/day) is FDA-approved maximum; however, doses up to 2 mg/kg/day IV have been used off-label.

  • Children

    1 mg/kg/day PO (Max: 80 mg/day); 1 mg/kg/day IV (Max: 40 mg/day) is FDA-approved maximum; however, doses up to 2 mg/kg/day IV have been used off-label.

  • Infants

    3 to 11 months: 2 mg/kg/day PO. Safety and efficacy of IV have not been established; however, doses up to 2 mg/kg/day IV have been used off-label.

    1 to 2 months: 1 mg/kg/day PO. Safety and efficacy of IV have not been established; however, doses up to 2 mg/kg/day IV have been used off-label.

  • Neonates

    1 mg/kg/day PO. Safety and efficacy of IV have not been established; however, 0.5 mg/kg/day IV has been used off-label.

Patients with Hepatic Impairment Dosing

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Patients with Renal Impairment Dosing

General Recommendations

Pediatrics

The following has been recommended based on a dose of 0.5 to 1 mg/kg/DAY divided every 12 hours in pediatric patients with normal renal function:

GFR 30 to 50 mL/minute/1.73 m2: 0.5 mg/kg/dose every 24 hours.

GFR 10 to 29 mL/minute/1.73 m2: 0.25 mg/kg/dose every 24 hours.

GFR less than 10 mL/minute/1.73 m2: 0.125 mg/kg/dose every 24 hours.[32569]

 

Intravenous Dosage

Adults

CrCl less than 50 mL/minute: Decrease dose 50% or extend the dosing interval to 36 to 48 hours based on clinical response.[51456]

Pediatrics

The following guidance has been recommended based on a pharmacokinetic study of pediatric patients with stable chronic renal insufficiency (n = 18):

CrCl 50 mL/minute/1.73m2 or more: 0.5 mg/kg/dose (Max: 20 mg) IV every 12 to 24 hours.

CrCl 11 to 49 mL/minute/1.73m2: 0.5 mg/kg/dose (Max: 20 mg) IV every 36 to 48 hours.

CrCl 10 mL/minute/1.73m2 or less: 0.5 mg/kg/dose (Max: 20 mg) IV every 72 to 96 hours or 0.25 mg/kg/dose (Max: 10 mg) IV every 36 to 48 hours.[51466]

 

Oral Dosage

Adults and Pediatric patients weighing 40 kg or more (maximum recommended dosage)

Active duodenal or gastric ulcer:

CrCl 30 to 60 mL/minute: 20 mg PO once daily or 40 mg PO every other day.

CrCl less than 30 mL/minute: 10 mg PO once daily or 20 mg PO every other day.

Symptomatic nonerosive GERD:

CrCl 30 to 60 mL/minute: 20 mg PO once daily.

CrCl less than 30 mL/minute: 10 mg PO once daily or 20 mg PO every other day.

Erosive esophagitis diagnosed by endoscopy:

CrCl 30 to 60 mL/minute: 20 mg PO once daily, 40 mg PO once daily, or 40 mg PO every other day.

CrCl less than 30 mL/minute: 10 mg PO once daily, 20 mg PO once daily, or 20 mg PO every other day.

Risk reduction for duodenal ulcer recurrence:

CrCl 30 to 60 mL/minute: 10 mg PO once daily or 20 mg PO every other day.

CrCl less than 30 mL/minute: 10 mg PO every other day.

Pathological hypersecretory conditions: Avoid use.[44392][51477]

 

Intermittent hemodialysis

Adults

Dose after dialysis.[32569]

Pediatrics

0.125 mg/kg/dose every 24 hours.[32569]

 

Peritoneal dialysis

Adults

Administer 10% of normal dose.[32569]

Pediatrics

0.125 mg/kg/dose every 24 hours.[32569]

 

Continuous renal replacement therapy (CRRT)

Adults

Administer 10% to 50% of normal dose.[32569]

Pediatrics

0.5 mg/kg/dose every 24 hours.[32569]

† Off-label indication
Revision Date: 11/03/2023, 04:59:52 PM

References

24596 - Taha AS, Hudson N, Hawkey CJ, et al. Famotidine for the prevention of gastric and duodenal ulcers caused by nonsteroidal antiinflammatory drugs. N Engl J Med 1996;334:1435-9.25029 - Nagita A, Manago M, Aoki S, et al. Pharmacokinetics and pharmacodynamics of famotidine in children with gastroduodenal ulcers. Ther Drug Monit 1994;16:444-9.25030 - James LP, Kearns GL. Pharmacokinetics and pharmacodynamics of famotidine in paediatric patients. Clin Pharmacokinet 1996;31:103-10.26015 - Baghaie AA, Mojtahedzadeh M, Levine RL, et al. Comparison of the effect of intermittent administration and continuous infusion of famotidine on gastric pH in critically ill patients: results of a prospective, randomized, crossover study. Crit Care Med 1995;23:687-691.26115 - DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190-200.32569 - Aronoff GR, Bennett WM, Berns JS, et al. Drug prescribing in renal failure: dosing guidelines for adults and children, 5th ed. Philadelphia: American College of Physicians; 2007.44392 - Pepcid AC (famotidine tablet) consumer package insert. New Brunswick, NJ: Johnson & Johnson Consumer Companies, Inc.; 2023 March.51456 - Pepcid (famotidine) injection package insert. Whitehouse Station, NJ: Merck & Co., Inc,; 2006 Oct.51466 - Maples HD, James LP, Stowe CD, et al. Famotidine disposition in children and adolescents with chronic renal insufficiency. J Clin Pharmacol 2003;43:7-14.51477 - Famotidine powder for oral suspension prescription package insert. Memphis TN: Northstar Rx LLC; 2021 Jun.51488 - Pepcid AC (famotidine) tablet package insert. Fort Washington, PA: Johnson & Johnson Merck Consumer Pharmaceuticals Co.; 2011 Mar.51490 - Pepcid AC Maximum Strength (famotidine) tablet package insert. Fort Washington, PA: Johnson & Johnson Merck Consumer Pharmaceuticals Co.; 2010 Dec.51494 - Wenning LA, Murphy MG, James LP, et al. Pharmacokinetics of famotidine in infants. Clin Pharmacokinet 2005;44:395-406.51510 - Aanpreung P, Susiva C, Vanprapar N, et al. A randomized clinical trial comparing the efficacy of ranitidine and famotidine on intragastric acidity in critically ill pediatric patients. J Med Assoc Thai 1998;81:185-9.51511 - Behrens R, Hofbeck M, Singer H, et al. Frequency of stress lesions of the upper gastrointestinal tract in paediatric patients after cardiac surgery: effects of prophylaxis. Br Heart J 1994;72:186-9.51981 - Crill CM, Hak EB. Upper gastrointestinal tract bleeding in critically ill pediatric patients. Pharmacotherapy 1999;19(2):162-80.55232 - Lightdale JR, Gremse DA. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics 2013;131:1684-95.60443 - Laine L, Kivitz AJ, Bello AE, et al. Double-blind randomized trials of single-tablet ibuprofen/high-dose famotidine vs. ibuprofen alone for reduction of gastric and duodenal ulcers. Am J Gastroenterol. 2012;107:379-386.60444 - Tuskey A, Peura D. The use of H2 antagonists in treating and preventing NSAID-induced mucosal damage. Arthritis Res Ther. 2013;15 (Suppl 3):S6. Review. Epub 2013 Jul 24.60445 - American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration - Application to healthy patients undergoing elective procedures - an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011;114:495-511.66408 - Dobson G, Chow L, Filteau L, et al. Guidelines to the Practice of Anesthesia - Revised Edition 2021. Can J Anaesth. 2021;68:92-129.67626 - ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm. 1999 Feb 15;56(4):347-79.69080 - McHugh K, Repanshek Z. Anaphylaxis: emergency department treatment. Emerg Med Clin North Am 2022;40:19-32.69771 - Kumpf VJ, Parrish CR. The clinician’s toolkit for the adult short bowel patient part II: pharmacologic interventions. Practical Gastroenterology. 2022;46:12-31.69772 - Iyer K, DiBaise JK, Rubio-Tapia A. AGA clinical practice update on management of short bowel syndrome: expert review. Clin Gastroenterol Hepatol. 2022;20:2185-2194.e2.

How Supplied

Famotidine Chewable tablet

Pepcid AC Chewable Tablet (null) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) (off market)

Famotidine Oral tablet

Acid Controller 10mg Tablet (51660-0035) (OHM Laboratories Inc, a Sun Pharma Company) (off market)

Famotidine Oral tablet

CVS Acid Controller 10mg Tablet (null) (CVS Health) nullCVS Acid Controller 10mg Tablet package photo

Famotidine Oral tablet

CVS Acid Controller 10mg Tablet (null) (CVS Health) (off market)

Famotidine Oral tablet

CVS Acid Controller 10mg Tablet (null) (CVS Health) (off market)

Famotidine Oral tablet

CVS Acid Controller 10mg Tablet (null) (CVS Health) null

Famotidine Oral tablet

CVS Acid Controller 10mg Tablet (59779-0141) (CVS Health) nullCVS Acid Controller 10mg Tablet package photo

Famotidine Oral tablet

CVS Acid Controller 10mg Tablet (59779-0141) (CVS Health) null

Famotidine Oral tablet

CVS Acid Controller 10mg Tablet (69842-0063) (CVS Health) null

Famotidine Oral tablet

Equaline Heartburn Prevention Tablet (41163-0207) (Albertson's, Inc) (off market)

Famotidine Oral tablet

Equate Famotidine 10mg Original Strength Tablet (49035-0118) (Wal-Mart Stores, Inc.) null

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Famotidine 10mg Tablet (58602-0705) (Aurohealth LLC, an Aurobindo Company) null

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Famotidine 10mg Tablet (58602-0705) (Aurohealth LLC, an Aurobindo Company) null

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Famotidine 10mg Tablet (58602-0705) (Aurohealth LLC, an Aurobindo Company) null

Famotidine Oral tablet

Famotidine 10mg Tablet (50268-0302) (AvPAK; a Division of AvKARE Inc) (off market)

Famotidine Oral tablet

Famotidine 10mg Tablet (68001-0494) (BluePoint Laboratories) nullFamotidine 10mg Tablet package photo

Famotidine Oral tablet

Famotidine 10mg Tablet (69230-0326) (Camber Consumer Care, Inc.) null

Famotidine Oral tablet

Famotidine 10mg Tablet (55111-0118) (Dr. Reddy's Laboratories, Inc) null

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Famotidine 10mg Tablet (57896-0767) (Geri-Care Pharmaceuticals) null

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Famotidine 10mg Tablet (00182-2662) (Teva Pharmaceuticals USA) (off market)

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Famotidine Oral tablet

GNP Acid Reducer 10mg Tablet (24385-0255) (AmerisourceBergen Corporation) null

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Heartburn Relief 10mg Tablet (00904-5529) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

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Leader Acid Reducer 10mg Tablet (37205-0614) (Cardinal Health, Inc.) (off market)

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Leader Acid Reducer 10mg Tablet (70000-0048) (Cardinal Health, Inc.) null

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Pepcid AC 10mg Gelcap (null) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) (off market)

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Pepcid AC 10mg Tablet (16837-0872) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) null

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Pepcid AC 10mg Tablet (null) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) null

Famotidine Oral tablet

Premier Value Acid Controller 10mg Tablet (68016-0010) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

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Premier Value Acid Controller 10mg Tablet (68016-0010) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

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Publix Acid Reducer 10mg Tablet (56062-0141) (Publix Super Markets, Inc) null

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Sunmark Acid Reducer 10mg Tablet (49348-0442) (McKesson Corporation) null

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Today's Health Famotidine 10mg Tablet (null) (Today's Health, Inc.) null

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Top Care Acid Reducer 10mg Tablet (36800-0141) (Topco Associates LLC) null

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Walgreens Acid Controller 10mg Tablet (00363-0141) (Walgreens Co) nullWalgreens Acid Controller 10mg Tablet package photo

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Zantac 360 10mg Tablet (41167-0360) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

Famotidine Oral tablet

Acid Controller Maximum Strength 20mg Tablet (51660-0036) (OHM Laboratories Inc, a Sun Pharma Company) (off market)

Famotidine Oral tablet

CVS Acid Controller Maximum Strength 20mg Tablet (55111-0396) (CVS Health) (off market)CVS Acid Controller Maximum Strength 20mg Tablet package photo

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CVS Acid Controller Maximum Strength 20mg Tablet (null) (CVS Health) (off market)

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CVS Acid Controller Maximum Strength 20mg Tablet (null) (CVS Health) (off market)

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CVS Acid Controller Maximum Strength 20mg Tablet (null) (CVS Health) (off market)

Famotidine Oral tablet

CVS Acid Controller Maximum Strength 20mg Tablet (null) (CVS Health) null

Famotidine Oral tablet

CVS Acid Controller Maximum Strength 20mg Tablet (59779-0194) (CVS Health) null

Famotidine Oral tablet

CVS Acid Controller Maximum Strength 20mg Tablet (59779-0194) (CVS Health) null

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CVS Acid Controller Maximum Strength 20mg Tablet (null) (CVS Health) (off market)

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CVS Acid Controller Maximum Strength 20mg Tablet (59779-0194) (CVS Health) null

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Equate Famotidine Maximum Strength 20mg Tablet (49035-0650) (Wal-Mart Stores, Inc.) null

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Famotidine 20mg Maximum Strength Tablet (69230-0327) (Camber Consumer Care, Inc.) null

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Famotidine 20mg Maximum Strength Tablet (57896-0769) (Geri-Care Pharmaceuticals) null

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Famotidine 20mg Maximum Strength Tablet (00536-1298) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

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Famotidine 20mg Tablet (62332-0001) (Alembic Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (68084-0172) (American Health Packaging) (off market)

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Famotidine 20mg Tablet (60687-0595) (American Health Packaging) null

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Famotidine 20mg Tablet (65862-0859) (Aurobindo Pharma USA Inc.) null

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Famotidine 20mg Tablet (58602-0706) (Aurohealth LLC, an Aurobindo Company) null

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Famotidine 20mg Tablet (42291-0281) (AvKARE, Inc.) null

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Famotidine 20mg Tablet (50268-0303) (AvPAK; a Division of AvKARE Inc) null

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Famotidine 20mg Tablet (50268-0299) (AvPAK; a Division of AvKARE Inc) nullFamotidine 20mg Tablet package photo

Famotidine Oral tablet

Famotidine 20mg Tablet (68001-0240) (BluePoint Laboratories) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (68001-0397) (BluePoint Laboratories) null

Famotidine Oral tablet

Famotidine 20mg Tablet (31722-0017) (Camber Pharmaceuticals Inc) nullFamotidine 20mg Tablet package photo

Famotidine Oral tablet

Famotidine 20mg Tablet (61442-0121) (Carlsbad Technology Inc) null

Famotidine Oral tablet

Famotidine 20mg Tablet (72606-0509) (Celltrion USA, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (62135-0807) (Chartwell RX LLC) null

Famotidine Oral tablet

Famotidine 20mg Tablet (55111-0396) (Dr. Reddy's Laboratories, Inc) null

Famotidine Oral tablet

Famotidine 20mg Tablet (55111-0119) (Dr. Reddy's Laboratories, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (51407-0683) (Golden State Medical Supply, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (68645-0140) (Legacy Pharmaceutical Packaging, LLC) null

Famotidine Oral tablet

Famotidine 20mg Tablet (68645-0594) (Legacy Pharmaceutical Packaging, LLC) null

Famotidine Oral tablet

Famotidine 20mg Tablet (70756-0051) (Lifestar Pharma, LLC.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (00904-5553) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (00904-7193) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) nullFamotidine 20mg Tablet package photo

Famotidine Oral tablet

Famotidine 20mg Tablet (63739-0645) (McKesson Packaging) null

Famotidine Oral tablet

Famotidine 20mg Tablet (63739-0325) (McKesson Packaging Inc) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (63739-0484) (McKesson Packaging Inc) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (51079-0966) (Mylan Institutional LLC) null

Famotidine Oral tablet

Famotidine 20mg Tablet (00378-3020) (Mylan Pharmaceuticals Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (16714-0361) (NorthStar Rx LLC) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (66267-0543) (NuCare Pharmaceuticals Inc) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (49884-0608) (Par Pharmaceuticals, an Endo Company) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (43063-0086) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (55289-0765) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (55289-0765) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (43063-0695) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (43063-0695) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (72789-0027) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 20mg Tablet (72789-0331) (PD-Rx Pharmaceuticals, Inc.) nullFamotidine 20mg Tablet package photo

Famotidine Oral tablet

Famotidine 20mg Tablet (00781-1736) (Sandoz Inc. a Novartis Company) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (00172-5728) (Teva Pharmaceuticals USA) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (00093-0896) (Teva Pharmaceuticals USA) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (00172-5728) (Teva Pharmaceuticals USA) nullFamotidine 20mg Tablet package photo

Famotidine Oral tablet

Famotidine 20mg Tablet (00591-3123) (Teva/Actavis US) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (62037-0955) (Teva/Actavis US) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (00228-2679) (Teva/Actavis US) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (62037-0955) (Teva/Actavis US) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (64679-0936) (Wockhardt USA, LLC) (off market)

Famotidine Oral tablet

Famotidine 20mg Tablet (72865-0214) (XL Care Pharmaceuticals, Inc) null

Famotidine Oral tablet

Famotidine 20mg Tablet (70710-1683) (Zydus Pharmaceuticals (USA) Inc.) nullFamotidine 20mg Tablet package photo

Famotidine Oral tablet

Foster & Thrive Acid Reducer Maximum Strength 20mg Tablet (70677-1101) (McKesson Corporation) nullFoster & Thrive Acid Reducer Maximum Strength 20mg Tablet package photo

Famotidine Oral tablet

GNP Acid Reducer 20mg Maximum Strength Tablet (46122-0737) (AmerisourceBergen Corporation) null

Famotidine Oral tablet

GNP Acid Reducer Maximum Strength 20mg Tablet (24385-0385) (AmerisourceBergen Corporation) nullGNP Acid Reducer Maximum Strength 20mg Tablet package photo

Famotidine Oral tablet

GNP Acid Reducer Maximum Strength 20mg Tablet (46122-0168) (AmerisourceBergen Corporation) null

Famotidine Oral tablet

GNP Acid Reducer Maximum Strength 20mg Tablet (24385-0385) (AmerisourceBergen Corporation) null

Famotidine Oral tablet

GoodSense Acid Reducer Maximum Strength 20mg Tablet (00113-0194) (Goodsense a Division of Perrigo) null

Famotidine Oral tablet

Health Mart Famotidine Maximum Strength 20mg Tablet (62011-0143) (McKesson Corporation) (off market)

Famotidine Oral tablet

Heartburn Relief 20mg Tablet (00904-5780) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Famotidine Oral tablet

Kirkland Acid Controller Maximum Strength 20mg Tablet (63981-0194) (Costco Wholesale Corporation) null

Famotidine Oral tablet

Leader Acid Reducer 20mg Maximum Strength Tablet (70000-0049) (Cardinal Health, Inc.) null

Famotidine Oral tablet

Leader Acid Reducer Maximum Strength 20mg Tablet (37205-0861) (Cardinal Health, Inc.) null

Famotidine Oral tablet

Leader Acid Reducer Maximum Strength 20mg Tablet (70000-0503) (Cardinal Health, Inc.) (off market)

Famotidine Oral tablet

Member's Mark Acid-Pep Maximum Strength 20mg Tablet (68196-0121) (Sam's Club West) null

Famotidine Oral tablet

Pepcid 20mg Tablet (42998-0973) (Bausch Health US, LLC) (off market)

Famotidine Oral tablet

Pepcid 20mg Tablet (00187-4420) (Bausch Health US, LLC) null

Famotidine Oral tablet

Pepcid 20mg Tablet (00006-0963) (Marathon Pharmaceuticals LLC) (off market)

Famotidine Oral tablet

Pepcid 20mg Tablet (42998-0963) (Marathon Pharmaceuticals LLC) (off market)

Famotidine Oral tablet

Pepcid 20mg Tablet (42998-0973) (Marathon Pharmaceuticals LLC) (off market)

Famotidine Oral tablet

Pepcid 20mg Tablet (00006-0963) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

Famotidine Oral tablet

Pepcid 20mg Tablet (55289-0473) (PD-Rx Pharmaceuticals, Inc.) (off market)

Famotidine Oral tablet

Pepcid 20mg Tablet (60346-0355) (Quality Care Pharmaceuticals Inc Dba Qcp Inc) null

Famotidine Oral tablet

Pepcid AC Maximum Strength 20mg Tablet (16837-0855) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) null

Famotidine Oral tablet

Pepcid AC Maximum Strength 20mg Tablet (null) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) null

Famotidine Oral tablet

Pepcid AC Maximum Strength 20mg Tablet (null) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) null

Famotidine Oral tablet

Pepcid AC Maximum Strength 20mg Tablet (null) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) (off market)

Famotidine Oral tablet

Pepcid AC Maximum Strength 20mg Tablet (null) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) (off market)

Famotidine Oral tablet

Pepcid AC Maximum Strength 20mg Tablet (null) (Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division) (off market)

Famotidine Oral tablet

Premier Value Acid Controller 20mg Tablet (null) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Famotidine Oral tablet

Publix Acid Reducer Maximum Strength 20mg Tablet (56062-0194) (Publix Super Markets, Inc) null

Famotidine Oral tablet

Quality Choice Acid Controller Maximum Strength 20mg Tablet (63868-0486) (Chain Drug Marketing Association) (off market)

Famotidine Oral tablet

Quality Choice Famotidine Maximum Strength 20mg Tablet (63868-0319) (Chain Drug Marketing Association) nullQuality Choice Famotidine Maximum Strength 20mg Tablet package photo

Famotidine Oral tablet

Quality Choice Famotidine Maximum Strength 20mg Tablet (63868-0584) (Chain Drug Marketing Association) null

Famotidine Oral tablet

RITE AID Acid Reducer Maximum Strength 20mg Tablet (null) (Rite Aid Corp) null

Famotidine Oral tablet

RITE AID Acid Reducer Maximum Strength 20mg Tablet (null) (Rite Aid Corp) nullRITE AID Acid Reducer Maximum Strength 20mg Tablet package photo

Famotidine Oral tablet

RITE AID Acid Reducer Maximum Strength 20mg Tablet (null) (Rite Aid Corp) nullRITE AID Acid Reducer Maximum Strength 20mg Tablet package photo

Famotidine Oral tablet

Sunmark Acid Reducer Maximum Strength 20mg Tablet (49348-0817) (McKesson Corporation) null

Famotidine Oral tablet

Sunmark Acid Reducer Maximum Strength 20mg Tablet (49348-0817) (McKesson Corporation) null

Famotidine Oral tablet

Top Care Acid Reducer Maximum Strength 20mg Tablet (36800-0194) (Topco Associates LLC) null

Famotidine Oral tablet

Walgreens Acid Controller 20mg Tablet (null) (Walgreens Co) nullWalgreens Acid Controller 20mg Tablet package photo

Famotidine Oral tablet

Walgreens Acid Controller Maximum Strength 20mg Tablet (00363-0701) (Walgreens Co) nullWalgreens Acid Controller Maximum Strength 20mg Tablet package photo

Famotidine Oral tablet

Walgreens Acid Controller Maxium Strength 20mg Tablet (00363-0194) (Walgreens Co) null

Famotidine Oral tablet

Zantac 360 20mg Tablet (41167-0361) (Chattem, Inc. is a wholly-owned subsidiary of Sanofi-Aventis ) null

Famotidine Oral tablet

Famotidine 40mg Tablet (62332-0002) (Alembic Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (67877-0843) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)Famotidine 40mg Tablet package photo

Famotidine Oral tablet

Famotidine 40mg Tablet (67877-0889) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) nullFamotidine 40mg Tablet package photo

Famotidine Oral tablet

Famotidine 40mg Tablet (65862-0860) (Aurobindo Pharma USA Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (42291-0282) (AvKARE, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (50268-0304) (AvPAK; a Division of AvKARE Inc) null

Famotidine Oral tablet

Famotidine 40mg Tablet (68001-0241) (BluePoint Laboratories) null

Famotidine Oral tablet

Famotidine 40mg Tablet (68001-0398) (BluePoint Laboratories) null

Famotidine Oral tablet

Famotidine 40mg Tablet (31722-0018) (Camber Pharmaceuticals Inc) nullFamotidine 40mg Tablet package photo

Famotidine Oral tablet

Famotidine 40mg Tablet (61442-0122) (Carlsbad Technology Inc) null

Famotidine Oral tablet

Famotidine 40mg Tablet (72606-0510) (Celltrion USA, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (62135-0808) (Chartwell RX LLC) null

Famotidine Oral tablet

Famotidine 40mg Tablet (55111-0120) (Dr. Reddy's Laboratories, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (60429-0721) (Golden State Medical Supply, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (51407-0684) (Golden State Medical Supply, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (68645-0141) (Legacy Pharmaceutical Packaging, LLC) null

Famotidine Oral tablet

Famotidine 40mg Tablet (70756-0052) (Lifestar Pharma, LLC.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (00904-5554) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (00378-3040) (Mylan Pharmaceuticals Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (16714-0362) (NorthStar Rx LLC) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (49884-0609) (Par Pharmaceuticals, an Endo Company) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (43063-0533) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (43063-0696) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (43063-0696) (PD-Rx Pharmaceuticals, Inc.) null

Famotidine Oral tablet

Famotidine 40mg Tablet (72789-0345) (PD-Rx Pharmaceuticals, Inc.) nullFamotidine 40mg Tablet package photo

Famotidine Oral tablet

Famotidine 40mg Tablet (00781-1746) (Sandoz Inc. a Novartis Company) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (00172-5729) (Teva Pharmaceuticals USA) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (00093-0897) (Teva Pharmaceuticals USA) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (00172-5729) (Teva Pharmaceuticals USA) nullFamotidine 40mg Tablet package photo

Famotidine Oral tablet

Famotidine 40mg Tablet (00591-3124) (Teva/Actavis US) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (62037-0956) (Teva/Actavis US) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (62037-0956) (Teva/Actavis US) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (64679-0937) (Wockhardt USA, LLC) (off market)

Famotidine Oral tablet

Famotidine 40mg Tablet (72865-0215) (XL Care Pharmaceuticals, Inc) null

Famotidine Oral tablet

Famotidine 40mg Tablet (70710-1684) (Zydus Pharmaceuticals (USA) Inc.) nullFamotidine 40mg Tablet package photo

Famotidine Oral tablet

Pepcid 40mg Tablet (42998-0974) (Bausch Health US, LLC) (off market)

Famotidine Oral tablet

Pepcid 40mg Tablet (00187-4440) (Bausch Health US, LLC) null

Famotidine Oral tablet

Pepcid 40mg Tablet (00006-0964) (Marathon Pharmaceuticals LLC) (off market)

Famotidine Oral tablet

Pepcid 40mg Tablet (42998-0964) (Marathon Pharmaceuticals LLC) (off market)

Famotidine Oral tablet

Pepcid 40mg Tablet (42998-0974) (Marathon Pharmaceuticals LLC) (off market)

Famotidine Oral tablet

Pepcid 40mg Tablet (00006-0964) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

Famotidine Oral tablet

Pepcid 40mg Tablet (55289-0146) (PD-Rx Pharmaceuticals, Inc.) (off market)

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (27241-0249) (Ajanta Pharma USA Inc) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (69238-2090) (Amneal Pharmaceuticals LLC) null

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (67877-0775) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (70377-0113) (Biocon Pharma Inc.) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (31722-0063) (Camber Pharmaceuticals Inc) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (43386-0500) (Gavis Pharmaceuticals, LLC, wholly owned subsidiary of Lupin) null

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (51407-0452) (Golden State Medical Supply, Inc.) null

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (68180-0150) (Lupin Pharmaceuticals, Inc.) (off market)Famotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (68180-0150) (Lupin Pharmaceuticals, Inc.) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (16714-0244) (NorthStar Rx LLC) null

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (72603-0171) (NorthStar Rx LLC) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (70954-0316) (Novitium Pharma, LLC ) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (00574-0147) (Paddock Laboratories Inc, a Perrigo Family) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (00832-6045) (Upsher-Smith Laboratories, LLC) nullFamotidine 40mg/5mL Powder for Suspension package photo

Famotidine Powder for oral suspension

Famotidine 40mg/5mL Powder for Suspension (68382-0444) (Zydus Pharmaceuticals (USA) Inc.) null

Famotidine Powder for oral suspension

Pepcid 40mg/5ml Powder for Suspension (00006-3538) (Bausch Health US, LLC) (off market)

Famotidine Powder for oral suspension

Pepcid 40mg/5ml Powder for Suspension (65649-0211) (Bausch Health US, LLC) (off market)Pepcid 40mg/5ml Powder for Suspension package photo

Famotidine Powder for oral suspension

Pepcid 40mg/5ml Powder for Suspension (00006-3538) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)Pepcid 40mg/5ml Powder for Suspension package photo

Famotidine Solution for injection

Pepcid 20mg/50ml Premixed Solution for Injection (00338-3423) (Baxter Medication Delivery) (off market)

Famotidine Solution for injection

Pepcid 20mg/50ml Premixed Solution for Injection (00006-3537) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (10019-0045) (Baxter Anesthesia/Critical Care) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (10019-0046) (Baxter Anesthesia/Critical Care) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (55390-0029) (Bedford Laboratories, a Hikma Company) (off market)Famotidine 10mg/ml Solution for Injection package photo

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (55390-0028) (Bedford Laboratories, a Hikma Company) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (55390-0027) (Bedford Laboratories, a Hikma Company) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (55390-0026) (Bedford Laboratories, a Hikma Company) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (63323-0738) (Fresenius Kabi AG) null

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (10019-0046) (Hikma Pharmaceuticals USA inc.) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (10019-0045) (Hikma Pharmaceuticals USA inc.) null

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (00074-2362) (Hospira Worldwide, Inc., a Pfizer Company) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (61703-0238) (Hospira Worldwide, Inc., a Pfizer Company) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (61703-0239) (Hospira Worldwide, Inc., a Pfizer Company) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (NOVAPLUS) (10019-0047) (Baxter Anesthesia/Critical Care) (off market)

Famotidine Solution for injection

Famotidine 10mg/ml Solution for Injection (NOVAPLUS) (10019-0048) (Baxter Anesthesia/Critical Care) (off market)

Famotidine Solution for injection

Famotidine 200mg/20ml Solution for Injection (70860-0753) (Athenex Pharmaceutical Division LLC) null

Famotidine Solution for injection

Famotidine 200mg/20ml Solution for Injection (00069-0126) (Mylan Institutional LLC) (off market)

Famotidine Solution for injection

Famotidine 200mg/20ml Solution for Injection (67457-0457) (Mylan Institutional LLC ) null

Famotidine Solution for injection

Famotidine 200mg/20ml Solution for Injection (00069-0126) (Pfizer Injectables) (off market)

Famotidine Solution for injection

Famotidine 200mg/20mLSolution for Injection (00641-6021) (Hikma Pharmaceuticals USA Inc.) null

Famotidine Solution for injection

Famotidine 20mg/2ml Solution for Injection (70860-0751) (Athenex Pharmaceutical Division LLC) null

Famotidine Solution for injection

Famotidine 20mg/2ml Solution for Injection (63323-0739) (Fresenius Kabi AG) null

Famotidine Solution for injection

Famotidine 20mg/2ml Solution for Injection (00641-6022) (Hikma Pharmaceuticals USA Inc.) null

Famotidine Solution for injection

Famotidine 20mg/2ml Solution for Injection (00069-0121) (Mylan Institutional LLC) (off market)

Famotidine Solution for injection

Famotidine 20mg/2ml Solution for Injection (67457-0433) (Mylan Institutional LLC ) null

Famotidine Solution for injection

Famotidine 20mg/2ml Solution for Injection (00069-0121) (Pfizer Injectables) (off market)

Famotidine Solution for injection

Famotidine 20mg/2mL Solution for Injection (PREMIER ProRx) (63323-0739) (Fresenius Kabi AG) null

Famotidine Solution for injection

Famotidine 40mg/4ml Solution for Injection (00069-0125) (Mylan Institutional LLC) (off market)

Famotidine Solution for injection

Famotidine 40mg/4ml Solution for Injection (67457-0448) (Mylan Institutional LLC ) null

Famotidine Solution for injection

Famotidine 40mg/4ml Solution for Injection (00069-0125) (Pfizer Injectables) (off market)

Famotidine Solution for injection

Famotidine 40mg/4mL Solution for Injection (63323-0738) (Fresenius Kabi AG) null

Famotidine Solution for injection

Famotidine 40mg/4mL Solution for Injection (00641-6023) (Hikma Pharmaceuticals USA Inc.) null

Famotidine Solution for injection

Pepcid 10mg/ml Solution for Injection (00006-3539) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

Famotidine Solution for injection

Pepcid 10mg/ml Solution for Injection (00006-3541) (Merck Sharp & Dohme Corp., a Subsidiary of Merck & Co., Inc.) (off market)

Famotidine Solution for injection

Famotidine 20mg/50ml Solution for Injection (00338-5197) (Baxter Medication Delivery) null

Description/Classification

Description

Famotidine is an oral and parenteral histamine type 2-receptor antagonist (H2RA) used in the treatment of gastrointestinal disorders such as peptic ulcer and gastroesophageal reflux disease (GERD). The actions and indications of famotidine differ little from the other agents in the same class, except that famotidine is less likely than cimetidine to interact with other drugs.[44392] Over-the-counter oral formulations are available for the prophylaxis and treatment of heartburn and acid indigestion in adolescent and adult patients. H2RAs are often used for stress ulcer prophylaxis in critically ill patients; however, evidence for benefit is lacking, and use may increase the risk of adverse reactions such as pneumonia and Clostridioides difficile infection.[64985][65013] Reserve stress ulcer prophylaxis for patients with risk factors for clinically significant gastrointestinal bleeding (e.g., multiple organ dysfunction, prolonged mechanical ventilation, coagulopathy, persistent shock, concomitant corticosteroid therapy).[61770][64985]

NOTE: Some famotidine 10 mg and 20 mg tablets are marketed as Zantac 360, which may create confusion since the brand name was previously associated with a ranitidine product.[66660]

Classifications

  • Alimentary Tract and Metabolism
    • Gastric Acid-Related Disorder Agents
      • Peptic Ulcer and Gastro-Esophageal Reflux Disease/GERD Agents
        • H2 Antagonists
Revision Date: 05/11/2021, 03:18:37 PM

References

44392 - Pepcid AC (famotidine tablet) consumer package insert. New Brunswick, NJ: Johnson & Johnson Consumer Companies, Inc.; 2023 March.61770 - Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017;45:486-552.64985 - Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020;21:e52-e106.65013 - Duffet M, Chan A, Closs J, et al. Stress ulcer prophylaxis in critically ill children: a multicenter observational study. Pediatr Crit Care Med 2020;21:e107-e113.66660 - Institute for Safe Medication Practices (ISMP). Acute Care ISMP Medication Safety Alert 2021;26 (9):2-3.

Administration Information

General Administration Information

For storage information, see the specific product information within the How Supplied section.

Route-Specific Administration

Oral Administration

  • May be administered without regard to meals.[44392]

Oral Solid Formulations

  • Tablets: May administer with food, water, or milk to minimize gastric irritation.[44392]
  • Orally disintegrating tablets: No water is needed for administration. Instruct patients to open the tablet blister pack with dry hands, place the tablet on the tongue, allow to disintegrate, then swallow with saliva.[51476]

Oral Liquid Formulations

Oral suspension

  • Reconstitute by slowly adding 46 mL of purified water. Shake vigorously for 5 to 10 seconds after adding water.
  • After reconstitution, each 5 mL contains 40 mg of famotidine.
  • Shake suspension well before each use. Measure dosage with a calibrated device for accuracy.
  • Storage of reconstituted suspension: Store at room temperature for up to 30 days.[51477]

Injectable Administration

  • Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.[51456]
  • Updates for coronavirus disease 2019 (COVID-19): The FDA is allowing famotidine 10 mg/mL to be used beyond the labeled in-use time to help ensure access during COVID-related drug shortages. This period should be as short as possible, and for a maximum of 2 hours at room temperature or 4 hours when refrigerated. In-use time is defined as the maximum amount of time allowed to elapse between penetration of a closed-container system or after reconstitution of a lyophilized drug before patient administration.[65833]

Intravenous Administration

Intermittent IV Injection

  • Dilute 20 mg of famotidine injection to a total of 5 or 10 mL with 0.9% Sodium Chloride Injection or other compatible solution to give concentrations of 4 or 2 mg/mL, respectively.
  • Inject appropriate dose over 2 minutes or more and at a rate of 10 mg/minute or less.[51456]

 

Intermittent IV Infusion (vials)

  • Dilute 20 mg of famotidine in 100 mL of 5% Dextrose Injection or 0.9% Sodium Chloride Injection or other compatible IV solution to give a final concentration of 0.2 mg/mL.
  • Infuse over 15 to 30 minutes.
  • Storage: If not used immediately, store diluted solutions under refrigeration and use within 48 hours of preparation. Although when diluted in common compatible solutions (e.g., 0.9% Sodium Chloride Injection, 5% Dextrose Injection, Lactated Ringer's Injection), famotidine is stable for 7 days at room temperature, there are no data available to confirm sterility under these conditions.[51456]

 

Intermittent IV Infusion (Galaxy containers)

  • The premixed infusion container contains famotidine 20 mg per 50 mL 0.9% Sodium Chloride Injection.
  • Check the container for leaks before use by squeezing the bag firmly. If leaks are found, discard solution as sterility may be impaired.
  • Do not add supplementary medication.
  • Do not use unless solution is clear, and the seal is intact.
  • Do not use plastic containers in series connections. Such use could result in air embolism due to residual air being drawn from the primary container before administration of the fluid from the secondary container is complete.
  • Suspend container from eyelet support.
  • Remove plastic protector from outlet port at bottom of container.
  • Attach administration set. Refer to complete directions accompanying set.
  • Infuse over 15 to 30 minutes.[51456]

 

Continuous IV Infusion

  • For adults, dilute 40 mg of famotidine in 250 mL of 5% Dextrose Injection or 0.9% Sodium Chloride Injection or other compatible solution. Infuse over 24 hours at a rate of 11 mL/hour or as specified by a physician.
  • Use a controlled-rate infusion device.
  • Storage: The diluted solution is stable for up to 48 hours at room temperature.
  • Alternatively, the dosage may be added to a compatible TPN solution for administration over 24 hours.[51493]

Clinical Pharmaceutics Information

From Trissel's 2‚Ñ¢ Clinical Pharmaceutics Database

Famotidine

pH Range
pH 5 to 5.6 (injection) pH 5.7 to 6.4 (premixed infusion)
ReferencesAnon. Manufacturer's information and labeling. (Package insert).
Sodium Content
Famotidine premixed infusion solution provides 0.156 mEq of sodium per milliliter.
ReferencesMcEvoy GK (ed). AHFS Drug Information (current edition). Bethesda, MD: American Society of Health-System Pharmacists.
Osmolality/Osmolarity
Famotidine injection in the single-dose formulation is mildly hypotonic having an osmolarity of 217 mOsm/L. Famotidine injection in the multiple-dose formulation with benzyl alcohol is isotonic having an osmolarity of 290 mOsm/L.
ReferencesMcEvoy GK (ed). AHFS Drug Information (current edition). Bethesda, MD: American Society of Health-System Pharmacists.
Stability
Refrigeration of famotidine injection vials is recommended for long-term storage. However, the manufacturer indicates the drug may be stored for up to 3 months at controlled room temperature. Ross reported that the vials may be stored even longer, for up to 26 weeks at controlled room temperature not exceeding 25 degree C. Infusion Solutions: The manufacturer indicates that famotidine is compatible and stable for 7 days at room temperature and refrigerated in common infusion solutions including the following: Dextrose 5% and 10% Lactated Ringer's injection Sodium chloride 0.9% The manufacturer also indicates that famotidine at a concentration of 0.2 mg/mL is compatible and stable for 7 days at room temperature in sodium bicarbonate 5%. However, at higher concentrations precipitation may occur. Keyi et al. reported that Merck famotidine 0.2 mg/mL in dextrose 5% and in sodium chloride 0.9% packaged in Becton Dickinson polyvinyl chloride (PVC) bags was compatible and stable for 15 days at room temperature both exposed to and protected from light. HPLC analysis found the famotidine concentrations remained within 95% of the initial values. Packaging in Syringes: Bullock et al. reported that Merck famotidine 2 mg/mL in dextrose 5%, sodium chloride 0.9%, or sterile water for injection and packaged in Becton Dickinson plastic syringes was stable with HPLC analysis finding no drug loss in 14 days under refrigeration. Keyi et al. reported that Merck famotidine 0.2 mg/mL in dextrose 5% and in sodium chloride 0.9% packaged in Becton Dickinson polypropylene syringes was compatible and stable for 15 days at room temperature both exposed to and protected from light. HPLC analysis found the famotidine concentrations remained within 95% of the initial values. Shea and Souney reported that Merck famotidine 2 mg/mL in dextrose 5%, sodium chloride 0.9%, or sterile water for injection in Becton Dickinson plastic syringes -20 degree C was stable with HPLC analysis finding about 5 to 8% loss in 8 weeks. Kaushal et al. evaluated the stability of Baxter famotidine 2 mg/mL diluted with sterile water for injection and packaged in 12-mL polypropylene syringes sealed with sterile tip caps. Samples were stored for 30 days at room temperature of 23 to 25 degree C exposed to fluorescent light, refrigerated at 2 to 6 degree C protected from exposure to light, and frozen at -20 degree C protected from exposure to light. No visible haze, precipitation, or color change was observed. The pH remained stable at all temperatures. No significant increase in absorbance at 600 nm was found. Stability-indicating HPLC analysis found little change in famotidine concentration at room temperature and frozen at -20 degree C in 30 days. The refrigerated samples exhibited no loss at the 22-day time point. However, one of the refrigerated samples was found to be at 85% in 30 days while the other 2 samples were above 90%. The authors offered no explanation for the anomalous result, which is inconsistent with other studies.
ReferencesAnon. Manufacturer's information and labeling. (Package insert).
ReferencesBullock LS, Fitzgerald JF, Mazur HI. Stability of intravenous famotidine stored in polyvinyl chloride syringes. DICP Ann Pharmacother. 1989; 23
ReferencesCohen V, Jellinek SP, Teperikidis L, et al. Room-temperature storage of medications labeled for refrigeration. Am J Health-Syst Pharm. 2007; 64
ReferencesKaushal G, Woldemariam M, Sayre BE, et al. Stability of famotidine in polypropylene syringes using a stability-indicating HPLC assay. J Liq Chromatog Rel Tech. 2011; 34
ReferencesKeyi X, Gagnon N, Bisson C, et al. Stability of famotidine in polyvinyl chloride minibags and polypropylene syringes and compatibility of famotidine with selected drugs. Ann Pharmacother. 1993; 27
ReferencesRoss MB. Additional stability guidelines for routinely refrigerated drug products. Am J Hosp Pharm. 1988; 45
ReferencesShea PF, Souney PF. Stability of famotidine frozen in polypropylene syringes. Am J Hosp Pharm. 1990; 47
pH Effects
Famotidine in aqueous buffer solutions exhibited identical stability at pH 4 and pH 6 with essentially no loss over the 7-day study period. However, at pH 2 extensive and rapid loss of the drug occurred with over 60% loss in 24 hours. Famotidine reportedly exhibits maximum stability at pH 5 to 6.3.
ReferencesIslam MS, Narurkar MM et al. Solubility, stability and ionization behavior of famotidine. J Pharm Pharmacol. 1993; 45
ReferencesKirilmaz L, Ercakir K, Ekiz-Gucer N, et al. The stability of famotidine hydrochloride solutions at different pH values. Pharm Acta Helv. 1992; 67
ReferencesWu Y, Fassihi R. Stability of metronidazole, tetracycline HCl, and famotidine alone and in combination. Int J Pharm. 2005; 290
Light Exposure
Famotidine does not exhibit substantial photo-instability. Stability studies have reported no drug stability differences whether exposed to or protected from light.
ReferencesKaushal G, Woldemariam M, Sayre BE, et al. Stability of famotidine in polypropylene syringes using a stability-indicating HPLC assay. J Liq Chromatog Rel Tech. 2011; 34
ReferencesKeyi X, Gagnon N, Bisson C, et al. Stability of famotidine in polyvinyl chloride minibags and polypropylene syringes and compatibility of famotidine with selected drugs. Ann Pharmacother. 1993; 27
ReferencesUnderberg WJM, Koomen JM, Beijnen JH. Stability of famotidine in commonly used nutritional infusion fluids. J Parenter Sci Tech. 1988; 42
Freezing
The manufacturer recommends that famotidine injection be protected from freezing during storage. If the vials are inadvertently frozen, the manufacturer recommends thawing at room temperature and insuring that the solution is entirely thawed. The use of a microwave oven is not recommended because of the possibility of a hazardous build up of pressure in the vials. Bullock et al. reported that Merck famotidine 0.2 mg/ml in dextrose 5% and in sodium chloride 0.9% in polyvinyl chloride (PVC) bags frozen at -20 degree C was stable with HPLC analysis finding no drug loss after 28 days frozen followed by 14 days under refrigeration. Shea and Souney reported that Merck famotidine 2 mg/mL in dextrose 5%, sodium chloride 0.9%, or sterile water for injection in Becton Dickinson plastic syringes frozen at -20 degree C was stable with HPLC analysis finding about 5 to 8% loss in 8 weeks. Kaushal et al. evaluated the stability of Baxter famotidine 2 mg/mL diluted with sterile water for injection and packaged in 12-mL polypropylene syringes sealed with sterile tip caps. Samples were stored for 30 days frozen at -20 degree C protected from exposure to light. No visible haze, precipitation, or color change was observed. The pH remained stable at all temperatures. No significant increase in absorbance at 600 nm was found. Stability-indicating HPLC analysis found little change in famotidine concentration.
ReferencesAnon. Manufacturer's information and labeling. (Package insert).
ReferencesBullock LS, Fitzgerald JF, Glick MR. Stability of famotidine in minibags refrigerated and/or frozen. DICP Ann Pharmacother. 1989; 23
ReferencesKaushal G, Woldemariam M, Sayre BE, et al. Stability of famotidine in polypropylene syringes using a stability-indicating HPLC assay. J Liq Chromatog Rel Tech. 2011; 34
ReferencesShea PF, Souney PF. Stability of famotidine frozen in polypropylene syringes. Am J Hosp Pharm. 1990; 47
Sorption Leaching
Famotidine has not been found to undergo substantial sorption to polyvinyl chloride (PVC), polypropylene (in syringes), or glass containers. In addition, Xu et al. reported no sorption occurred to a polyurethane central catheter from Arrow International as well as no leaching of the chlorhexidine antimicrobial in it.
ReferencesBullock LS, Fitzgerald JF, Glick MR. Stability of famotidine in minibags refrigerated and/or frozen. DICP Ann Pharmacother. 1989; 23
ReferencesBullock LS, Fitzgerald JF, Mazur HI. Stability of intravenous famotidine stored in polyvinyl chloride syringes. DICP Ann Pharmacother. 1989; 23
ReferencesGupta VD, Parasrampuria J, Bethea C. Chemical stabilities of famotidine and ranitidine hydrochloride in intravenous admixtures. J Clin Pharm Ther. 1988; 13
ReferencesKaushal G, Woldemariam M, Sayre BE, et al. Stability of famotidine in polypropylene syringes using a stability-indicating HPLC assay. J Liq Chromatog Rel Tech. 2011; 34
ReferencesKeyi X, Gagnon N, Bisson C, et al. Stability of famotidine in polyvinyl chloride minibags and polypropylene syringes and compatibility of famotidine with selected drugs. Ann Pharmacother. 1993; 27
ReferencesShea PF, Souney PF. Stability of famotidine frozen in polypropylene syringes. Am J Hosp Pharm. 1990; 47
ReferencesUnderberg WJM, Koomen JM, Beijnen JH. Stability of famotidine in commonly used nutritional infusion fluids. J Parenter Sci Tech. 1988; 42
ReferencesXu QA, Zhang Y, Trissel LA, et al. Adequacy of a new chlorhexidine-bearing polyurethane central catheter for administration of 82 selected parenteral drugs. Ann Pharmacother. 2000; 34
Other Information
Multiple Drugs: Nassr et al. reported the stability of a six-drug combination consisting of morphine sulfate (Sabex) 10 mg/mL, octreotide acetate (Sandoz) 0.01 mg/mL, haloperidol lactate (Sabex) 0.5 mg/mL, famotidine (Merck) 0.4 mg/mL, metoclopramide hydrochloride (Sabex) 0.5 mg/mL, and dimenhydrinate 5 mg/mL diluted in sodium chloride 0.9% and packaged in 5-mL polypropylene syringes. The samples were stored refrigerated at 4 degree C and at room temperature of 25 degree C for 96 hours. No visible haze, color change, particulates, or gas evolution was observed. Stability-indicating HPLC analysis found little or no drug loss occurred. Octreotide was below the limit of detection and was not tested.
ReferencesNassr S, Brunet M, Lavoie P, et al. HPLC-DAD method for studying the stability of solutions containing morphine, dexamethasone, haloperidol, midazolam, famotidine, metoclopramide, and dimenhydrinate. J Liq Chromatog Rel Technol. 2001; 24
Stability Max
Maximum reported stability periods: In D5W- 15 days at room temperature, 63 days refrigerated, and 8 weeks frozen. In NS- 15 days at room temperature, 63 days refrigerated, and 8 weeks frozen.
ReferencesGupta VD, Parasrampuria J, Bethea C. Chemical stabilities of famotidine and ranitidine hydrochloride in intravenous admixtures. J Clin Pharm Ther. 1988; 13
ReferencesKeyi X, Gagnon N, Bisson C, et al. Stability of famotidine in polyvinyl chloride minibags and polypropylene syringes and compatibility of famotidine with selected drugs. Ann Pharmacother. 1993; 27
ReferencesShea PF, Souney PF. Stability of famotidine frozen in polypropylene syringes. Am J Hosp Pharm. 1990; 47
Revision Date: 08/17/2020, 12:33:10 PMCopyright 2004-2024 by Lawrence A. Trissel. All Rights Reserved.

References

44392 - Pepcid AC (famotidine tablet) consumer package insert. New Brunswick, NJ: Johnson & Johnson Consumer Companies, Inc.; 2023 March.51456 - Pepcid (famotidine) injection package insert. Whitehouse Station, NJ: Merck & Co., Inc,; 2006 Oct.51476 - Pepcid (famotidine) tablets, oral suspension, and orally disintegrating tablets package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2001 Mar.51477 - Famotidine powder for oral suspension prescription package insert. Memphis TN: Northstar Rx LLC; 2021 Jun.51493 - Bullock L, Fitzgerald JF, Glick MR, et al. Stability of famotidine 20 and 40 mg/L and amino acids in total parenteral nutrient solutions. Am J Hosp Pharm 1989;46:2321-5.65833 - US Food and Drug Administration (FDA). Information for health care facilities and providers on "in-use time". Available on the World Wide Web at https://www.fda.gov/drugs/coronavirus-covid-19-drugs/information-health-care-facilities-and-providers-use-time-covid-19. Accessed August 13, 2020.

Adverse Reactions

Moderate

  • cholestasis
  • confusion
  • conjunctivitis
  • constipation
  • delirium
  • depression
  • edema
  • hallucinations
  • hepatitis
  • impotence (erectile dysfunction)
  • jaundice
  • leukopenia
  • palpitations
  • pernicious anemia
  • QT prolongation
  • thrombocytopenia
  • vitamin B12 deficiency

Mild

  • acne vulgaris
  • agitation
  • alopecia
  • anorexia
  • anxiety
  • arthralgia
  • asthenia
  • diarrhea
  • dizziness
  • drowsiness
  • dysgeusia
  • fatigue
  • fever
  • flushing
  • gynecomastia
  • headache
  • infection
  • insomnia
  • lethargy
  • libido decrease
  • muscle cramps
  • musculoskeletal pain
  • nausea
  • paranoia
  • paresthesias
  • pruritus
  • rash
  • tinnitus
  • urticaria
  • vomiting
  • xerosis
  • xerostomia

Severe

  • agranulocytosis
  • anaphylactoid reactions
  • angioedema
  • arrhythmia exacerbation
  • atrophic gastritis
  • AV block
  • bronchospasm
  • pancytopenia
  • rhabdomyolysis
  • seizures
  • Stevens-Johnson syndrome
  • toxic epidermal necrolysis

Similar to other H2-antagonists, famotidine causes infrequent adverse reactions. In controlled clinical trials, the incidence of adverse reactions in patients who received famotidine 40 mg at bedtime was similar to that in the placebo group. The following reactions have occurred in greater than 1% of patients and may be causally related to the drug: headache (4.7%), dizziness (1.3%), constipation (1.2%), and diarrhea (1.7%). Other gastrointestinal adverse events reported in clinical trials or post approval include: cholestasis with jaundice, hepatitis, hepatic enzyme abnormalities, vomiting, nausea, abdominal discomfort, anorexia, dysgeusia (reported as taste disorder), and xerostomia. The relationship between these events and famotidine therapy has been unclear in many cases.[44392]

Reversible mental status changes, including agitation, confusion, delirium, hallucinations, hostility, paranoia, depression, insomnia, and disorientation have been reported rarely following famotidine therapy. Anxiety, libido decrease, paresthesias, and drowsiness have also been reported.[44392] A review of central nervous system reactions to H2-antagonists revealed that the incidence varies widely depending on the specific report, and that no single H2-antagonist is more likely to induce CNS reactions than another.[23494] Central nervous system reactions are more likely to occur in elderly patients and/or those with renal impairment. Seizures have been rarely reported in patients with renal impairment. Additionally, in a clinical study of famotidine in 35 infants < 1 year of age with GERD symptoms, agitation was reported in 5 patients that resolved when famotidine was discontinued.[44392]

Few cases of toxic epidermal necrolysis and Stevens-Johnson syndrome have been reported with famotidine therapy. Anaphylactoid reactions have also been reported. Additional hypersensitivity and dermatological reactions reported for famotidine in clinical trials or post approval include: orbital or facial edema, angioedema, urticaria, rash (unspecified), conjunctivitis, alopecia, acne vulgaris, pruritus, xerosis, and flushing. The relationship between these events and famotidine therapy has been unclear in many cases.[44392]

Increasing evidence suggests a link between acid-suppression therapy and respiratory infection, specifically pneumonia (community- and hospital-acquired). Several mechanisms have been proposed to account for this association. One such mechanism states that gastric pH serves as a barrier against pathogenic colonization of the gastrointestinal tract. An increase in gastric pH allows for bacterial and viral invasion which, in theory, can precipitate respiratory infections.[32661] Another proposed mechanism accounts for the role that gastric acid may have on stimulating the cough reflex that allows for the clearing of infectious agents from the respiratory tract. Finally, the fact that acid-suppressive therapy may impair white blood cell function, which in turn may lead to a depressed immune response to an infection, is listed among possible mechanisms.[35601] Regardless of the mechanism, the use of H2-blockers [32661] and/or PPIs [35601] has been associated with the development of pneumonia. Data from a large epidemiological trial, including 364,683 individuals who developed 5551 first occurrences of community-acquired pneumonia (CAP), suggest an increased risk of developing CAP among users of acid-suppressive therapy compared to those who stopped therapy. After adjusting for confounders, the adjusted relative risk (RR) for CAP among PPI users compared to those who stopped therapy was 1.89 (95% CI, 1.36—2.62). Likewise, users of H2-blockers had an adjusted RR of 1.63 (95% CI, 1.07—2.48) compared to those who stopped therapy.[32661] In a second large cohort trial, including 63,878 hospital admissions, acid-suppressive therapy was ordered in 52% (83% PPI and 23% H2- blocker, with some patients exposed to both) of new admissions. Hospital-acquired pneumonia occurred in 2,219 admissions (3.5%) with a higher incidence recorded among acid-suppressive therapy exposed patients compared to non-exposed patients. A subset analysis found a statistically significant association between PPI use (OR, 1.3; 95% CI, 1.1—1.4) and pneumonia. A non-significant association was found with H2-blockers (OR, 1.2; 95% CI, 0.98—1.4); however, the lack of significance was attributed to the studies lack of power to detect significance for an OR of less than 1.3.[35601] Until more is known about the relationship between acid-suppression and pneumonia, clinicians are encouraged to carefully select patients before empirically initiating acid-suppressive therapy with H2-blockers or PPIs. A causal relationship between the use of famotidine and pneumonia has not been established.

Atrophic gastritis, a precursor for gastric cancer, has been associated with prolonged acid suppression with high dose H2-blockers like famotidine in patients who are H. pylori positive. A 'test and treat' approach for baseline H. pylori infections is recommended for patients with reflux esophagitis on long term acid suppression therapy. Treatment of baseline infection decreases inflammation and may reverse corpus gastritis.[33113]

Cardiovascular adverse events reported for famotidine in clinical trials or post approval include: arrhythmia exacerbation, AV block, and palpitations. The relationship between these events and famotidine therapy has been unclear in many cases. In addition, QT prolongation has been reported in patients with impaired renal function whose dose/dosing interval of famotidine may not have been adjusted appropriately.[44392]

Hematological adverse events have been reported for famotidine in clinical trials or post approval and include few cases of agranulocytosis, pancytopenia, leukopenia, and thrombocytopenia. The relationship between these events and famotidine therapy has been unclear in many cases.[44392]

Miscellaneous adverse events reported for famotidine in clinical trials or post-marketing include: fever, asthenia, fatigue, lethargy, rhabdomyolysis, musculoskeletal pain including muscle cramps, arthralgia, bronchospasm, interstitial pneumonia, and tinnitus. In addition, few cases of impotence (erectile dysfunction) and gynecomastia have been reported; however, in controlled clinical trials, the incidences were not greater than those seen with placebo. The relationship between these events and famotidine therapy has been unclear in many cases.[44392]

Long-term (e.g., generally > 3 years) treatment with acid-suppressing agents can lead to malabsorption of vitamin B12 (cyanocobalamin). One large case-controlled study compared patients with and without an incident diagnosis of vitamin B12 deficiency (n = 25,956 and 184,199, respectively). A correlation was demonstrated between vitamin B12 deficiency and gastric acid-suppression therapy. Patients receiving >= 2 years of a proton pump inhibitor (PPI)(OR, 1.65 [95% CI, 1.58—1.73]) or >= 2 years of a H2-receptor antagonist (OR, 1.25 [95% CI, 1.17—1.34]) were associated with having an increased risk for vitamin B12 deficiency. A dose-dependant relationship was evident, as daily doses > 1.5 PPI pills/day were more strongly associated with vitamin B12 deficiency (OR, 1.95 [95% CI, 1.77—2.15]) compared to daily doses < 0.75 pills/day (OR, 1.63 [95% CI, 1.48—1.78]; p = 0.007 for interaction).[56553] The possibility of cyanocobalamin deficiency and pernicious anemia should be considered if clinical symptoms are observed. Neurological manifestations of pernicious anemia can occur in the absence of hematologic changes.

Revision Date: 06/29/2018, 02:30:44 PM

References

23494 - Cantu TG, Korek JS. Central nervous system reactions to histamine-2 receptor blockers. Ann Intern Med 1991;114:1027-34.32661 - Laheij RJ, Sturkenboom MC, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004;292:1955-60.33113 - Malfertheiner P, Megraud F, O'Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772-81.35601 - Herzig SJ, Howell MD, Ngo LH, et al. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA 2009;301:2120-8.44392 - Pepcid AC (famotidine tablet) consumer package insert. New Brunswick, NJ: Johnson & Johnson Consumer Companies, Inc.; 2023 March.56553 - Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.

Contraindications/Precautions

Absolute contraindications are italicized.

  • H2-blocker hypersensitivity
  • breast-feeding
  • gastric cancer
  • geriatric
  • infection
  • neonates
  • pregnancy
  • renal failure
  • renal impairment
  • vitamin B12 deficiency

Famotidine is contraindicated in any patient hypersensitive to the drug or with other H2-blocker hypersensitivity.[50742]

Symptomatic response to therapy with famotidine does not preclude the presence of gastric cancer. Patients who have a suboptimal response or early symptomatic relapse after completing therapy should consider evaluation for gastric malignancy.[50742] In the patient who is self-medicating with nonprescription (OTC) formulations, the continuation of heartburn, acid indigestion, or dyspepsia beyond 2 weeks signals the need to consult a health care professional for evaluation.[44392] [51488]

Symptomatic response to therapy with famotidine does not preclude the presence of H. pylori infection. H2-blockers, as single agents, will not eradicate H. pylori infection, if present.[63136]

Famotidine should be used cautiously in patients with renal impairment or renal failure as there is a close relationship between the drug's elimination half-life and creatinine clearance. Dosages of famotidine should be adjusted in patients with moderate or severe renal impairment. Central nervous system (CNS) adverse reactions, including confusion, delirium, hallucinations, disorientation, agitation, seizures, and lethargy, have been reported in older adults and patients with moderate and severe renal impairment treated with famotidine; in some cases, the dosages were not adjusted as recommended for renal impairment.[50742]

Animal studies and epidemiologic data during pregnancy suggest famotidine use when necessary is not harmful, even though there are no adequate and well-controlled studies evaluating famotidine use in pregnant patients.[20917] [50742] [51456] [51477] In one such study of human data, exposure to H2-blockers, including famotidine, was not associated with an increased risk for congenital malformations (adjusted OR 1.03, 95% CI: 0.80, 1.32); also, no such association was found when therapeutic pregnancy terminations were included in the analysis (adjusted OR 1.17, 95% CI: 0.93, 1.46). Exposure to H2-blockers was not associated with perinatal mortality, premature delivery, low birth weight, or low Apgar scores.[68907] In animal reproduction studies, no adverse development effects were observed with oral famotidine at doses up to approximately 243 and 122 times, respectively, the recommended human dose of 80 mg/day for the treatment of erosive esophagitis.[50742] [51477] Guidelines recommend a trial of lifestyle modifications as first-line therapy for heartburn and gastroesophageal reflux disease (GERD) during pregnancy, followed by antacids if lifestyle adjustments are ineffective. For ongoing symptoms, H2-blockers such as famotidine can be used. Other medications should be reserved for pregnant patients who fail H2-blocker therapy.[68890] Self-medication with H2-blockers (OTC formulations) during pregnancy is not recommended. Pregnant patients should see their health care professional for a proper diagnosis and for treatment recommendations.[45899] Famotidine has been used in limited circumstances at term to prevent acid aspiration during labor; some guidelines recommend an H2-blocker (PO or IV) for all women presenting for cesarean delivery.[66408]

There are limited data suggesting the presence of famotidine in human breast milk; however, there were no effects on the breastfed infant; experts and guidelines consider use of famotidine compatible with breast-feeding. There are no data on famotidine effects on milk production. Famotidine is present in the milk of lactating rats.[50742] [51477] [45899] [68890] Famotidine is indicated for use in infants and is used in newborns at doses that are higher than those excreted in breast milk.[45876] According to guidelines, if heartburn/gastroesophageal reflux (GERD) symptoms persist after delivery, antacids and sucralfate are safe to use during lactation because they are not concentrated in breast milk. H2-blockers are excreted in breast milk, but cimetidine and famotidine are considered safe for use during lactation and may be used if symptoms persist despite antacid use. Famotidine is preferred in lactation due to the low concentration in breast milk.[68890] [45899]

No special precautions have been advised for famotidine use in geriatric adults vs. younger adults, but dosage adjustments are necessary in older adults with reduced renal function. If critically ill, the older adults in some uncontrolled studies have appeared to be more likely to exhibit central nervous system (CNS) reactions to the H2-antagonists.[50742] According to the Beers Criteria, H2-receptor antagonists are considered potentially inappropriate medications (PIMs) in geriatric patients with delirium/high risk of delirium (potential for new-onset or worsening delirium) and should be avoided in this patient population. Dosage reduction of H2-receptor antagonists is recommended in geriatric adults with a creatinine clearance less than 50 mL/minute due to the potential for mental status changes.[63923]

Daily treatment with gastric acid-suppressing medication over a long period of time (e.g., generally more than 3 years) may lead to malabsorption of cyanocobalamin and vitamin B12 deficiency. One large case-controlled study compared patients with and without an incident diagnosis of vitamin B12 deficiency. A correlation was demonstrated between vitamin B12 deficiency and gastric acid-suppression therapy with PPIs or H2-blockers of greater than 2 years duration. A dose-dependent relationship was also evident, as larger daily pill counts were more strongly associated with vitamin B12 deficiency.[56553] Consider the possibility of cyanocobalamin deficiency if clinical symptoms are observed.

Famotidine injection multidose vials contain benzyl alcohol as a preservative and should be avoided in neonates. There have been reports of fatal 'gasping syndrome' in neonates (less than 1 month of age) after the administration of parenteral solutions containing the preservative benzyl alcohol at dosages more than 99 mg/kg/day. The minimum amount of benzyl alcohol to cause toxicity is unknown. Therefore, use preservative-free famotidine injectable formulations in neonates.[51456]

Revision Date: 11/10/2023, 08:26:14 AM

References

20917 - Garbis H, Elefant E, Diav-Citrin O, et al. Pregnancy outcome after exposure to ranitidine and other H2-blockers. A collaborative study of the European Network of Teratology Information Services. Reprod Toxicol. 2005;19:453-844392 - Pepcid AC (famotidine tablet) consumer package insert. New Brunswick, NJ: Johnson & Johnson Consumer Companies, Inc.; 2023 March.45876 - Orenstein SR, Shalaby TM, Devandry SN et al. Famotidine for infant gastro-oesophageal reflux: a multi-centre, randomized, placebo-controlled, withdrawal trial. Aliment Pharmacol Ther 2003;17:1097-107.45899 - Mahadevan U, Kane S. American Gastroenterological Association Institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology 2006;131:283-311.50742 - Pepcid (famotidine) tablets prescription package insert. Bridgewater NJ: Valeant Pharmaceuticals North America LLC; 2018 Nov.51456 - Pepcid (famotidine) injection package insert. Whitehouse Station, NJ: Merck & Co., Inc,; 2006 Oct.51477 - Famotidine powder for oral suspension prescription package insert. Memphis TN: Northstar Rx LLC; 2021 Jun.51488 - Pepcid AC (famotidine) tablet package insert. Fort Washington, PA: Johnson & Johnson Merck Consumer Pharmaceuticals Co.; 2011 Mar.56553 - Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.63136 - Chey WD, Leontiadis GI, Howden CW, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017;112:212-238.63923 - The American Geriatrics Society 2019 Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019;00:1-21.66408 - Dobson G, Chow L, Filteau L, et al. Guidelines to the Practice of Anesthesia - Revised Edition 2021. Can J Anaesth. 2021;68:92-129.68890 - Abushamma S, Early DS. American College of Obstetricians and Gynecologists. ACOG: A Guide to Upper Gastrointestinal Tract, Biliary, and Pancreatic Disorders: Clinical Updates in Women's Health Care Primary and Preventive Care Review. Obstet Gynecol 2021;137:1152.68907 - Matok I, Gorodischer R, Koren G, et al. The safety of H(2)-blockers use during pregnancy. J Clin Pharmacol. 2010;50:81-87. Epub 2009 Sep 29.

Mechanism of Action

Famotidine competitively inhibits the binding of histamine to H2-receptors on the gastric basolateral membrane of parietal cells, reducing basal and nocturnal gastric acid secretions. The drug also decreases the gastric acid response to stimuli such as food, caffeine, insulin, betazole, or pentagastrin. Famotidine reduces the total volume of gastric juice, thus indirectly decreasing pepsin secretion. The drug does not appear to alter gastric motility, gastric emptying, esophageal pressures, biliary secretions, or pancreatic secretions. Famotidine may aid in gastromucosal healing, and it may protect the mucosa from the irritant effects caused by aspirin and nonsteroidal antiinflammatory agents.

Revision Date: 07/28/2015, 06:07:19 PM

References

Pharmacokinetics

Famotidine is administered orally and parenterally. Plasma protein binding is approximately 15% to 20%. There is no cumulative effect with repeat doses; plasma concentrations after multiple doses are similar to those after single doses. Famotidine undergoes minimal first-pass metabolism. The majority (65 to 70%) of a famotidine dose is excreted in the urine; 30 to 35% of the dose is metabolized by the liver. The S-oxide metabolite is the only 1 identified in humans. Famotidine elimination half-life is 2.5 to 3.5 hours in adults with normal renal function.[44392][51477]

 

Affected cytochrome P450 isoenzymes: CYP1A2, OAT1, OAT3, MATE-1

Famotidine is a weak inhibitor of CYP1A2. In vitro studies also indicate that famotidine is a substrate for human organic anion transporter (OAT) 1 and 3 and an inhibitor of multidrug and toxin extrusion protein 1 (MATE-1).[44392][51477]

Route-Specific Pharmacokinetics

Oral Route

Bioavailability of famotidine is approximately 40% to 45% in adults. Famotidine tablets, oral suspension, and orally disintegrating tablets are bioequivalent. Food may slightly increase and antacids may slightly decrease the bioavailability of famotidine; however, the effects are considered clinically insignificant. The onset of action is usually within 1 hour after oral administration with maximum effects occurring within 1 to 3 hours depending on the dose. The duration of action is roughly 10 to 12 hours. Twenty-five to 30% of an oral dose is excreted in urine as unchanged drug.[44392][51477]

Intravenous Route

Sixty-five to 70% of an intravenous dose of famotidine is excreted in urine as unchanged drug.[51456]

Special Populations

Renal Impairment

In adult patients with severe renal impairment (creatinine clearance less than 30 mL/minute), the systemic exposure (AUC) of famotidine increased at least 5-fold. In adult patients with moderate renal impairment (creatinine clearance between 30 to 60 mL/minute), the AUC of famotidine increased at least 2-fold.[44392][51477]

Pediatrics

Children and Adolescents

The mean oral bioavailability in 8 pediatric patients 11 to 15 years of age was 50%. The mean half-life was 2 to 3.4 hours in pediatric patients 1 to 15 years of age.[44392] [51456] [51477]

 

Neonates and Infants

After a single administration of 0.5 mg/kg orally in patients from birth to 12 months of age, the bioavailability was approximately 42%. The AUC increased 1.4-fold after a single oral dose of 1 mg/kg compared to 0.5 mg/kg and 2.7-fold after multiple oral doses of 1 mg/kg compared to 0.5 mg/kg. The half-life was 5.82 in infants birth to 12 months of age. Plasma clearance was reduced, and elimination half-life was prolonged in pediatric patients from birth to 3 months of age compared to older pediatric patients. After intravenous administration of 0.5 mg/kg, total clearance was 0.13 +/- 0.06 L/hour/kg, 0.21 +/- 0.06 L/hour/kg, and 0.49 +/- 0.17 L/hour/kg in pediatric patients younger than 1 month of age, younger than 3 months of age, and 4 to 12 months of age, respectively. Elimination half-life was 10.5 hours, 8.1 hours, and 4.5 hours in pediatric patients younger than 1 month of age, younger than 3 months of age, and 4 to 12 months of age, respectively. The duration of acid suppression was longer in pediatric patients from birth to 3 months of age compared to older pediatric patients.[44392] [51456] [51477]

Geriatric

There are no clinically significant age-related changes in famotidine pharmacokinetics in elderly patients versus younger adults. However, in elderly patients with decreased renal function, the clearance of famotidine may be reduced.[44392][51477]

Revision Date: 08/21/2019, 05:46:58 PM

References

44392 - Pepcid AC (famotidine tablet) consumer package insert. New Brunswick, NJ: Johnson & Johnson Consumer Companies, Inc.; 2023 March.51456 - Pepcid (famotidine) injection package insert. Whitehouse Station, NJ: Merck & Co., Inc,; 2006 Oct.51477 - Famotidine powder for oral suspension prescription package insert. Memphis TN: Northstar Rx LLC; 2021 Jun.

Pregnancy/Breast-feeding

pregnancy

Animal studies and epidemiologic data during pregnancy suggest famotidine use when necessary is not harmful, even though there are no adequate and well-controlled studies evaluating famotidine use in pregnant patients.[20917] [50742] [51456] [51477] In one such study of human data, exposure to H2-blockers, including famotidine, was not associated with an increased risk for congenital malformations (adjusted OR 1.03, 95% CI: 0.80, 1.32); also, no such association was found when therapeutic pregnancy terminations were included in the analysis (adjusted OR 1.17, 95% CI: 0.93, 1.46). Exposure to H2-blockers was not associated with perinatal mortality, premature delivery, low birth weight, or low Apgar scores.[68907] In animal reproduction studies, no adverse development effects were observed with oral famotidine at doses up to approximately 243 and 122 times, respectively, the recommended human dose of 80 mg/day for the treatment of erosive esophagitis.[50742] [51477] Guidelines recommend a trial of lifestyle modifications as first-line therapy for heartburn and gastroesophageal reflux disease (GERD) during pregnancy, followed by antacids if lifestyle adjustments are ineffective. For ongoing symptoms, H2-blockers such as famotidine can be used. Other medications should be reserved for pregnant patients who fail H2-blocker therapy.[68890] Self-medication with H2-blockers (OTC formulations) during pregnancy is not recommended. Pregnant patients should see their health care professional for a proper diagnosis and for treatment recommendations.[45899] Famotidine has been used in limited circumstances at term to prevent acid aspiration during labor; some guidelines recommend an H2-blocker (PO or IV) for all women presenting for cesarean delivery.[66408]

breast-feeding

There are limited data suggesting the presence of famotidine in human breast milk; however, there were no effects on the breastfed infant; experts and guidelines consider use of famotidine compatible with breast-feeding. There are no data on famotidine effects on milk production. Famotidine is present in the milk of lactating rats.[50742] [51477] [45899] [68890] Famotidine is indicated for use in infants and is used in newborns at doses that are higher than those excreted in breast milk.[45876] According to guidelines, if heartburn/gastroesophageal reflux (GERD) symptoms persist after delivery, antacids and sucralfate are safe to use during lactation because they are not concentrated in breast milk. H2-blockers are excreted in breast milk, but cimetidine and famotidine are considered safe for use during lactation and may be used if symptoms persist despite antacid use. Famotidine is preferred in lactation due to the low concentration in breast milk.[68890] [45899]

Revision Date: 05/01/2023, 05:13:30 PM

References

20917 - Garbis H, Elefant E, Diav-Citrin O, et al. Pregnancy outcome after exposure to ranitidine and other H2-blockers. A collaborative study of the European Network of Teratology Information Services. Reprod Toxicol. 2005;19:453-845876 - Orenstein SR, Shalaby TM, Devandry SN et al. Famotidine for infant gastro-oesophageal reflux: a multi-centre, randomized, placebo-controlled, withdrawal trial. Aliment Pharmacol Ther 2003;17:1097-107.45899 - Mahadevan U, Kane S. American Gastroenterological Association Institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology 2006;131:283-311.50742 - Pepcid (famotidine) tablets prescription package insert. Bridgewater NJ: Valeant Pharmaceuticals North America LLC; 2018 Nov.51456 - Pepcid (famotidine) injection package insert. Whitehouse Station, NJ: Merck & Co., Inc,; 2006 Oct.51477 - Famotidine powder for oral suspension prescription package insert. Memphis TN: Northstar Rx LLC; 2021 Jun.66408 - Dobson G, Chow L, Filteau L, et al. Guidelines to the Practice of Anesthesia - Revised Edition 2021. Can J Anaesth. 2021;68:92-129.68890 - Abushamma S, Early DS. American College of Obstetricians and Gynecologists. ACOG: A Guide to Upper Gastrointestinal Tract, Biliary, and Pancreatic Disorders: Clinical Updates in Women's Health Care Primary and Preventive Care Review. Obstet Gynecol 2021;137:1152.68907 - Matok I, Gorodischer R, Koren G, et al. The safety of H(2)-blockers use during pregnancy. J Clin Pharmacol. 2010;50:81-87. Epub 2009 Sep 29.

Interactions

Level 2 (Major)

  • Atazanavir
  • Atazanavir; Cobicistat
  • Cefuroxime
  • Cysteamine
  • Dasatinib
  • Delavirdine
  • Dichlorphenamide
  • Erlotinib
  • Gefitinib
  • Ketoconazole
  • Ledipasvir; Sofosbuvir
  • Levoketoconazole
  • Neratinib
  • Nirogacestat
  • Pazopanib
  • Risedronate
  • Secretin
  • Selpercatinib
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sotorasib
  • Sparsentan
  • Tizanidine

Level 3 (Moderate)

  • Acalabrutinib
  • Albuterol; Budesonide
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamine; Dextroamphetamine Salts
  • Bosutinib
  • Budesonide
  • Budesonide; Formoterol
  • Budesonide; Glycopyrrolate; Formoterol
  • Bupivacaine; Lidocaine
  • Cabotegravir; Rilpivirine
  • Cefpodoxime
  • Dacomitinib
  • Dextroamphetamine
  • Diphenhydramine; Naproxen
  • Dolutegravir; Rilpivirine
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir Disoproxil Fumarate
  • Fosamprenavir
  • Infigratinib
  • Itraconazole
  • Lidocaine
  • Lidocaine; Epinephrine
  • Lidocaine; Prilocaine
  • Mefloquine
  • Naproxen
  • Naproxen; Esomeprazole
  • Naproxen; Pseudoephedrine
  • Nilotinib
  • Octreotide
  • Pexidartinib
  • Rasagiline
  • Rilpivirine
  • Sonidegib
  • Sumatriptan; Naproxen
  • Thalidomide
  • Warfarin

Level 4 (Minor)

  • Alogliptin; Metformin
  • Aripiprazole
  • Bisacodyl
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Canagliflozin; Metformin
  • Dapagliflozin; Metformin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Ertugliflozin; Metformin
  • Ferric Maltol
  • Glipizide; Metformin
  • Glyburide; Metformin
  • Iron
  • Iron Salts
  • Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate
  • Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate
  • Linagliptin; Metformin
  • Metformin
  • Metformin; Repaglinide
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate
  • Norethindrone; Ethinyl Estradiol; Ferrous fumarate
  • Pioglitazone; Metformin
  • Polyethylene Glycol; Electrolytes; Bisacodyl
  • Polysaccharide-Iron Complex
  • Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
  • Theophylline, Aminophylline
Acalabrutinib: (Moderate) Separate the administration of acalabrutinib capsules and H2-blockers if these agents are used together; administer acalabrutinib capusles 2 hours before the H2-blocker. Acalabrutinib capsule solubility decreases with increasing pH values; therefore, coadministration may result in decreased acalabrutinib exposure and effectiveness. [62578] Albuterol; Budesonide: (Moderate) Monitor for loss of oral, enteric-coated budesonide efficacy during concomitant famotidine use. Since the dissolution of oral, enteric-coated budesonide is pH dependent, the release properties and uptake of the drug may be altered when used after H2-blockers. [34979] [52910] Alogliptin; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Amphetamine: (Moderate) Use amphetamine; dextroamphetamine and H2-blockers concomitantly with caution. Gastrointestinal alkalinizing agents may increase exposure to amphetamine; dextroamphetamine and exacerbate its actions. [62038] Amphetamine; Dextroamphetamine Salts: (Moderate) Use amphetamine; dextroamphetamine and H2-blockers concomitantly with caution. Gastrointestinal alkalinizing agents may increase exposure to amphetamine; dextroamphetamine and exacerbate its actions. [62038] Amphetamine; Dextroamphetamine: (Moderate) Use amphetamine; dextroamphetamine and H2-blockers concomitantly with caution. Gastrointestinal alkalinizing agents may increase exposure to amphetamine; dextroamphetamine and exacerbate its actions. [62038] Aripiprazole: (Minor) Coadministration of aripiprazole with famotidine decreases aripiprazole's solubility and rate of absorption. The Cmax of aripiprazole and the metabolite dehydroaripiprazole are decreased by 37% and 21%, respectively, and the AUC of aripiprazole and the dehydroaripiprazole metabolite are decreased by 13% and 15%, respectively. This interaction does not appear to cause clinically relevant effects and therefore no dosage adjustments are required. [8110] Atazanavir: (Major) Coadministration of H2-blockers with atazanavir reduces serum atazanavir concentrations; however, H2-blockers can be used under specific administration restrictions. Although data are insufficient to recommend atazanavir dosing in children < 40 kg receiving concomitant H2-blockers, the same recommendations regarding timing and maximum doses of concomitant H2-blockers should be followed. In treatment-naive patients >= 40 kg, do not exceed an H2- blocker dose equivalent to famotidine 40 mg twice daily, and give atazanavir 300 mg with ritonavir 100 mg once daily with food. Give atazanavir simultaneously with and/or at least 10 hours after the H2- blocker. If a treatment-naive adult or adolescent (>= 40 kg) cannot tolerate ritonavir, do not exceed an H2- blocker dose equivalent to famotidine 20 mg twice daily, and the atazanavir dose should be increased to 400 mg once daily with food given at least 2 hours before or 10 hours after the H2- blocker. Data are insufficent to recommend atazanavir dosing in children or adolescents < 40 kg not receiving ritonavir boosting. In treatment-naive patients on a cobicistat-boosted regimen, cobicistat and atazanavir may be administered without dosage adjustment if given at the same time or a minimum of 10 hours after dosing of the H2-blocker. The H2-blocker dose should not exceed a dose that is comparable to 40 mg/day of famotidine in treatment-naive patients. In treatment-experienced patients >= 40 kg, do not exceed an H2- blocker dose equivalent to famotidine 20 mg twice daily, and give atazanavir 300 mg with ritonavir 100 mg once daily with food. Give atazanavir simultaneously with and/or at least 10 hours after the H2- blocker. In treatment-experienced patients >= 40 kg receiving H2-antagonists and tenofovir, atazanavir should be dosed 400 mg with ritonavir 100 mg once daily with food. In antiretroviral-experienced patients on a cobicistat-boosted regimen, the dosage of cobicistat with atazanavir needs to be increased if administered with H2-blockers; the recommended dose is cobicistat 150 mg/day with atazanavir 400 mg/day and 20 mg/day or less of famotidine or other comparably dosed H2-blocker. Significant reductions in atazanavir serum concentrations may lead to therapeutic failure and the development of HIV resistance. Closely monitor patients for antiretroviral therapeutic failure and resistance development during treatment with an H2- blocker. [28142] [58000] Atazanavir; Cobicistat: (Major) Coadministration of H2-blockers with atazanavir reduces serum atazanavir concentrations; however, H2-blockers can be used under specific administration restrictions. Although data are insufficient to recommend atazanavir dosing in children < 40 kg receiving concomitant H2-blockers, the same recommendations regarding timing and maximum doses of concomitant H2-blockers should be followed. In treatment-naive patients >= 40 kg, do not exceed an H2- blocker dose equivalent to famotidine 40 mg twice daily, and give atazanavir 300 mg with ritonavir 100 mg once daily with food. Give atazanavir simultaneously with and/or at least 10 hours after the H2- blocker. If a treatment-naive adult or adolescent (>= 40 kg) cannot tolerate ritonavir, do not exceed an H2- blocker dose equivalent to famotidine 20 mg twice daily, and the atazanavir dose should be increased to 400 mg once daily with food given at least 2 hours before or 10 hours after the H2- blocker. Data are insufficent to recommend atazanavir dosing in children or adolescents < 40 kg not receiving ritonavir boosting. In treatment-naive patients on a cobicistat-boosted regimen, cobicistat and atazanavir may be administered without dosage adjustment if given at the same time or a minimum of 10 hours after dosing of the H2-blocker. The H2-blocker dose should not exceed a dose that is comparable to 40 mg/day of famotidine in treatment-naive patients. In treatment-experienced patients >= 40 kg, do not exceed an H2- blocker dose equivalent to famotidine 20 mg twice daily, and give atazanavir 300 mg with ritonavir 100 mg once daily with food. Give atazanavir simultaneously with and/or at least 10 hours after the H2- blocker. In treatment-experienced patients >= 40 kg receiving H2-antagonists and tenofovir, atazanavir should be dosed 400 mg with ritonavir 100 mg once daily with food. In antiretroviral-experienced patients on a cobicistat-boosted regimen, the dosage of cobicistat with atazanavir needs to be increased if administered with H2-blockers; the recommended dose is cobicistat 150 mg/day with atazanavir 400 mg/day and 20 mg/day or less of famotidine or other comparably dosed H2-blocker. Significant reductions in atazanavir serum concentrations may lead to therapeutic failure and the development of HIV resistance. Closely monitor patients for antiretroviral therapeutic failure and resistance development during treatment with an H2- blocker. [28142] [58000] Bisacodyl: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage. [4701] Bismuth Subsalicylate: (Minor) H2-blockers may increase the systemic absorption of bismuth from bismuth-containing compounds like bismuth subsalicylate. [7825] Bismuth Subsalicylate; Metronidazole; Tetracycline: (Minor) H2-blockers may increase the systemic absorption of bismuth from bismuth-containing compounds like bismuth subsalicylate. [7825] Bosutinib: (Moderate) Bosutinib displays pH-dependent aqueous solubility; therefore, concomitant use of bosutinib and H2-blockers may result in decreased plasma exposure of bosutinib. Separate the administration of bosutinib and H2-blockers by more than 2 hours. [51739] Budesonide: (Moderate) Monitor for loss of oral, enteric-coated budesonide efficacy during concomitant famotidine use. Since the dissolution of oral, enteric-coated budesonide is pH dependent, the release properties and uptake of the drug may be altered when used after H2-blockers. [34979] [52910] Budesonide; Formoterol: (Moderate) Monitor for loss of oral, enteric-coated budesonide efficacy during concomitant famotidine use. Since the dissolution of oral, enteric-coated budesonide is pH dependent, the release properties and uptake of the drug may be altered when used after H2-blockers. [34979] [52910] Budesonide; Glycopyrrolate; Formoterol: (Moderate) Monitor for loss of oral, enteric-coated budesonide efficacy during concomitant famotidine use. Since the dissolution of oral, enteric-coated budesonide is pH dependent, the release properties and uptake of the drug may be altered when used after H2-blockers. [34979] [52910] Bupivacaine; Lidocaine: (Moderate) Concomitant use of systemic lidocaine and famotidine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Monitor for lidocaine toxicity if used together. Lidocaine is a CYP3A4 and CYP1A2 substrate; famotidine inhibits CYP1A2. [32857] [51834] Cabotegravir; Rilpivirine: (Moderate) Coadministration with famotidine may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure. To decrease the risk of virologic failure, avoid use of famotidine for at least 12 hours before and at least 4 hours after administering rilpivirine. [44376] Canagliflozin; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Cefpodoxime: (Moderate) H2-blockers should be avoided during treatment with cefpodoxime. Coadministration could result in antibiotic failure. H2-blockers increase gastric pH. Cefpodoxime proxetil requires low gastric pH for dissolution. While the rate of absorption is not affected, coadministration reduces cefpodoxime AUC, peak plasma concentration (by 42%), and extent of absorption (by 32%). [31026] [50193] [59407] [59408] Cefuroxime: (Major) Avoid the concomitant use of H2-blockers and cefuroxime. Drugs that reduce gastric acidity, such as H2-blockers, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. [28573] Cysteamine: (Major) Monitor white blood cell (WBC) cystine concentration closely when administering delayed-release cysteamine (Procysbi) with H2-blockers. Drugs that increase the gastric pH may cause the premature release of cysteamine from delayed-release capsules, leading to an increase in WBC cystine concentration. [54560] Dacomitinib: (Moderate) Administer dacomitinib at least 6 hours before or 10 hours after famotidine. Taking these medications at the same time may reduce dacomitinib absorption and decrease its efficacy. [63584] Dapagliflozin; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Dasatinib: (Major) Do not administer H2-blockers with dasatinib due to the potential for decreased dasatinib exposure and reduced efficacy. Consider using an antacid if acid suppression therapy is needed. Administer the antacid at least 2 hours prior to or 2 hours after the dose of dasatinib. Concurrent use of an H2-blocker reduced the mean Cmax and AUC of dasatinib by 63% and 61%, respectively. [60087] Delavirdine: (Major) Coadministration of delavirdine with H2-blockers results in decreased absorption of delavirdine. Administration of delavirdine and H2-blockers should be separated by at least 1 hour. Chronic use of H2-blockers with delavirdine is not recommended. [5206] Dextroamphetamine: (Moderate) Use amphetamine; dextroamphetamine and H2-blockers concomitantly with caution. Gastrointestinal alkalinizing agents may increase exposure to amphetamine; dextroamphetamine and exacerbate its actions. [62038] Dichlorphenamide: (Major) Concomitant use of dichlorphenamide and famotidine is not recommended because of an increased risk of famotidine-related adverse effects. Monitor closely for signs of famotidine-related drug toxicity if coadministration cannot be avoided. Increased famotidine exposure is possible. Dichlorphenamide inhibits OAT1. Famotidine is a sensitive OAT1 substrate. Consider if an alternative to famotidine would be appropriate for the patient. [56579] [60122] Diphenhydramine; Naproxen: (Moderate) Avoid concomitant use of enteric-coated, delayed-release naproxen and H2-blockers due to the gastric pH elevating effects of H2-blockers. Enteric-coated, delayed-release naproxen tablets are designed to dissolve at a pH of 6 or more. [32122] Dolutegravir; Rilpivirine: (Moderate) Coadministration with famotidine may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure. To decrease the risk of virologic failure, avoid use of famotidine for at least 12 hours before and at least 4 hours after administering rilpivirine. [44376] Empagliflozin; Linagliptin; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Empagliflozin; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Coadministration with famotidine may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure. To decrease the risk of virologic failure, avoid use of famotidine for at least 12 hours before and at least 4 hours after administering rilpivirine. [44376] Emtricitabine; Rilpivirine; Tenofovir Disoproxil Fumarate: (Moderate) Coadministration with famotidine may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure. To decrease the risk of virologic failure, avoid use of famotidine for at least 12 hours before and at least 4 hours after administering rilpivirine. [44376] Erlotinib: (Major) If concomitant use of erlotinib with famotidine is necessary, erlotinib must be taken 10 hours after the last dose of famotidine and at least 2 hours before the next dose. Erlotinib displays pH-dependent solubility with decreased solubility at a higher pH; the increased gastric pH resulting from famotidine therapy may reduce the bioavailability of erlotinib. Increasing the dose of erlotinib without modifying the administration schedule is unlikely to compensate for loss of exposure. Erlotinib exposure was decreased by 33% and the Cmax by 54% when erlotinib was administered 2 hours after a single dose of an H2-antagonist. When administered at least 10 hours after an evening dose of an H2-antagonist and 2 hours before the morning dose, erlotinib exposure was decreased by 15% and Cmax by 17%. [30555] Ertugliflozin; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Ferric Maltol: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Fosamprenavir: (Moderate) Monitor for decreased fosamprenavir efficacy if coadministered with H2-blockers. Concurrent use may decrease the plasma concentrations of fosamprenavir leading to a reduction of antiretroviral efficacy and the potential development of viral resistance. [29012] Gefitinib: (Major) Avoid coadministration of famotidine with gefitinib if possible due to decreased exposure to gefitinib, which may lead to reduced efficacy. If concomitant use is unavoidable, take gefitinib 6 hours after the last dose or 6 hours before the next dose of famotidine. Gefitinib exposure is affected by gastric pH. Coadministration with high doses of another H2-blocker to maintain gastric pH above 5 decreased gefitinib exposure by 47%. [45935] Glipizide; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Glyburide; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Infigratinib: (Moderate) Separate the administration of infigratinib and H2-receptor antagonists if concomitant use is necessary. Coadministration may decrease infigratinib exposure resulting in decreased efficacy. Administer infigratinib two hours before or ten hours after an H2-receptor antagonist. [66702] Iron Salts: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Iron Salts: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Iron: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Itraconazole: (Moderate) When administering H2-blockers with the 100 mg itraconazole capsule and 200 mg itraconazole tablet formulations, systemic exposure to itraconazole is decreased. Conversely, exposure to itraconazole is increased when H2-blockers are administered with the 65 mg itraconazole capsule. Administer H2-blockers at least 2 hours before or 2 hours after the 100 mg capsule or 200 mg tablet. Monitor for increased itraconazole-related adverse effects if H2-blockers are administered with itraconazole 65 mg capsules. [27983] [40233] [63821] Ketoconazole: (Major) Avoid use of H2-blockers with ketoconazole. Medications that increase gastric pH may impair ketoconazole absorption. [27982] [67231] Ledipasvir; Sofosbuvir: (Major) Solubility of ledipasvir decreases as gastric pH increases; thus, coadministration of ledipasvir; sofosbuvir with H2-blockers may result in lower ledipasvir plasma concentrations. Ledipasvir; sofosbuvir can be administered with H2-blockers if given simultaneously or separated by 12 hours. The H2-blocker dose should not exceed a dose that is comparable to famotidine 40 mg twice daily. [58167] Levoketoconazole: (Major) Avoid use of H2-blockers with ketoconazole. Medications that increase gastric pH may impair ketoconazole absorption. [27982] [67231] Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Lidocaine: (Moderate) Concomitant use of systemic lidocaine and famotidine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Monitor for lidocaine toxicity if used together. Lidocaine is a CYP3A4 and CYP1A2 substrate; famotidine inhibits CYP1A2. [32857] [51834] Lidocaine; Epinephrine: (Moderate) Concomitant use of systemic lidocaine and famotidine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Monitor for lidocaine toxicity if used together. Lidocaine is a CYP3A4 and CYP1A2 substrate; famotidine inhibits CYP1A2. [32857] [51834] Lidocaine; Prilocaine: (Moderate) Concomitant use of systemic lidocaine and famotidine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Monitor for lidocaine toxicity if used together. Lidocaine is a CYP3A4 and CYP1A2 substrate; famotidine inhibits CYP1A2. [32857] [51834] Linagliptin; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Mefloquine: (Moderate) H2-blockers may increase plasma concentrations of mefloquine. Patients on chronic mefloquine therapy might be at increased risk of adverse reactions, especially patients with a neurological or psychiatric history. In a small study involving 6 healthy subjects and 6 peptic ulcer patients, cimetidine increased the Cmax and AUC of mefloquine. In the study, the pharmacokinetics of mefloquine were determined after receiving a single oral mefloquine 500 mg dose alone and after 3-days of cimetidine 400 mg PO twice daily. In both healthy subjects and peptic ulcer patients, Cmax was increased 42.4% and 20.5%, respectively. The AUC was increased by 37.5% in both groups. Elimination half-life, total clearance, and volume of distribution were not significantly affected. An increase in adverse reactions was not noted. [32575] Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Metformin; Repaglinide: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Metformin; Saxagliptin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Metformin; Sitagliptin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Naproxen: (Moderate) Avoid concomitant use of enteric-coated, delayed-release naproxen and H2-blockers due to the gastric pH elevating effects of H2-blockers. Enteric-coated, delayed-release naproxen tablets are designed to dissolve at a pH of 6 or more. [32122] Naproxen; Esomeprazole: (Moderate) Avoid concomitant use of enteric-coated, delayed-release naproxen and H2-blockers due to the gastric pH elevating effects of H2-blockers. Enteric-coated, delayed-release naproxen tablets are designed to dissolve at a pH of 6 or more. [32122] Naproxen; Pseudoephedrine: (Moderate) Avoid concomitant use of enteric-coated, delayed-release naproxen and H2-blockers due to the gastric pH elevating effects of H2-blockers. Enteric-coated, delayed-release naproxen tablets are designed to dissolve at a pH of 6 or more. [32122] Neratinib: (Major) Take neratinib at least 2 hours before the next dose of an H2-blocker or 10 hours after the last dose of an H2-blocker due to decreased absorption and systemic exposure of neratinib; the solubility of neratinib decreases with increasing pH of the GI tract. The Cmax and AUC of neratinib were reduced by 57% and 48%, respectively, when administered 2 hours after a daily dose of ranitidine 300 mg. The Cmax and AUC of neratinib were reduced by 44% and 32%, respectively, when administered 2 hours before ranitidine 150 mg twice daily (given approximately 12 hours apart). [62127] Nilotinib: (Moderate) If concomitant use of these agents is necessary, administer the H2-blocker approximately 10 hours before and approximately 2 hours after the nilotinib dose. Nilotinib displays pH-dependent solubility with decreased solubility at a higher pH. The concomitant use of nilotinib and H2-blockers that elevate the gastric pH may reduce the bioavailability of nilotinib. In a study in healthy subjects, there was no significant change in nilotinib pharmacokinetics when a single 400-mg nilotinib dose was given 10 hours after and 2 hours prior to famotidine. [33557] Nirogacestat: (Major) Avoid concomitant use of nirogacestat and H2 receptor blockers. Concurrent use may impair nirogacestat absorption which may decrease nirogacestat exposure and reduce its efficacy. Antacids may be used with nirogacestat but administration should be separated by at least 2 hours. [69917] Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Octreotide: (Moderate) Coadministration of oral octreotide with H2-blockers may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including H2-blockers, may alter the absorption of octreotide and lead to a reduction in bioavailability. [65637] Pazopanib: (Major) Avoid coadministration of pazopanib with H2-blockers due to decreased absorption of pazopanib, which may decrease efficacy. If concomitant administration with a gastric acid-reducing agent is unavoidable, consider the use of a short-acting antacid in place of an H2-blocker; separate administration of the short-acting antacid and pazopanib by several hours to avoid a reduction in pazopanib exposure. Concomitant use of pazopanib with a proton pump inhibitor decreased pazopanib exposure (AUC and Cmax) by approximately 40%. [49829] Pexidartinib: (Moderate) Administer pexidartinib 2 hours before or 10 hours after H2-blockers as concurrent administration may reduce pexidartinib exposure. Although the effects of H2-blockers on pexidartinib pharmacokinetics have not been studied, other acid-reducing agents have been shown to decrease pexidartinib exposure by 50%. [64535] Pioglitazone; Metformin: (Minor) Famotidine may decrease the renal clearance of metformin secondary to competition for renal tubular transport systems. Such an interaction has been observed when cimetidine was administered with metformin. The decrease in renal excretion led to a 40% increase in metformin AUC. Although interactions with cationic drugs remain theoretical (except for cimetidine), caution is warranted when famotidine and metformin are prescribed concurrently. Famotidine may be less likely to interact with metformin versus cimetidine or ranitidine because of less tubular excretion. [7775] Polyethylene Glycol; Electrolytes; Bisacodyl: (Minor) The concomitant use of bisacodyl tablets with H2-blockers can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Avoid H2-blockers within 1 hour before or after the bisacodyl dosage. [4701] Rasagiline: (Moderate) Monitor for dopaminergic adverse effects during concurrent use of rasagiline and famotidine. Coadministration may result in increased rasagiline concentrations. A dose reduction of rasagiline may be necessary. Rasagiline is primarily metabolized by CYP1A2; famotidine is a weak CYP1A2 inhibitor. When administered with a strong CYP1A2 inhibitor, the AUC of rasagiline was increased by 83%. [32223] [51834] Rilpivirine: (Moderate) Coadministration with famotidine may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure. To decrease the risk of virologic failure, avoid use of famotidine for at least 12 hours before and at least 4 hours after administering rilpivirine. [44376] Risedronate: (Major) Use of H2-blockers with delayed-release risedronate tablets (Atelvia) is not recommended. Co-administration of drugs that raise stomach pH increases risedronate bioavailability due to faster release of the drug from the enteric coated tablet. This interaction does not apply to risedronate immediate-release tablets. [42080] Secretin: (Major) Discontinue use of H2-blockers at least 2 days before administering secretin. Patients who are receiving H2-blockers at the time of stimulation testing may be hyperresponsive to secretin stimulation, falsely suggesting gastrinoma. [61502] Selpercatinib: (Major) Avoid coadministration of selpercatinib with famotidine due to the risk of decreased selpercatinib exposure which may reduce its efficacy. If concomitant use is unavoidable, take selpercatinib 2 hours before or 10 hours after administration of famotidine. Coadministration with acid-reducing agents decreases selpercatinib plasma concentrations; however, no clinically significant differences in the pharmacokinetics of selpercatinib were observed when given under fasting conditions with multiple daily doses of another H2-receptor antagonist given 10 hours prior to and 2 hours after the selpercatinib dose. [65387] Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Sofosbuvir; Velpatasvir: (Major) H2-blockers may be administered simultaneously with or 12 hours apart from velpatasvir. H2-blocker doses should not exceed doses comparable to famotidine 40 mg twice daily. Velpatasvir solubility decreases as pH increases; therefore, drugs that increase gastric pH are expected to decrease the concentrations of velpatasvir, potentially resulting in loss of antiviral efficacy. [60911] Sofosbuvir; Velpatasvir; Voxilaprevir: (Major) H2-blockers may be administered simultaneously with or 12 hours apart from velpatasvir. H2-blocker doses should not exceed doses comparable to famotidine 40 mg twice daily. Velpatasvir solubility decreases as pH increases; therefore, drugs that increase gastric pH are expected to decrease the concentrations of velpatasvir, potentially resulting in loss of antiviral efficacy. [60911] Sonidegib: (Moderate) Based on population PK analysis, the concomitant administration of a histamine-2-receptor antagonist such as famotidine decreases the geometric mean sonidegib steady-state AUC (0-24 hours) value by 34%. [6000] Sotorasib: (Major) Avoid coadministration of sotorasib and gastric acid-reducing agents, such as H2-receptor antagonists. Coadministration may decrease sotorasib exposure resulting in decreased efficacy. If necessary, sotorasib may be administered 4 hours before or 10 hours after a locally acting antacid. Coadministration with an H2-receptor antagonist decreased sotorasib exposure by 38% under fed conditions. [66700] Sparsentan: (Major) Avoid concurrent use of sparsentan and H2 receptor antagonists due to the risk for decreased sparsentan exposure which may reduce its efficacy. Medications that affect gastric pH may reduce sparsentan absorption. [68641] Sumatriptan; Naproxen: (Moderate) Avoid concomitant use of enteric-coated, delayed-release naproxen and H2-blockers due to the gastric pH elevating effects of H2-blockers. Enteric-coated, delayed-release naproxen tablets are designed to dissolve at a pH of 6 or more. [32122] Thalidomide: (Moderate) Thalidomide and other agents that slow cardiac conduction such as H2-blockers should be used cautiously due to the potential for additive bradycardia. [49713] Theophylline, Aminophylline: (Minor) Aminophylline is a prodrug of theophylline, and is primarily metabolized in the liver by the CYP1A2 isoenzyme. In general, famotidine does not interact with aminophylline and does not affect theophylline levels in most patients. One small study documented a significant decrease in theophylline clearance after therapy with famotidine. Be alert for any evidence of interaction, and monitor the patients aminophylline therapy as per standard of care or if side effects are reported. [50759] (Minor) Theophylline is primarily metabolized in the liver by the CYP1A2 isoenzyme. In general, famotidine does not interact with theophylline and does not affect theophylline levels in most patients. One small study documented a significant decrease in theophylline clearance after therapy with famotidine. Be alert for any evidence of interaction, and monitor the patients theophylline therapy as per standard of care or if side effects are reported. [50759] Tizanidine: (Major) Avoid concomitant use of tizanidine and famotidine as increased tizanidine exposure may occur. If use together is necessary, initiate tizanidine at 2 mg and increase by 2 to 4 mg/day based on clinical response. Discontinue tizanidine if hypotension, bradycardia, or excessive drowsiness occurs. Tizanidine is a CYP1A2 substrate and famotidine is a weak CYP1A2 inhibitor. [51477] [52430] Warfarin: (Moderate) Closely monitor the INR if coadministration of warfarin with famotidine is necessary as concurrent use may increase the exposure of warfarin leading to increased bleeding risk. Famotidine is a CYP1A2 inhibitor and the R-enantiomer of warfarin is a CYP1A2 substrate. The S-enantiomer of warfarin exhibits 2 to 5 times more anticoagulant activity than the R-enantiomer, but the R-enantiomer generally has a slower clearance. [28549] [51834]
Revision Date: 01/11/2024, 04:54:00 PM

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Monitoring Parameters

  • intragastric pH
  • serum creatinine/BUN

US Drug Names

  • Heartburn Relief
  • Pepcid
  • Pepcid AC
  • Pepcid AC Maximum Strength
  • Zantac 360
;