Ibuprofen and famotidine

Generic name:

Ibuprofen and famotidine

Drug class:

Nonsteroidal anti-inflammatory drug (NSAID) and H₂-receptor antagonist

Dosage form:

Oral tablets (film-coated)

Root of administration:

Oral

Dose:

• Ibuprofen: 200–800 mg every 6–8 hours as needed (maximum 3200 mg/day)
• Famotidine: 20 mg twice daily (maximum 40 mg/day)
• Combination tablet: typically 1 tablet (e.g., ibuprofen 800 mg/famotidine 26.6 mg) twice daily
• Adjust dose in hepatic or renal impairment; varies by indication; consult label

Mechanism of action:

Ibuprofen reversibly inhibits cyclooxygenase (COX-1 and COX-2), reducing prostaglandin synthesis to decrease inflammation, pain, and fever. Famotidine competitively blocks H₂ receptors on gastric parietal cells, reducing basal and stimulated gastric acid secretion and providing gastroprotection.

Drug usage cases:

• Osteoarthritis
• Rheumatoid arthritis
• Acute musculoskeletal pain
• Dysmenorrhea
• Dental pain
• Fever management
• Gout flares
• Peptic ulcer disease prophylaxis in NSAID users
• Off-label: migraine, tension headache, back pain

Drug contra indications:

• Hypersensitivity to ibuprofen, famotidine, aspirin, or other NSAIDs
• History of NSAID-induced asthma, urticaria, or allergic reactions
• Active gastrointestinal bleeding or peptic ulcer
• Severe hepatic impairment
• Severe renal impairment (CrCl < 30 mL/min)
• Congestive heart failure (NYHA class III/IV)
• Pregnancy in the third trimester
• Children under approved age (varies by formulation)

Side effects:

• Gastrointestinal: dyspepsia, nausea, abdominal pain, constipation, diarrhea, GI bleeding, peptic ulceration
• Cardiovascular: hypertension, edema, increased risk of myocardial infarction and stroke (with chronic use)
• Renal: acute renal failure, fluid retention, hyperkalemia
• Central nervous system: headache, dizziness, somnolence, aseptic meningitis
• Dermatologic: rash, pruritus, photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis
• Hepatic: elevated liver enzymes, hepatitis
• Hematologic: anemia, thrombocytopenia, leukopenia, prolonged bleeding time
• Allergic: anaphylaxis, angioedema
• Famotidine-specific: constipation, diarrhea, headache, dry mouth, confusion (elderly)

Warnings:

• Risk of serious GI adverse events including bleeding, ulceration, perforation; monitor for signs of GI toxicity
• Cardiovascular risk: may increase risk of fatal MI and stroke; use lowest effective dose for shortest duration
• Renal toxicity: monitor renal function, especially in volume-depleted patients
• Hypersensitivity reactions: can occur without prior exposure; discontinue if rash or allergic reactions develop
• Use with caution in patients with cardiovascular disease, hypertension, or risk factors for these conditions
• Avoid concomitant NSAIDs, corticosteroids, anticoagulants, SSRIs, or other ulcerogenic drugs unless necessary
• Famotidine: use with caution in severe renal impairment; adjust dose accordingly
• Masking of symptoms: may obscure fever or inflammation that would indicate a developing infection

Use during pregnancy or breastfeeding:

Pregnancy: Ibuprofen crosses the placenta and is generally contraindicated in the third trimester due to risk of premature closure of the fetal ductus arteriosus and oligohydramnios; use only if clearly needed and avoid late pregnancy. Famotidine is Category B; animal studies show no harm but adequate human studies are lacking.

Breastfeeding: Ibuprofen is excreted in breast milk in low amounts and is generally considered compatible with breastfeeding at recommended doses. Famotidine is also excreted in breast milk in low concentrations; monitor infant for adverse effects. Consider minimizing dose and duration.