Famotidine instructions for administration

# Instructions for administration
Duodenal ulcer
Benign gastric ulcer
Gastroesophageal reflux disease
Pediatric patients <1 year of age (GERD)
Pediatric patients 1-16 years of age
Pathological hypersecretory conditions
Oral suspension
Orally disintegrating tablets
Concomitant use of antacids
Patients with moderate/severe renal insufficiency

## Duodenal ulcer
- Acute therapy: The recommended adult oral dosage for active duodenal ulcer is 40 mg once a day at bedtime. Most patients heal within 4 weeks; there is rarely reason to use Famotidine at full dosage for longer than 6 to 8 weeks. A regimen of 20 mg b.i.d. is also effective.
- Maintenance therapy: The recommended adult oral dose is 20 mg once a day at bedtime. Return to top

## Benign gastric ulcer
- Acute therapy: The recommended adult oral dosage for active benign gastric ulcer is 40 mg once a day at bedtime. Return to top

## Gastroesophageal reflux disease
The recommended oral dosage for treatment of adult patients with symptoms of GERD is 20 mg b.i.d. for up to 6 weeks. The recommended oral dosage for the treatment of adult patients with esophagitis including erosions and ulcerations and accompanying symptoms due to GERD is 20 or 40 mg b.i.d. for up to 12 weeks. Return to top

## Pediatric patients <1 year of age (GERD)
Studies suggest the following starting doses in pediatric patients <1 year of age: Gastroesophageal Reflux Disease (GERD) - 0.5 mg/kg/dose of Famotidine oral suspension for the treatment of GERD for up to 8 weeks once daily in patients <3 months of age and 0.5 mg/kg/dose twice daily in patients 3 months to <1 year of age. Patients should also be receiving conservative measures (e.g., thickened feedings). The use of intravenous Famotidine in pediatric patients <1 year of age with GERD has not been adequately studied. Return to top

## Pediatric patients 1-16 years of age
Studies suggest the following starting doses in pediatric patients 1 to 16 years of age:
- Peptic ulcer: 0.5 mg/kg/day p.o. at bedtime or divided b.i.d. up to 40 mg/day.
- Gastroesophageal Reflux Disease with or without esophagitis including erosions and ulcerations: 1.0 mg/kg/day p.o. divided b.i.d. up to 40 mg b.i.d.
While published uncontrolled studies suggest effectiveness of Famotidine in the treatment of gastroesophageal reflux disease and peptic ulcer, data in pediatric patients are insufficient to establish percent response with dose and duration of therapy. Therefore, treatment duration (initially based on adult duration recommendations) and dose should be individualized based on clinical response and/or pH determination (gastric or esophageal) and endoscopy. Published uncontrolled clinical studies in pediatric patients have employed doses up to 1 mg/kg/day for peptic ulcer and 2 mg/kg/day for GERD with or without esophagitis including erosions and ulcerations. Return to top

## Pathological hypersecretory conditions
The dosage of Famotidine in patients with pathological hypersecretory conditions varies with the individual patient. The recommended adult oral starting dose for pathological hypersecretory conditions is 20 mg q 6 h. In some patients, a higher starting dose may be required. Doses should be adjusted to individual patient needs and should continue as long as clinically indicated. Doses up to 160 mg q 6 h have been administered to some adult patients with severe Zollinger-Ellison Syndrome. Return to top

## Oral suspension
Famotidine for oral suspension may be substituted for Famotidine tablets in any of the above indications. Return to top

## Orally disintegrating tablets
Famotidine orally disintegrating tablets may be substituted for Famotidine tablets in any of the above indications at the same recommended dosages. Return to top

## Concomitant use of antacids
Antacids may be given concomitantly if needed. Return to top

## Patients with moderate/severe renal insufficiency
In adult patients with moderate (creatinine clearance < 50 mL/min) or severe (creatinine clearance < 10 mL/min) renal insufficiency, the elimination half-life of Famotidine is increased. For patients with severe renal insufficiency, it may exceed 20 hours, reaching approximately 24 hours in anuric patients. Since CNS adverse effects have been reported in patients with moderate and severe renal insufficiency, to avoid excess accumulation of the drug in patients with moderate or severe renal insufficiency, the dose of Famotidine may be reduced to half the dose or the dosing interval may be prolonged to 36 to 48 hours as indicated by the patients clinical response.
Based on the comparison of pharmacokinetic parameters for Famotidine in adults and pediatric patients, dosage adjustment in pediatric patients with moderate or severe renal insufficiency should be considered. Return to top
Adapted from the FDA Package Insert.