From the Guidelines
Famotidine 20 mg twice daily is a recommended dose for reducing the incidence of peptic ulcers 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 benefits of this dosing regimen include:
- Reduced incidence of gastric ulcers, with a rate of 3.4% in the famotidine group versus 15% in the placebo group (P0.0002) 1
- Reduced incidence of duodenal ulcers, with a rate of 0.5% versus 8.5% (P0.0045) 1
- Reduced incidence of erosive esophagitis, with a rate of 4.4% versus 19% (P0.0001) 1 It's also worth noting that the use of H2 antagonists like famotidine may be considered as an alternative to PPIs in the setting of dual-antiplatelet therapy, as they do not interfere with the antiplatelet activity of clopidogrel 1. In terms of side effects, the 20 mg twice daily dose of famotidine is typically well-tolerated, with minimal side effects, which may include headache, constipation, or diarrhea. Overall, the evidence suggests that famotidine 20 mg twice daily is a safe and effective dose for reducing the risk of peptic ulcers and bleeding in patients taking low-dose aspirin 1.
From the FDA Drug Label
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 Table 6: Patients with Improvement of Symptomatic GERD (N=376) Famotidine 20mg twice daily (N=154) Week 6 82% a In 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 (Table 7). Table 7: Patients with Endoscopic Healing of Erosive Esophagitis - U. S. Study (N=318) Famotidine 20mg twice daily (N=125) Week 6 32% Week 12 54% a
The effect of Famotidine (Pepcid) 20 milligrams (mg) twice daily (bid) is:
- Improvement in symptomatic GERD: 82% of patients had improvement in symptomatic GERD at Week 6 2
- Healing of erosive esophagitis: 32% of patients had healing of erosive esophagitis at Week 6 and 54% at Week 12 2
- Relief of daytime and nighttime heartburn: patients had faster relief of daytime and nighttime heartburn compared to placebo 2
- Reduction of duodenal ulcer recurrence: lower rates of DU recurrence compared to placebo 2
From the Research
Effect of Famotidine 20mg Twice Daily
- Famotidine 20mg twice daily is effective in healing both duodenal and gastric ulcers, with 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.
- In the treatment of erosive or ulcerative reflux esophagitis, famotidine 20mg twice daily achieves significant relief of symptoms, but overall endoscopic healing is better with famotidine 40mg twice daily 4.
- Famotidine 20mg twice daily is effective in relieving gastrooesophageal reflux symptoms in patients without erosive oesophagitis, with significant improvement in global assessment of symptoms at 2 and 6 weeks 5.
- In the treatment of gastritis, famotidine 20mg twice daily is effective in relieving symptoms, including epigastric pain, heartburn, and discomfort, with endoscopic assessment showing healing of erosions and hemorrhages in a substantial number of patients 6.
Comparison with Other Doses
- Famotidine 40mg twice daily is more effective than 20mg twice daily in achieving overall endoscopic healing in patients with erosive or ulcerative reflux esophagitis, particularly in those with more severe esophagitis 4.
- In patients with gastroesophageal reflux disease (GERD), famotidine 20mg twice daily is effective, but long-term treatment with higher doses may be necessary to prevent recurrence 7.