India · Paediatric mg/kg & Adult · GERD · Peptic Ulcer · Stress Ulcer · Pepcid · Topcid · Famocid
| Patient | Indication | Dose | Frequency | Duration |
|---|---|---|---|---|
| Child (1 month–16 yr) | GERD | 0.5 mg/kg/dose (max 40 mg) | BD (every 12h) | 4–8 weeks |
| Child (1 month–16 yr) | Peptic ulcer | 0.5 mg/kg/dose (max 40 mg) | OD at bedtime | 4–8 weeks |
| Infant ≤ 3 months | GERD / acid | 0.5 mg/kg/dose | OD | Up to 8 weeks |
| Adult | GERD | 20 mg | BD | 6–12 weeks |
| Adult | Peptic ulcer (active) | 40 mg | OD at bedtime | 4–8 weeks |
| Adult | Peptic ulcer (maintenance) | 20 mg | OD at bedtime | Ongoing |
| Adult / Child | Stress ulcer (ICU) — IV | 20 mg (adult) / 0.25–0.5 mg/kg | Every 12h IV | ICU stay |
| Adult | Zollinger-Ellison | 20 mg 6-hourly (titrate up) | QDS | Ongoing |
Famotidine is a potent, selective histamine H2-receptor antagonist (H2RA) that reduces basal and stimulated gastric acid secretion. It is approximately 7.5 times more potent than ranitidine (now withdrawn from the Indian and global market due to NDMA contamination concerns) and 20 times more potent than cimetidine. In the post-ranitidine era, famotidine has become the most widely used H2RA in India and is available as Topcid, Famocid, and Pepcid across Indian pharmacies in both tablet and injection form.
In paediatric practice, famotidine is particularly valued because — unlike proton pump inhibitors (PPIs) — it has a well-established safety profile in infants and young children, does not significantly affect cytochrome P450 enzymes, and is available as a liquid suspension suitable for weight-based dosing in small children. The IAP endorses famotidine as a first-line H2RA for paediatric GERD and peptic ulcer disease.
The standard paediatric famotidine dose is 0.5 mg/kg/dose, capped at a maximum of 40 mg per dose. For GERD (the most common indication in children), this is given twice daily (every 12 hours). For peptic ulcer disease, it is given once daily at bedtime. For infants aged 3 months or younger, the dose is the same (0.5 mg/kg) but given only once daily, given immature hepatic and renal metabolism.
The oral suspension 8 mg/ml formulation is the most practical option for children under 5 years or those who cannot swallow tablets. For a 10 kg child at 0.5 mg/kg: 5 mg per dose = 0.625 ml of 8mg/ml suspension. For a 20 kg child: 10 mg per dose = 1.25 ml. Tablet splitting (20 mg tablets) is feasible for older children where the dose is ≥ 10 mg, but the suspension provides better accuracy for younger children.
For active peptic ulcer disease (duodenal or gastric), the standard adult dose is famotidine 40 mg once daily at bedtime, or 20 mg twice daily, for 4–8 weeks. Bedtime dosing is preferred because nocturnal acid secretion is the primary driver of ulcer persistence. After healing confirmation (endoscopy or clinical response), maintenance therapy with 20 mg once daily at bedtime can prevent recurrence. For GERD without oesophagitis: 20 mg twice daily for 6–12 weeks. For erosive GERD or oesophagitis, a PPI may offer superior mucosal healing.
In India, there is a tendency to over-prescribe PPIs (omeprazole, pantoprazole) for even mild acid-related symptoms. Famotidine is appropriate — and preferred — for: on-demand acid relief, mild-moderate GERD, peptic ulcer disease (especially in H. pylori-positive patients on eradication therapy), stress ulcer prophylaxis in ICU, and paediatric acid suppression. PPIs are preferred for severe GERD with oesophagitis, Barrett's oesophagus, NSAID-induced ulcer prevention in high-risk patients, and H. pylori eradication regimens. Unlike long-term PPI use, famotidine does not carry the risk of hypomagnesaemia, C. difficile-associated diarrhoea (at lower frequency), or bone density reduction.
In critically ill patients (ICU, mechanical ventilation, coagulopathy), famotidine 20 mg IV every 12 hours is the standard stress ulcer prophylaxis regimen in India, particularly in centres where IV pantoprazole is unavailable or cost-prohibitive. In paediatric ICU patients, IV famotidine 0.25–0.5 mg/kg every 12 hours is used.