Famotidine

INDICATIONS AND USAGE Famotidine Injection is supplied as a premixed solution in GALAXY plastic containers and is intended for intravenous use only. Famotidine Injection is indicated in some hospitalized patients with pathological hypersecretory conditions or intractable ulcers, or as an alternative to the oral dosage forms for short term use in patients who are unable to take oral medication for the following conditions: 1. Short term treatment of active duodenal ulcer. Most adult patients heal within 4 weeks; there is rarely reason to use famotidine at full dosage for longer than 6 to 8 weeks. Studies have not assessed the safety of famotidine in uncomplicated active duodenal ulcer for periods of more than eight weeks. 2. Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of an active ulcer. Controlled studies in adults have not extended beyond one year. 3. Short term treatment of active benign gastric ulcer. Most adult patients heal within 6 weeks. Studies have not assessed the safety or efficacy of famotidine in uncomplicated active benign gastric ulcer for periods of more than 8 weeks. 4. Short term treatment of gastroesophageal reflux disease (GERD). Famotidine is indicated for short term treatment of patients with symptoms of GERD (see CLINICAL PHARMACOLOGY IN ADULTS, Clinical Studies ). Famotidine is also indicated for the short term treatment of esophagitis due to GERD including erosive or ulcerative disease diagnosed by endoscopy (see CLINICAL PHARMACOLOGY IN ADULTS, Clinical Studies ). 5. Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison Syndrome, multiple endocrine adenomas) (see CLINICAL PHARMACOLOGY IN ADULTS, Clinical Studies ).

2 DOSAGE AND ADMINISTRATION Administration Information ( 2.1 ) Famotidine Injection is intended for use in adult and pediatric hospitalized patients, or as an alternative to oral famotidine. Discontinue as soon as the patient is able to tolerate oral treatment and switch to an appropriate oral medication. Recommended Dosage ( 2.2 ) Adults: 20 mg every 12 hours. For pathological hypersecretory conditions titrate the dosage to individual patient needs. Pediatric Patients 1 year of age and older: 0.25 mg/kg every 12 hours; titrate to a maximum of 0.5 mg/kg every 12 hours (up to maximum of 20 mg every 12 hours) based on clinical response and/or gastric pH determination and endoscopy. Administer as an intravenous injection over at least 2 minutes or an intravenous infusion over 15 minutes to 30 minutes. Refer to the prescribing information for oral famotidine products for the recommended duration of famotidine treatment. Renal Impairment ( 2.3 ) See the full prescribing information for the recommended dosage for adult patients with moderate or severe renal impairment. 2.1 Important Administration Information Famotidine Injection is intended for use in adult and pediatric hospitalized patients, or as an alternative to oral famotidine. Discontinue Famotidine Injection as soon as the patient is able to tolerate oral treatment and switch to an appropriate oral medication. 2.2 Recommended Dosage in Adults and Pediatric Patients 1 Year of Age and Older The recommended dosage of Famotidine Injection in adults and pediatric patients 1 year of age and older is shown in Tables 1 and 2 , respectively. Administer Famotidine Injection as an intravenous injection over at least 2 minutes or as an intravenous infusion over 15 minutes to 30 minutes [see Dosage and Administration ( 2.4 )]. Refer to the prescribing information for oral famotidine products for the recommended duration of famotidine treatment. Table 1. Recommended Dosage 1 of Famotidine Injection in Adults 1 Refer to the prescribing information for oral famotidine products for the recommended duration of famotidine treatment. Indication Recommended Dosage Active Duodenal Ulcer 20 mg every 12 hours Active Gastric Ulcer Symptomatic Nonerosive GERD Erosive Esophagitis Diagnosed by Endoscopy Reduction of the Risk of Duodenal Ulcer Recurrence Pathological Hypersecretory Conditions Starting dosage is 20 mg every 12 hours; titrate the dosage to individual patient needs Table 2. Recommended Dosage 1 of Famotidine Injection in Pediatric Patients 1 Year of Age and Older 1 Refer to the prescribing information for oral famotidine products for the recommended duration of famotidine treatment. Indication Recommended Dosage Peptic Ulcer Disease 0.25 mg/kg every 12 hours (maximum 20 mg every 12 hours) Titrate to a maximum dosage of 0.5 mg/kg every 12 hours (maximum of 20 mg every 12 hours) based on clinical response and/or gastric pH determination and endoscopy. 2.3 Recommended Dosage in Patients with Renal Impairment Adults The recommended dosage for adult patients with moderate to severe renal impairment is shown in Table 3 . Administer Famotidine Injection as an intravenous injection over at least 2 minutes or as an intravenous infusion over 15 minutes to 30 minutes [see Dosage and Administration ( 2.4 )]. Table 3. Recommended Dosage 1 of Famotidine Injection in Adults with Renal Impairment 1 Refer to the prescribing information for oral famotidine products for the recommended duration of famotidine treatment. 2 The dosage required to treat pathological hypersecretory conditions may exceed the maximum doses evaluated in patients with impaired renal function. The risk for increased adverse reactions in renally impaired patients treated with Famotidine Injection for pathological hypersecretory conditions is unknown. Indication Recommended Dosage Creatinine Clearance 30 to 60 mL/minute Creatinine Clearance less than 30 mL/minute Active Duodenal Ulcer 20 mg once daily 10 mg once daily Active Gastric Ul …

3 DOSAGE FORMS AND STRENGTHS Injection: a clear, colorless, solution supplied ready-to-use as: 20 mg/5 mL (4 mg/mL) single-dose vial 40 mg/10 mL (4 mg/mL) multi-dose vial 200 mg/50 mL (4 mg/mL) multi-dose vial Injection: 20 mg/5 mL (4 mg/mL) single-dose vial 40 mg/10 mL (4 mg/mL) multi-dose vial 200 mg/50 mL (4 mg/mL) multi-dose vial

4 CONTRAINDICATIONS Famotidine Injection is contraindicated in patients with a history of serious hypersensitivity reactions (e.g., anaphylaxis) to famotidine or other H 2 -receptor antagonists. History of serious hypersensitivity reactions (e.g., anaphylaxis) to famotidine or other H 2 -receptor antagonists. ( 4 )

6 ADVERSE REACTIONS Most common adverse reactions (>1%) are: headache, dizziness, constipation, and diarrhea. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Sagent Pharmaceuticals at 1-866-625-1618 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety of Famotidine Injection has been established based on adequate and well-controlled studies of an oral famotidine product. The following is a summary of the adverse reactions reported in those studies. Oral famotidine was studied in 7 U.S. and international placebo- and active-controlled trials in approximately 2,500 patients. A total of 1,442 patients were treated with oral famotidine, including 302 treated with 40 mg twice daily, 456 treated with 20 mg twice daily, 461 treated with 40 mg once daily, and 396 treated with 20 mg once daily. The population was 17 to 91 years old, fairly well distributed between sex and race; however, the predominant race was White. Adverse reactions reported in ≥1% of patients treated with oral famotidine in clinical trials were: headache, dizziness, constipation, and diarrhea. The following other adverse reactions were reported in less than 1% of patients treated with oral famotidine in clinical trials: Body as a Whole : fever, asthenia, fatigue Cardiovascular : palpitations Gastrointestinal : cholestatic jaundice, elevated liver enzymes, vomiting, nausea, abdominal discomfort, anorexia, dry mouth Hematologic : thrombocytopenia Hypersensitivity : orbital edema, rash, conjunctival injection, bronchospasm Musculoskeletal : musculoskeletal pain, arthralgia Nervous System/Psychiatric : seizure, hallucinations, depression, anxiety, decreased libido, insomnia, somnolence Respiratory : interstitial pneumonia Skin : pruritus, dry skin, flushing Special Senses : tinnitus, taste disorder Other : impotence Adverse reactions reported with oral famotidine may also occur with Famotidine Injection. In addition, transient irritation at the injection site was reported with intravenous famotidine. 6.2 Postmarketing Experience The following adverse reactions have been identified during post-approval use of famotidine. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Cardiovascular : arrhythmia, AV block, prolonged QT interval Gastrointestinal : cholestatic jaundice, hepatitis Hematologic : agranulocytosis, pancytopenia, leukopenia Hypersensitivity : anaphylaxis, angioedema, facial edema, urticaria Musculoskeletal : rhabdomyolysis, muscle cramps Nervous System/Psychiatric : confusion, agitation, paresthesia Respiratory : interstitial pneumonia Skin : toxic epidermal necrolysis/Stevens-Johnson syndrome

7 DRUG INTERACTIONS Drugs Dependent on Gastric pH for Absorption : Systemic exposure of the concomitant drug may be significantly reduced leading to loss of efficacy. See the prescribing information for other drugs dependent on gastric pH for absorption. ( 7.1 ) Tizanidine (CYP1A2) Substrate : Potential for substantial increases in blood concentrations of tizanidine resulting in hypotension, bradycardia or excessive drowsiness; avoid concomitant use, if possible. ( 7.2 ) 7.1 Drugs Dependent on Gastric pH for Absorption Famotidine can reduce the absorption of other drugs due to its effect on reducing intragastric acidity, leading to loss of efficacy of the concomitant drug. See the prescribing information for other drugs dependent on gastric pH for absorption. 7.2 Tizanidine (CYP1A2 Substrate) Although not studied clinically, famotidine is considered a weak CYP1A2 inhibitor and may lead to substantial increases in blood concentrations of tizanidine, a CYP1A2 substrate. Avoid concomitant use with Famotidine Injection. If concomitant use is necessary, monitor for hypotension, bradycardia or excessive drowsiness. Refer to the full prescribing information for tizanidine.

8 USE IN SPECIFIC POPULATIONS Renal Impairment : QT prolongation reported in patients with moderate and severe renal impairment. ( 2.3 , 8.6 ) 8.1 Pregnancy Risk Summary Available data with H 2 -receptor antagonists, including famotidine, in pregnant women over decades of use have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Reproductive studies have been performed in rats and rabbits at intravenous doses of up to 200 mg/kg/day, with no obvious adverse developmental effects (see Data ) . Famotidine Injection contains benzyl alcohol as a preservative [see How Supplied/Storage and Handling ( 16 )] . Because benzyl alcohol is rapidly metabolized by a pregnant female, benzyl alcohol exposure in the fetus is unlikely. The background risk for major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Data Animal Data Reproductive studies have been performed in rats and rabbits at oral doses of up to 2,000 and 500 mg/kg/day, respectively, and in both species at intravenous doses of up to 200 mg/kg/day and have revealed no significant evidence of impaired fertility or harm to the fetus due to famotidine. 8.2 Lactation Risk Summary There are limited data available on the presence of famotidine in human breast milk following oral administration. There were no effects on the breastfed infant. There are no data on famotidine effects on milk production. Famotidine Injection contains benzyl alcohol as a preservative. Because benzyl alcohol is rapidly metabolized by a lactating female, benzyl alcohol exposure in the breastfed neonate is unlikely. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Famotidine Injection and any potential adverse effects on the breastfed child from famotidine or from the underlying maternal condition. 8.4 Pediatric Use Peptic Ulcer Disease The safety and effectiveness of Famotidine Injection have been established in pediatric patients 1 year to less than 17 years of age for the treatment of peptic ulcer disease in hospitalized patients or as an alternative to oral famotidine. Use of Famotidine Injection in this age group is supported by evidence from adequate and well-controlled studies of oral famotidine in adults with additional pharmacokinetic and pharmacodynamic data in pediatric patients 1 year to less than 17 years of age [see Dosage and Administration ( 2.2 ) and Clinical Pharmacology ( 12.2 , 12.3 )] . A safe and effective dosage has not been established in pediatric patients 1 year to less than 17 years of age with renal impairment for the treatment of peptic ulcer disease. The safety and effectiveness of Famotidine Injection for the treatment of peptic ulcer disease in pediatric patients less than 1 year of age have not been established. Other Conditions The safety and effectiveness of Famotidine Injection for the treatment of symptomatic nonerosive GERD, erosive esophagitis due to GERD, pathological hypersecretory conditions and reduction of the risk of DU recurrence have not been established in pediatric patients. Risk of Benzyl Alcohol Toxicity in Neonates Famotidine Injection is not approved for use in neonates. Serious adverse reactions, including fatal reactions, of new onset or worsening metabolic acidosis that progressed to neurotoxicity, and in some cases gasping syndrome, have been reported in low-birth weight neonates and preterm neonates who received benzyl alcohol (BA)-containing drugs intravenously. Gasping syndrome is a life-threatening condition in neonates caused by BA toxicity that is characterized by new onset or worsening metabolic acidosis with gradual neurological deterioratio …

12.1 Mechanism of Action Famotidine is a competitive inhibitor of histamine H 2 -receptors. The primary clinically important pharmacologic activity of famotidine is inhibition of gastric secretion. Both the acid concentration and volume of gastric secretion are suppressed by famotidine, while changes in pepsin secretion are proportional to volume output.

DESCRIPTION The active ingredient in Famotidine Injection is a histamine H 2 -receptor antagonist. Famotidine is N'-(aminosulfonyl)-3-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl]thio]propanimidamide. The empirical formula of famotidine is C 8 H 15 N 7 O 2 S 3 and its molecular weight is 337.45. Its structural formula is: Famotidine is a white to pale yellow crystalline compound that is freely soluble in glacial acetic acid, slightly soluble in methanol, very slightly soluble in water, and practically insoluble in ethanol. Famotidine Injection is supplied as a sterile solution, for intravenous use only, in plastic single dose GALAXY containers. Each 50 mL of the premixed, iso-osmotic intravenous injection contains 20 mg Famotidine, USP, and the following inactive ingredients: L-aspartic acid 6.8 mg, sodium chloride, USP, 450 mg, and Water for Injection. The pH ranges from 5.7 to 6.4 and may have been adjusted with additional L-aspartic acid and/or with sodium hydroxide. The GALAXY plastic container is fabricated from a specially designed multilayer plastic. Solutions are in contact with the polyethylene layer of the container and can leach out certain chemical components of the plastic in very small amounts within the expiration period. The suitability and safety of the plastic have been confirmed in tests in animals according to the USP biological tests for plastic containers, as well as by tissue culture toxicity studies. Famotidine Structural Formula

OVERDOSAGE The adverse reactions in overdose cases are similar to the adverse reactions encountered in normal clinical experience (see ADVERSE REACTIONS ). Oral doses of up to 640 mg/day have been given to adult patients with pathological hypersecretory conditions with no serious adverse effects. In the event of overdosage, treatment should be symptomatic and supportive. In the event of overdosage, the patient should be monitored, and supportive therapy should be employed. Due to low binding to plasma proteins, famotidine is eliminated by hemodialysis. There is a limited experience on the usefulness of hemodialysis as a treatment for famotidine overdosage. The intravenous LD 50 of famotidine for mice and rats ranged from 254-563 mg/kg and the minimum lethal single I.V. dose in dogs was approximately 300 mg/kg. Signs of acute intoxication in I.V. treated dogs were emesis, restlessness, pallor of mucous membranes or redness of mouth and ears, hypotension, tachycardia and collapse. The oral LD 50 of famotidine in male and female rats and mice was greater than 3000 mg/kg and the minimum lethal acute oral dose in dogs exceeded 2000 mg/kg. Famotidine did not produce overt effects at high oral doses in mice, rats, cats and dogs, but induced significant anorexia and growth depression in rabbits starting with 200 mg/kg/day orally.

HOW SUPPLIED FOR INTRAVENOUS USE ONLY Famotidine Injection, USP, is supplied as follows: NDC Famotidine Injection, USP (Preservative-free) Package Factor (10 mg per mL) 25021-753-02 20 mg per 2 mL Single-Dose Vial 25 vials per carton NDC Famotidine Injection, USP (Preservative) Package Factor (10 mg per mL) 25021-754-04 40 mg per 4 mL Two-Dose Vial 10 vials per carton 25021-754-20 200 mg per 20 mL Multi-Dose Vial 10 vials per carton Storage Conditions Store refrigerated between 2° and 8°C (36° and 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 ). Sterile, Nonpyrogenic. The container closure is not made with natural rubber latex. sagent ® Mfd. for SAGENT Pharmaceuticals Schaumburg, IL 60195 (USA) Made in India ©2024 Sagent Pharmaceuticals August 2024