From the Guidelines
Taking Pepcid (famotidine) twice a day is a viable option for patients who require acid suppression, especially when considering the potential interactions between proton pump inhibitors (PPIs) and antiplatelet therapy, as evidenced by studies such as 1. When managing patients on dual antiplatelet therapy, such as those with acute coronary syndrome (ACS), the choice of acid-suppressive therapy is crucial due to potential drug interactions.
- The use of PPIs with clopidogrel has been a subject of concern due to the potential reduction in the efficacy of clopidogrel, as suggested by studies examining the pharmacokinetics and pharmacodynamics of thienopyridines with PPIs 1.
- However, the study also notes that not all PPIs have the same effect, with pantoprazole possibly being less inhibitory on CYP450 2C19 compared to other PPIs like omeprazole.
- An alternative approach could be the use of H2 antagonists like famotidine, which have been shown to be effective in reducing the incidence of peptic ulcers and bleeding in patients taking low-dose aspirin, without significantly interfering with the antiplatelet activity of clopidogrel, as seen in the FAMOUS trial mentioned in 1.
- The dosage of Pepcid (famotidine) 20 mg twice daily has been found beneficial in such scenarios, providing a balance between efficacy in acid suppression and minimal interference with antiplatelet therapy.
- It's essential for healthcare providers to weigh the benefits and risks of different acid-suppressive therapies in the context of dual antiplatelet therapy, considering factors such as the specific medications used, patient comorbidities, and the potential for drug interactions, as highlighted in 1.
From the FDA Drug Label
2.3 Administration Instructions • Take Famotidine once daily before bedtime or twice daily in the morning and before bedtime, as recommended.
Table 1 shows the recommended dosage of Famotidine 20 mg and 40 mg tablets in adults and pediatric patients weighing 40 kg or greater with normal renal function.
Active duodenal ulcer (DU) 40mg once daily; or 20mg twice daily Symptomatic non-erosive GERD 20mg twice daily
The recommended dosage for Famotidine includes taking 20mg twice daily for certain conditions, which indicates that taking Pepcid (Famotidine) twice a day is okay for specific indications, as long as the patient has normal renal function and meets the other specified criteria 2.
From the Research
Dosage of Pepcid (Famotidine)
- The standard dosage of Pepcid (Famotidine) is 20mg twice a day or 40mg at bedtime for the treatment of peptic ulcer disease 3.
- A study comparing the efficacy of famotidine 20mg twice a day versus 40mg twice a day in the treatment of erosive or ulcerative reflux esophagitis found that the higher dose was more effective in achieving healing and symptom relief 4.
Efficacy of Pepcid (Famotidine)
- Famotidine has been shown to be effective in healing both duodenal and gastric ulcers, as well as in preventing recurrence of duodenal ulcer 3.
- In the treatment of non-erosive gastro-oesophageal reflux disease, famotidine 20mg twice a day was found to be less effective than omeprazole in H. pylori-negative patients, but similar in efficacy in H. pylori-positive patients 5.
Comparison with Other Treatments
- Proton-pump inhibitors (PPIs) such as omeprazole have been shown to be more effective than histamine2-receptor antagonists like famotidine in the treatment of gastroesophageal reflux disease (GERD) 6, 5.
- A review of GERD treatment options found that PPIs are the most common treatment, and that lifestyle changes, medication, and surgery are the main treatment options for GERD 7.