What is the effect of taking Famotidine 20 mg twice a day?

From the Guidelines

Famotidine 20 mg twice daily is a recommended dosing regimen for reducing the incidence of peptic ulcers, hematomas, and bleeding in patients taking low-dose aspirin, as evidenced by the FAMOUS trial 1. The FAMOUS trial, a phase II, double-blind, randomized, placebo-controlled trial, found that among patients with a history of coronary heart disease, diabetes mellitus, or cerebrovascular disease who were taking low-dose ASA, 12 weeks of famotidine 20 mg twice daily was beneficial in reducing the incidence of peptic ulcer or hematomas of 5 cm, intracranial hemorrhage, and bleeding that required surgery 1. Some key points to consider when taking famotidine 20 mg twice daily include:

• The rate of occurrence of a gastric ulcer at endoscopy at 12 weeks was 3.4% in the famotidine group versus 15% in the placebo group (P0.0002) 1
• Duodenal ulcer occurred in 0.5% versus 8.5% (P0.0045) 1
• Erosive esophagitis was seen in 4.4% versus 19% (P0.0001) 1
• Clopidogrel use was 19% and dipyridamole use in the famotidine group 1 It is essential to note that famotidine is a histamine-2 (H2) blocker that reduces stomach acid production by blocking histamine receptors in the stomach lining. Some general considerations for taking famotidine include:
• Take famotidine with a full glass of water, with or without food
• Common side effects may include headache, dizziness, or constipation
• If you're taking other medications, space them at least 2 hours apart from famotidine as it can affect absorption of certain drugs
• Seek medical attention if you experience severe side effects like irregular heartbeat, seizures, or signs of infection
• Those with kidney disease may require dose adjustment 1

From the FDA Drug Label

As shown in Table 4,70% of patients treated with Famotidine 40 mg tablets at bedtime were healed by Week 4. ... Famotidine Tablets 20mg twice daily (N=84) ... Week 2 38% ... Week 4 67%

In the U. S. trial that enrolled patients with symptoms of GERD and without endoscopic evidence of esophageal erosion or ulceration. As shown in Table 6, patients treated with Famotidine 20 mg twice daily had greater improvement in symptomatic GERD than patients treated with 40 mg at bedtime or placebo

The U. S. trial comparing orally-administered Famotidine 40 mg twice daily to placebo and orally administered Famotidine 20 mg twice daily showed a significantly greater percentage of healing of erosive esophagitis for Famotidine 40 mg tablets twice daily at Weeks 6 and 12

• The effect of taking Famotidine 20 mg twice a day includes:
  • Healing of duodenal ulcers in 67% of patients by Week 4
  • Improvement in symptomatic GERD in 82% of patients by Week 6
  • Healing of erosive esophagitis in 32% of patients by Week 6 and 54% by Week 12 2

From the Research

Effect of Famotidine 20 mg Twice a Day

The effect of taking Famotidine 20 mg twice a day has been studied in several clinical trials.

• Famotidine is a highly selective histamine H2-receptor antagonist, approximately 20 to 50 times more potent at inhibiting gastric acid secretion than cimetidine and 8 times more potent than ranitidine on a weight basis 3.
• Therapeutic trials have shown that famotidine 20 mg twice daily may be an effective alternative to standard doses of cimetidine for healing gastric ulcers and to standard doses of cimetidine and ranitidine for healing duodenal ulcers 4.
• Famotidine 20 mg twice daily achieves healing rates and symptom relief similar or superior to those achieved by cimetidine 800mg daily or ranitidine 300mg daily in patients with peptic ulcer disease 3.
• The cumulative healing rate with famotidine was 46% at two weeks, 77% at four weeks, and 91% at eight weeks 5.
• Adverse effects were uncommon with all dosages examined, and the most common adverse experiences were headache and constipation 5.

Comparison with Other Treatments

• Famotidine was equal in efficacy to ranitidine or cimetidine and superior to placebo and gefarnate at all times examined 5.
• There were no significant differences in efficacy or side effects associated with different oral dosing regimens of famotidine, including 20 mg BID, 40 mg HS, and 40 mg BID 5.
• Famotidine appeared to be effective in ranitidine-resistant patients with severe gastroesophageal reflux disease (GERD) 6.

Tolerability and Safety

• Famotidine is very well tolerated and is free of the antiandrogenic effects infrequently reported with cimetidine 3.
• Famotidine is not associated with altered hepatic metabolism of drugs 4, 3.
• Adverse effects led to the discontinuation of therapy in only a few patients, and no patient undergoing therapy for active duodenal ulcer had a biochemical abnormality that required a change in therapy or that was drug related in the opinion of the investigator 5.