From the FDA Drug Label
Famotidine is indicated for short term treatment of patients with symptoms of GERD The doses and regimen for parenteral administration in patients with GERD have not been established.
The patient's symptoms of heartburn can be treated with famotidine IV for short-term treatment of GERD symptoms. However, the dosage and regimen for parenteral administration in patients with GERD have not been established 1, 1.
From the Research
For a patient with heartburn who is NPO after failing a modified barium swallow study, intravenous famotidine (Pepcid IV) is an appropriate treatment option, as it reduces stomach acid production and alleviates heartburn symptoms. The recommended dosage is typically 20 mg IV every 12 hours 2. This H2-receptor antagonist is suitable for IV administration since the patient has no nasogastric tube (NGT) and the family declines placement. Alternative options could include IV proton pump inhibitors like pantoprazole 40 mg daily if famotidine proves insufficient. It's essential to monitor the patient for symptom relief and consider addressing the underlying cause of dysphagia identified in the failed MBS. Once the patient is cleared for oral intake, transitioning to oral acid-suppressing medications would be appropriate. Some key points to consider in the management of heartburn in this context include:
- The use of antacids and acid-suppressing medications to manage symptoms
- The potential benefits and risks of different treatment options, including H2-receptor antagonists and proton pump inhibitors
- The importance of addressing the underlying cause of dysphagia and heartburn symptoms
- The need for careful monitoring and adjustment of treatment as necessary to ensure optimal symptom relief and minimize adverse effects. Given the most recent evidence from 2023 2, it is crucial to weigh the benefits and risks of acid-suppressing therapy in the context of gastroesophageal reflux disease, particularly in vulnerable populations such as neonates and infants, and to consider the potential for increased risk of certain adverse outcomes associated with the use of these medications.