famotidine (fa moe' ti deen) Apo-Famotidine, Novo-Famotidine, Pepcid, Pepcid AC, Pepcid IV, Pepcid RPD Pregnancy Category

B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Drug class: Histamine 2 (H2) receptor antagonist Therapeutic actions Competitively blocks the action of histamine at the histamine (H2) receptors of the parietal cells of the stomach; inhibits basal gastric acid secretion and chemically induced gastric acid secretion. Indications Short-term treatment and maintenance of duodenal ulcer Short-term treatment of benign gastric ulcer Treatment of pathologic hypersecretory conditions (eg, Zollinger-Ellison syndrome) Short-term treatment of GERD, esophagitis due to GERD OTC: Relief of symptoms of heartburn, acid indigestion, sour stomach

Contraindications and cautions Contraindicated with allergy to famotidine; renal failure; lactation. Use cautiously with pregnancy, renal or hepatic dysfunction.

Available forms Tablets10, 20, 40 mg; chewable tablets10 mg; orally disintegrating tablets20, 40 mg; gelcaps10 mg; powder for oral suspension40 mg/5 mL; injection10 mg/mL; injection, premixed20 mg/50 mL in 0.9% sodium chloride Dosages ADULTS Acute treatment of active duodenal ulcer: 40 mg PO or IV hs or 20 mg bid PO or IV. Therapy at full dosage should generally be discontinued after 68 wk. Maintenance therapy for duodenal ulcer: 20 mg PO hs. Benign gastric ulcer: 40 mg PO daily hs. Hypersecretory syndrome: 20 mg q 6 hr PO initially. Doses up to 160 mg q 6 hr have been administered. 20 mg IV q 12 hr in patients unable to take oral drugs.

GERD: 20 mg bid PO for up to 6 wk. For patients with esophagitis, the dose is 2040 mg bid PO for up to 12 wk. Heartburn, acid indigestion: 10 mg PO for relief; 10 mg PO 1 hr before eating for prevention. Do not exceed 20 mg/24 hr.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL IMPAIRMENT Reduce dosage to 20 mg PO hs or 40 mg PO q 3648 hr. Pharmacokinetics Metabolism: Hepatic; T1/2: 2.53.5 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine IV facts Preparation: For direct injection, dilute 2 mL (solution contains 10 mg/mL) with 0.9% sodium chloride injection, water for injection, 5% or 10% dextrose injection, lactated Ringers injection, or 5% sodium bicarbonate injection to a total volume of 510 mL. For infusion, 2 mL diluted with 100 mL 5% dextrose solution or other IVs. Stable for 48 hr at room temperature, 14 days if refrigerated. Infusion: Inject directly slowly, over not less than 2 min. Infuse over 1530 min; continuous infusion: 40 mg/24 hr. Adverse effects CNS: Headache, malaise, dizziness, somnolence, insomnia Dermatologic: Rash GI: Diarrhea, constipation, anorexia, abdominal pain Other: Muscle cramp, increase in total bilirubin, sexual impotence

Nursing considerations Assessment History: Allergy to famotidine; renal failure; lactation, pregnancy, hepatic impairment

Physical: Skin lesions; liver evaluation, abdominal examination, normal output; renal function tests, serum bilirubin
Route Oral IV Onset Slow < 1 Hr Peak 1-3 Hr 0.5 - 3 Hr Duration 6-12 Hr 8 - 15 Hr

Interventions If using one dose a day, administer drug hs. Decrease doses with renal failure. Arrange for administration of concurrent antacid therapy to relieve pain.

Teaching points Take this drug at bedtime (or in the morning and at bedtime). Therapy may continue for 46 wk or longer. Place rapidly disintegrating tablet on tongue and swallow with or without water. Take antacid exactly as prescribed, being careful of the times of administration. Have regular medical follow-up while using this drug to evaluate your response. Take OTC drug 1 hr before eating to prevent indigestion. Do not take more than two per day. You may experience these side effects: Constipation or diarrhea; loss of libido or impotence (reversible); headache (adjust lights, temperature, noise levels). Report sore throat, fever, unusual bruising or bleeding, severe headache, muscle or joint pain.