What is the recommended dose of IV Pepcid (famotidine)?

IV Famotidine Dosing

The standard dose of IV famotidine for adults is 20 mg administered intravenously every 12 hours. 1

Standard Adult Dosing

• 20 mg IV every 12 hours is the FDA-approved dose for hospitalized patients with pathological hypersecretory conditions, intractable ulcers, or those unable to take oral medication 1

• The medication can be administered by either:

  • Slow IV push over at least 2 minutes (dilute 2 mL in 5-10 mL of compatible solution) 1
  • IV infusion over 15-30 minutes (dilute 2 mL in 100 mL of compatible solution) 1

• Rapid IV injection (over 44 seconds) has been shown to be safe in ICU patients with no significant adverse cardiovascular effects compared to slow infusion, and is more cost-effective 2

Pediatric Dosing (Ages 1-16 Years)

• Starting dose: 0.25 mg/kg IV every 12 hours (maximum 40 mg/day) 1
• Administer over at least 2 minutes as IV push or as a 15-minute infusion 1
• Published studies have demonstrated gastric acid suppression with doses up to 0.5 mg/kg IV every 12 hours 1
• No data available for infants under 1 year of age 1

Pathological Hypersecretory Conditions (Zollinger-Ellison Syndrome)

• Initial dose: 20 mg IV every 12 hours 1
• Some patients may require higher starting doses 1
• Oral doses up to 160 mg every 6 hours have been used in severe cases 1
• Famotidine is 20-50 times more potent than cimetidine and 8 times more potent than ranitidine for acid suppression 3

Renal Dosing Adjustments

For patients with moderate to severe renal insufficiency (CrCl <50 mL/min):

• Reduce dose to half (10 mg every 12 hours), OR

• Prolong dosing interval to 36-48 hours 1

• The elimination half-life increases significantly in renal insufficiency, potentially exceeding 20 hours and reaching approximately 24 hours in anuric patients 1

• CNS adverse effects have been reported in patients with renal insufficiency, making dose adjustment critical 1

Administration Considerations

• Compatible IV solutions include: 0.9% Sodium Chloride, 5% and 10% Dextrose, Lactated Ringer's, and Water for Injection 1
• Diluted solutions are stable for 7 days at room temperature in most common IV solutions 1
• Antacids may be given concomitantly if needed 1
• Onset of antisecretory activity occurs within 1 hour, with duration lasting 10-12 hours 4

Key Safety Points

• Unlike cimetidine, famotidine does not have antiandrogenic effects or alter hepatic drug metabolism 5, 3
• Famotidine does not affect cardiovascular, renal, endocrine, or gastrointestinal motility functions 4
• The drug is well-tolerated with minimal adverse effects reported in clinical trials 3