Pepcid (Famotidine) Discontinuation Before Fundoplication Surgery
Pepcid (famotidine) does not require routine discontinuation before fundoplication surgery and can typically be continued up to the morning of surgery, as H2-receptor antagonists like famotidine are not associated with increased surgical bleeding risk and may actually provide benefit by reducing gastric acidity during the perioperative period.
Rationale for Continuation
Lack of Bleeding Risk
- Famotidine is an H2-receptor antagonist that reduces gastric acid secretion but has no effect on coagulation, platelet function, or surgical hemostasis 1.
- The perioperative antithrombotic guidelines classify surgeries by bleeding risk but do not include acid-suppressing medications like famotidine in their interruption recommendations, as these drugs do not contribute to surgical bleeding 1.
Potential Perioperative Benefits
- Preoperative famotidine administration (20-40 mg) effectively increases gastric pH above 4.0 and reduces gastric volume, which may decrease aspiration risk during anesthesia induction 2, 3.
- When famotidine is given both the night before and morning of surgery, it significantly reduces gastric acidity compared to placebo, with peak effectiveness when dosed 1-2 hours preoperatively 2, 3.
Practical Dosing Approach
Standard Preoperative Regimen
- Continue famotidine at the patient's usual dose through the morning of surgery with a small sip of water 2, 3.
- If the patient is not currently on famotidine, consider administering 20-40 mg orally the night before and morning of surgery (1-2 hours preoperatively) for aspiration prophylaxis 2, 3.
- Alternative routes (intravenous or intramuscular) given 1 hour before surgery are equally effective if oral administration is not feasible 2.
Important Caveats
- Avoid administering large volumes of intravenous crystalloid fluids (>500 mL) in the hours before surgery in patients taking famotidine, as this may paradoxically increase gastric volume and attenuate the pH-elevating effects of the medication 4.
- The timing of famotidine administration matters: a single dose given only the evening before surgery (>9 hours preoperatively) may not provide adequate gastric pH control at the time of induction 5.
Postoperative Considerations
Resumption After Fundoplication
- Most patients (approximately 80%) will resume acid suppression therapy, including PPIs or H2-antagonists like famotidine, after fundoplication surgery due to persistent or recurrent reflux symptoms 6.
- The decision to continue or restart famotidine postoperatively should be based on symptom control and the success of the surgical fundoplication 6.
Key Distinction from Anticoagulants
Do not confuse famotidine management with anticoagulant management: while medications like enoxaparin require 12-24 hour discontinuation before surgery and DOACs require 1-4 days of interruption based on bleeding risk, famotidine has no such requirement 1, 7. The perioperative guidelines for antithrombotic therapy do not apply to acid-suppressing medications 1.