Pharmacokinetics and Pharmacodynamics of Famotidine in Paediatric Patients

Abstract

Famotidine, an H2 receptor antagonist, has several potential advantages over cimetidine and ranitidine. These advantages include its potency, relatively longer elimination half-life, and lack of interaction with the cytochrome P450 isoforms. Eight studies addressing the use of famotidine in paediatric patients have been published. Data from these studies demonstrate that the pharmacokinetics and pharmacodynamics of intravenous famotidine appear to be similar in both children over the age of 1 year and adults. These data support a starting paediatric dosage for intravenous famotidine of 0.5 mg/kg every 8 to 12 hours. In addition, the safety and efficacy of famotidine in the treatment of peptic ulcer disease and esophagitis in paediatric patients is supported by these studies involving over 150 children. Future studies with famotidine in paediatrics should address its disposition in children under the age of 1 year and in children with compromised renal function, as well as the bioavailability of the oral formulation.

Pharmacokinetics and pharmacodynamics of famotidine and ranitidine in critically ill children

“…Several pharmacokinetic parameters in our PICU sample (including mean Cl value for famotidine 0.53 ± 0.17 L/h/kg; half‐life 2.25 ± 1.1 hours) were similar to those reported in the general pediatric population (mean Cl 54 ± 0.34 L/h/kg, half‐life 2.3 ± 1.3) . Conversely, the calculated mean volume of distribution (Vd) for both agents was lower than reported in previous investigations.…”

“…There is a general consensus that maintaining gastric pH above 4.0 is associated with less risk of mucosal ulceration and bleeding in critically ill pediatric patients . However this goal may not always be attained given the effect of acute illness and development on pharmacodynamics and pharmacokinetics of various agents, such as the H2 receptor blockers that are administered to decrease gastric acid production.…”

“…Stress ulcers leading to gastrointestinal bleeding occur in 5–20% of critically ill patients . Despite availability of proton pump inhibitors and limited evidence to guide agent selection and dosing, H2 receptor blocker prophylaxis is administered routinely in the pediatric intensive care unit (PICU) …”

“…Famotidine has been shown to be 7.5 times more potent than ranitidine in suppressing acid with a longer duration of action in adults . Data on IV famotidine use in the PICU setting is limited, particularly in comparison to other H2 receptor blocker therapy . Altered biodisposition of H2 receptor blockers in children compared to adults has been demonstrated secondary to immature hepatic and renal function .…”

Upper Gastrointestinal Tract Bleeding in Critically Ill Pediatric Patients

“…Famotidine half-life is much longer than that of ranitidine and cimetidine, and pharmacokinetics in children over 1 year of age are similar to those in adults. 146,151,156 In pediatric burn patients, cimetidine has rapid clearance and a short half-life, probably related to increased glomerular filtration. 152 It is also likely that burn patients have additional elimination routes through skin and wounds.…”