What dose of Pepcid (famotidine) can be prescribed during pregnancy?

From the Guidelines

Famotidine (Pepcid) can be prescribed during pregnancy at a dose of 20 mg twice daily, as it is considered a safe option for managing heartburn and acid reflux. The dose equivalence among H2 antagonists, as shown in a study published in the Journal of Hepatology 1, indicates that famotidine 20 mg twice daily is a standard dose, equivalent to other H2 antagonists like ranitidine 150 mg twice daily. Key points to consider when prescribing famotidine during pregnancy include:

• Famotidine is a pregnancy category B medication, meaning it has not demonstrated risk to the fetus in animal studies, and there are no adequate studies in pregnant women showing adverse effects 1.
• The recommended starting dose for heartburn and acid reflux during pregnancy is usually 20 mg twice daily, which can be adjusted based on symptom response.
• Lifestyle modifications, such as avoiding trigger foods, eating smaller meals, and elevating the head during sleep, should be tried first, but famotidine provides a safe pharmacological option when these measures are insufficient.
• Famotidine works by reducing stomach acid production by blocking histamine H2 receptors in the stomach, which helps relieve symptoms without crossing the placenta in significant amounts. It is essential to note that while the study 1 provides information on dose equivalence, it is crucial to prioritize the safety and well-being of the pregnant patient, and famotidine is generally preferred over category C medications when acid suppression is needed during pregnancy.

From the Research

Dosage of Pepcid During Pregnancy

The dosage of Pepcid (famotidine) that can be prescribed during pregnancy is not explicitly stated in the provided studies. However, the studies provide information on the safety and efficacy of famotidine during pregnancy.

• The study 2 found that exposure to famotidine during the first trimester of pregnancy was not associated with an increased risk of congenital malformations in infants.
• The study 3 developed a physiologically based pharmacokinetic (PBPK) model for famotidine in non-pregnant and pregnant populations, and found that famotidine exposure was predicted to be decreased by 24% in mid-pregnancy and 20% in late pregnancy compared to non-pregnant populations.
• The study 4 found that famotidine 20 mg twice daily or 40 mg at bedtime may be an effective alternative to standard doses of cimetidine for healing gastric ulcers and duodenal ulcers.
• The study 5 found that famotidine 40 mg twice a day was more effective than 20 mg twice a day in the treatment of erosive or ulcerative reflux esophagitis.
• The study 6 found that treatment with high-dose famotidine (40 mg twice daily) significantly reduces the cumulative incidence of both gastric and duodenal ulcers in patients with arthritis receiving long-term NSAID therapy.

Considerations for Prescribing Pepcid During Pregnancy

When prescribing Pepcid during pregnancy, the following considerations should be taken into account:

• The safety of famotidine during pregnancy has been established, but the optimal dosage has not been explicitly stated.
• The dosage of famotidine may need to be adjusted based on the individual patient's response to treatment and the severity of their symptoms.
• The study 3 suggests that famotidine exposure may be decreased during pregnancy, which may affect the efficacy of the treatment.
• The studies 5 and 6 suggest that higher doses of famotidine (40 mg twice daily) may be more effective in certain conditions, but the safety and efficacy of this dosage during pregnancy have not been established.