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Intravenous Dilution Guidelines

Famotidine - Pepcid ®

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

D5W, NS

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

[20 mg] [100 ml] [15-30 min]
[40 mg] [250 ml] [30 min]

Recommended concentration for infusion: 0.2 mg/ml

Stability / Miscellaneous

EXP: 7 days (RT).

Stability data:

Drug Stability
Refrigerated
Reconstituted
Vial/Powder
Notes P-Insert
Updated
Famotidine - Pepcid Store famotidine injection at 2° to 8°C (36° to 46°F).  If solution freezes, bring to room temperature; allow sufficient time to solubilize all the components.

It's recommended that if not used immediately after preparation, diluted solutions of famotidine injection should be refrigerated and used within 48 hours
Solution FOR INTRAVENOUS USE ONLY AFTER DILUTION.
06 05 15
Stability Room Temp: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
When added to or diluted with most commonly used intravenous solutions, e.g., Water for Injection, NS Injection, D5W and 10% Dextrose Injection, or Lactated Ringer’s Injection, diluted famotidine injection is physically and chemically stable (i.e., maintains at least 90% of initial potency) for 7 days at room temperature.

When added to or diluted with Sodium Bicarbonate Injection, 5%, famotidine injection at a concentration of 0.2 mg/mL (the recommended concentration of famotidine intravenous infusion solutions) is physically and chemically stable (i.e., maintains at least 90% of initial potency) for 7 days at room temperature. However, a precipitate may form at higher concentrations of famotidine injection (>0.2 mg/mL) in Sodium Bicarbonate Injection, 5%.

Renal Dosing


DOSAGE AND ADMINISTRATION
In some hospitalized patients with pathological hypersecretory conditions or intractable ulcers, or in patients who are unable to take oral medication, famotidine injection may be administered until oral therapy can be instituted.

Adult: The recommended dosage for famotidine injection in adult patients is 20 mg intravenously q 12 h.

The doses and regimen for parenteral administration in patients with GERD have not been established.

Dosage for Pediatric Patients
See package insert for PRECAUTIONS, Pediatric Use.

The studies described in PRECAUTIONS, Pediatric Use suggest that the starting dose in pediatric patients 1 to 16 years of age is 0.25 mg/kg intravenously (injected over a period of not less than two minutes or as a 15 minute infusion) q 12 h up to 40 mg/day.
While published uncontrolled clinical studies suggest effectiveness of famotidine in the treatment of 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 gastric pH determiniation and endoscopy. Published uncontrolled studies in pediatric patients have demonstrated gastric acid suppression with doses up to 0.5 mg/kg intravenously q 12 h.

No pharmacokinetic or pharmacodynamic data are available on pediatric patients under 1 year of age.

Dosage Adjustments for Patients with Moderate or 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 injection may be reduced to half the dose, or the dosing interval may be prolonged to 36 to 48 hours as indicated by the patient’s 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.

Pathological Hypersecretory Conditions (e.g., Zollinger-Ellison Syndrome, Multiple Endocrine Adenomas)
The dosage of famotidine in patients with pathological hypersecretory conditions varies with the individual patient. The recommended adult intravenous dose is 20 mg q 12 h. Doses should be adjusted to individual patient needs and should continue as long as clinically indicated. In some patients, a higher starting dose may be required. Oral doses up to 160 mg q 6 h have been administered to some adult patients with severe Zollinger-Ellison Syndrome.

Preparation of Intravenous Solutions
IV Push:
To prepare famotidine intravenous solutions, aseptically dilute 2mL of famotidine injection (solution containing 10mg/mL) with 0.9% Sodium Chloride Injection or other compatible intravenous solution (see Stability) to a total volume of either 5 mL or 10 mL, and inject over a period of not less than 2 minutes.

IVPB:
To prepare famotidine intravenous infusion solutions, aseptically dilute 2 mL of famotidine injection with 100 mL of 5% dextrose or other compatible solution (see Stability), and infuse over a 15 to 30 minute period.

Concomitant Use of Antacids:
Antacids may be given concomitantly if needed.

Stability
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

When added to or diluted with most commonly used intravenous solutions, e.g., Water for Injection, 0.9% Sodium Chloride Injection, 5% and 10% Dextrose Injection, or Lactated Ringer's Injection, diluted famotidine injection is physically and chemically stable (i.e., maintains at least 90% of initial potency) for 7 days at room temperature — see HOW SUPPLIED, Storage.

When added to or diluted with Sodium Bicarbonate Injection, 5%, famotidine injection at a concentration of 0.2 mg/mL (the recommended concentration of famotidine intravenous infusion solutions) is physically and chemically stable (i.e., maintains at least 90% of initial potency) for 7 days at room temperature — see HOW SUPPLIED, Storage. However, a precipitate may form at higher concentrations of famotidine injection (>0.2 mg/mL) in Sodium Bicarbonate Injection, 5%.

HOW SUPPLIED
FOR INTRAVENOUS USE ONLY

Famotidine Injection 10 mg/mL, is a non-preserved, clear, colorless solution and is supplied as follows:

NDC 55390-029-10, 2 mL single dose vials, carton of 10.

Famotidine Injection 10 mg/mL, is a preserved, clear, colorless solution and is supplied as follows:
NDC 55390-028-10, 4 mL two dose vial, carton of 10.
NDC 55390-027-01, 20 mL multidose vial, individually boxed.

Storage
Store famotidine injection at 2° to 8°C (36° to 46°F). If solution freezes, bring to room temperature; allow sufficient time to solubilize all the components.

Although diluted famotidine injection has been shown to be physically and chemically stable for 7 days at room temperature, there are no data on the maintenance of sterility after dilution. Therefore, it is recommended that if not used immediately after preparation, diluted solutions of famotidine injection should be refrigerated and used within 48 hours (see DOSAGE AND ADMINISTRATION).

Manufactured for: Manufactured by:
Bedford Laboratories™ Ben Venue Laboratories, Inc.
Bedford, OH 44146 Bedford, OH 44146
June 2002 FAM-P03

Source: [package insert]
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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