From the FDA Drug Label
In some hospitalized patients with pathological hypersecretory conditions or intractable duodenal ulcers, or in patients who are unable to take oral medication, ranitidine hydrochloride may be administered parenterally according to the following recommendations:
The recommended dosage for famotidine injection in adult patients is 20 mg intravenously q 12 h
The patient is NPO since midnight and has heartburn.
- Ranitidine (IV) can be administered to patients who are unable to take oral medication.
- Famotidine (IV) can be administered to patients who are unable to take oral medication. Considering the patient's condition, IV ranitidine or IV famotidine can be given to the patient. The dosage for IV ranitidine is 50 mg every 6 to 8 hours and for IV famotidine is 20 mg intravenously q 12 h 1 2.
From the Research
I recommend administering IV famotidine 20 mg for the patient's heartburn, as it is the most appropriate option given the patient's NPO status and the need for symptomatic relief. Since the patient is NPO (nothing by mouth) in preparation for what is likely a cholecystectomy for cholelithiasis, oral medications are contraindicated. Famotidine can be given intravenously as a slow push over 2 minutes or diluted in 50-100 mL of normal saline and infused over 15-30 minutes. Alternative IV options include pantoprazole 40 mg or ondansetron 4 mg if the heartburn is accompanied by nausea. The patient's heartburn may be related to acid reflux exacerbated by the underlying gallbladder condition, as gallstones can cause dyspeptic symptoms, as noted in a study on cholelithiasis management 3. IV acid suppressants like famotidine work by blocking histamine H2 receptors in the stomach, reducing acid production and alleviating heartburn symptoms. This approach provides symptomatic relief while maintaining the patient's NPO status for the planned procedure. It's worth noting that regular use of gastric acid suppressants, including H2RAs like famotidine, has been associated with an increased risk of cholelithiasis in a prospective cohort study 4. However, in this case, the benefits of symptomatic relief for the patient's heartburn outweigh the potential risks, and the use of IV famotidine is a reasonable choice given the patient's current clinical situation.