Is Pepcid (Famotidine) effective for treating chronic cough suspected to be caused by Gastroesophageal Reflux Disease (GERD)?

Famotidine for Chronic Cough Due to GERD

Famotidine (Pepcid) is recommended as part of a comprehensive treatment approach for chronic cough suspected to be caused by GERD, but only when patients report heartburn and regurgitation symptoms. 1

Evidence-Based Approach to GERD-Related Chronic Cough

When to Consider GERD as a Cause of Chronic Cough

• GERD should be considered as a potential cause of chronic cough after ruling out other common causes such as:
  • Environmental/occupational irritants
  • Smoking
  • ACE inhibitor use
  • Abnormal chest radiographic findings
  • Asthma
  • Upper airway cough syndrome
  • Nonasthmatic eosinophilic bronchitis 1

Treatment Algorithm for GERD-Related Chronic Cough

1. For patients with chronic cough AND heartburn/regurgitation symptoms:

   • H2-receptor antagonists (like famotidine) are recommended as part of treatment
   • Treatment should include:
     • Diet modification for weight loss if overweight/obese
     • Head of bed elevation
     • Avoiding meals within 3 hours of bedtime
     • Famotidine, PPIs, alginate, or antacid therapy sufficient to control symptoms 1, 2

2. For patients with chronic cough WITHOUT heartburn/regurgitation:

   • Famotidine or other acid-suppression therapy alone is NOT recommended
   • The CHEST guidelines explicitly recommend against using PPI therapy alone in this situation 1

Dosing and Duration

• For symptomatic GERD, famotidine 20mg twice daily has shown greater improvement (82%) compared to 40mg at bedtime (69%) or placebo (62%) 3
• Treatment response time:
  • GI symptoms typically respond within 4-8 weeks
  • Cough improvement may take up to 3 months 1

Important Clinical Considerations

Efficacy of Famotidine for GERD

• Famotidine is FDA-approved for symptomatic non-erosive GERD and erosive esophagitis 3
• In clinical trials, famotidine 20mg twice daily demonstrated significant improvement in symptomatic GERD compared to placebo 3

Limitations and Caveats

• There is nothing specific about the character or timing of cough due to GERD that distinguishes it from other causes 1
• GERD can cause cough without typical GI symptoms in up to 75% of cases ("silent reflux") 1
• H2-receptor antagonists like famotidine are less effective than PPIs but can be useful for breakthrough symptoms, particularly nighttime symptoms 2
• In H. pylori-negative patients, omeprazole has shown better control of GERD symptoms than famotidine, while similar efficacy was observed in H. pylori-positive patients 4

When to Consider Further Testing

• If a patient fails to respond to a 3-month trial of medical antireflux therapy:
  • Consider esophageal manometry and pH-metry
  • These tests should be performed after withholding PPI therapy for 7 days and H2 receptor antagonists for 3 days 1, 2

Bottom Line

Famotidine can be effective for treating chronic cough when it's related to GERD with typical reflux symptoms (heartburn/regurgitation). However, it should be used as part of a comprehensive approach that includes lifestyle modifications. For patients without typical reflux symptoms, acid suppression therapy alone is unlikely to resolve the cough, and alternative approaches should be considered.