page72
Side-effects
see notes above;
also malaise;
less com-
monly
tachycardia;
rarely
interstitial nephritis;
very
rarely
pancreatitis, galactorrhoea,
vasculitis,
alopecia
Dose
. 400 mg twice daily (with breakfast and at night)
or
800 mg at night (benign gastric and duodenal ulcer-
ation) for at least 4 weeks (6 weeks in gastric ulcer-
ation, 8 weeks in NSAID-associated ulceration); when
necessary the dose may be increased to 400 mg 4
times daily;
INFANT
under 1 year 20 mg/kg daily in
divided doses has been used;
CHILD
1–12 years, 25–
30 mg/kg daily in divided doses; max. 400 mg 4 times
daily
Maintenance, 400 mg at night
or
400 mg morning and
night
. Reflux oesophagitis,
400 mg 4 times daily for 4–8
weeks
. Prophylaxis of stress ulceration, 200–400 mg every 4–
6 hours
. Gastric acid reduction (prophylaxis of acid aspiration;
do not use syrup), obstetrics 400 mg at start of labour,
then up to 400 mg every 4 hours if required (max.
2.4 g daily); surgical procedures 400 mg 90–120 min-
utes before induction of general anaesthesia
. Short-bowel syndrome,
400 mg twice daily (with
breakfast and at bedtime) adjusted according to
response
. To reduce degradation of pancreatic enzyme supple-
ments,
0.8–1.6 g daily in 4 divided doses 1–1½ hours
before meals
1
Cimetidine
(Non-proprietary) A
Tablets
,
cimetidine 200 mg,
net price 60-tab pack =
£9.08;
400 mg,
60-tab pack = £7.61;
800 mg,
30-tab
pack = £22.86
Oral solution
,
cimetidine 200 mg/5 mL,
net price
300 mL = £14.56
Excipients
may include propylene glycol (see Excipients, p.
2)
1.
Cimetidine can be sold to the public for adults and children
over 16 years (provided packs do not contain more than 2
weeks’ supply) for the short-term symptomatic relief of
heartburn,
dyspepsia,
and hyperacidity (max.
single dose
200 mg,
max.
daily dose 800 mg),
and for the prophylactic
management of nocturnal heartburn (single night-time dose
100 mg)
Tagamet
c
(Chemidex) A
Tablets
,
all green,
f/c,
cimetidine 200 mg,
net price
120-tab pack = £19.58; 400 mg, 60-tab pack = £22.62;
800 mg,
30-tab pack = £22.62
Syrup
,
orange,
cimetidine 200 mg/5 mL.
Net price
600 mL = £28.49
Excipients
include propylene glycol 10%,
(see Excipients, p.
2)
FAMOTIDINE
Indications
see under Dose
Cautions
see notes above; interactions: Appendix 1
(histamine H
2
-antagonists) and notes above
Renal impairment
use normal dose every 36–48
hours or use half normal dose if eGFR less than
50 mL/minute/1.73 m
2
; seizures reported very rarely
Pregnancy
manufacturer advises avoid unless poten-
tial benefit outweighs risk
Breast-feeding
present in milk—not known to be
harmful but manufacturer advises avoid
Side-effects
see notes above;
also constipation;
less
commonly
dry mouth,
nausea,
vomiting,
flatulence,
taste disorders,
anorexia,
fatigue;
very rarely
chest
tightness,
interstitial pneumonia,
seizures,
paraes-
thesia
Dose
. Benign gastric and duodenal ulceration, treatment,
40 mg at night for 4–8 weeks; maintenance (duodenal
ulceration),
20 mg at night
. Reflux oesophagitis,
20–40 mg twice daily for 6–
12 weeks; maintenance,
20 mg twice daily
.
CHILD
not recommended
1
Famotidine
(Non-proprietary) A
Tablets
,
famotidine 20 mg,
net price 28-tab pack =
£4.47;
40 mg,
28-tab pack = £5.64
1.
Famotidine can be sold to the public for adults and children
over 16 years (provided packs do not contain more than 2
weeks’ supply) for the short-term symptomatic relief of
heartburn,
dyspepsia,
and hyperacidity,
and for the preven-
tion of these symptoms when associated with consumption
of food or drink including when they cause sleep disturbance
(max.
single dose 10 mg,
max.
daily dose 20 mg)
Pepcid
c
(MSD) A
Tablets
,
f/c,
famotidine 20 mg (beige),
net price 28-
tab pack = £13.37;
40 mg (brown),
28-tab pack =
£25.40
NIZATIDINE
Indications
see under Dose
Cautions
see notes above; also avoid rapid intra-
venous injection (risk of arrhythmias and postural
hypotension);
interactions: Appendix 1 (histamine
H
2
-antagonists) and notes above
Hepatic impairment
manufacturer advises caution
Renal impairment
use half normal dose if eGFR 20–
50 mL/minute/1.73 m
2
; use one-quarter normal dose
if eGFR less than 20 mL/minute/1.73 m
2
Pregnancy
manufacturer advises avoid unless essen-
tial
Breast-feeding
amount too small to be harmful
Side-effects
see notes above;
also sweating;
rarely
nausea,
fever,
vasculitis,
hyperuricaemia
Dose
. By mouth,
benign gastric,
duodenal or NSAID-asso-
ciated ulceration, treatment, 300 mg in the evening
or
150 mg twice daily for 4–8 weeks; maintenance,
150 mg at night
Gastro-oesophageal reflux disease, 150–300 mg twice
daily for up to 12 weeks
. By intravenous infusion,
for short-term use in peptic
ulcer as alternative to oral route (for hospital inpati-
ents),
by intermittent intravenous infusion over 15
minutes,
100 mg 3 times daily,
or
by continuous
intravenous infusion, 10 mg/hour; max. 480 mg daily
.
CHILD
not recommended
1
Nizatidine
(Non-proprietary) A
Capsules
, nizatidine 150 mg, net price 30-cap pack =
£12.04;
300 mg,
30-cap pack = £14.28
1.
Nizatidine can be sold to the public for the prevention and
treatment of symptoms of food-related heartburn and meal-
induced indigestion in adults and children over 16 years;
max. single dose 75 mg, max. daily dose 150 mg for max. 14
days
Axid
c
(Flynn) A
Capsules
,
nizatidine 150 mg (pale yellow/dark yel-
low), net price 28-cap pack (hosp.
only) = £6.87,
30-
cap pack = £7.97;
300 mg (pale yellow/brown),
30-
cap pack = £15.80
Injection
,
nizatidine 25 mg/mL.
For dilution and use
as an intravenous infusion.
Net price 4-mL amp =
£1.14
52
1.3.1 H
2
-receptor antagonists
BNF 61
1
Gastro-intestinal system