AlternativePepcid
Famotidine
H2-receptor antagonist
Preferred H2RA in pregnancy after ranitidine withdrawal (NDMA).
OralIV
First-line for
- Pregnancy GORD refractory to alginate
- Peptic ulcer disease in pregnancy
Mechanism
Reversible H2 receptor antagonism on parietal cells → ↓ gastric acid secretion.
"F for Famotidine, F for First H2 in pregnancy"
- Since ranitidine NDMA withdrawal, famotidine leads
- Halve dose if CrCl <50
- Minimal placental transfer
Dosing
- GORD/dyspepsia
- 20 mg BD PO
- PUD
- 40 mg at bedtime × 4–8 weeks
- Renal impairment
- Halve dose if CrCl <50
Contraindications
- CautionRenal impairment — reduce dose
Side effects
- Headache
- Dizziness
- Constipation or diarrhoea
- Rare thrombocytopenia
Fetal & maternal notes
- • No teratogenic signal
- • Compatible with breastfeeding
Key interactions
Antacids
Caution↓ famotidine absorption — separate 2 h
Cefpodoxime / itraconazole
CautionReduced absorption (need acid)
Clinical pearls
- 💡 Ranitidine WITHDRAWN 2020 (NDMA contamination) — do not prescribe
- 💡 Onset 1 h, duration 10–12 h
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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