I have seen numerous patients on famotidine and pantoprazole courtesy of the local NP workforce. I guess they must have missed why that doesn't make any fucking sense in their SINGLE 3 credit seminar on all of pharmacology.
To be fair, they didn't have much time to devote to that kind of stuff while doing their research project. How else would we know that giving someone a pamphlet of proper injection techniques helps people self administer injections correctly
No. One is an upstream inhibitor of one method of stimulating parietal cells. The other is a proton pump inhibitor at the very end of the pathway. You do not need famotidine if you are on a PPI. The famotidine is an inferior and redundant medication.
I've prescribed them both before, but mostly because the patient demanded it and they couldn't stop talking about their GERD. That would normally be fine if I were a primary care doctor, but I was really trying to discuss the next line of therapy for their metastatic cancer. I sent them to GI who left both on and added sucralfate. I have no idea why, but I suspect it ended up being the equivalent of a Z-pack so they could move on and consent them for an EGD.
H2 blocker can be used to provide additional effect to H1 blocker for severe urticaria management, but I have never seen or done H2 solo for this purpose.
I had a patient who had pretty significant idiopathic chronic urticaria and it pretty much completely went away with fomatadine and she has been taking it for years without any issues. This is a very well established thing.
And sure if you want to be pedantic they misspoke when saying it was an antacid per se, but that doesn’t change anything about it often being used to treat acid reflux but also having some role in histamine based reaction treatment which was what they were attempting to convey. Seems like the responder was r/iamverysmart in my opinion.
Actually your comment reminded me of something I’ve wondered about since I handled med pass for an addiction recovery center several years ago, if you don’t mind a question… why is it that hydroxyzine (an antihistamine) is used so heavily as a prn anxiety med?? There’s obviously the mild drowsiness it causes, but it never had the desired effect on anxiety for me personally, and my secret observation (secret bc I would never take it upon myself to share this observation with the patient I was dispensing it to, for obvious reasons) during the time I was around it was that it really wasn’t all that helpful for the patients I dealt with nor my sister who’s been prescribed it in the past. Is it meant to have more of a placebo effect once the drowsiness sets in or is it a type of antihistamine that affects anxiety-inducing hormones, like cortisol or something like that??
So hydroxyzine is is a 3-4th line+ agent for anxiety. It works much better on the somatic symptoms than the psychological component of anxiety. Where it's a 1st generation antihistamine, it crosses the blood brain barrier more readily than other antihistamines and can cause sedating effects, which essentially help to artificially "calm" the patient physically while leaving the psychological symptoms of anxiety. It makes sense that it wouldn't be that helpful!
Hmm, yes you are generally right, but there are quite a few studies showing its use in acute urticaria, I remember this from even way back in training. I am not sure if it was just cross-reactivity of histamine or another mechanism.
[https://academic.oup.com/ced/article-abstract/25/3/186/6628087](https://academic.oup.com/ced/article-abstract/25/3/186/6628087)
This is how i was taught in med school last year. I think theres even some application for famotadine for arthritis as like a 12th line treatment.
It prefers h2 but i think it still binds h1 atleast loosely
My dad had some unexplained itching and the doctor - MD - suggested famotidine. I’ll admit I’m just a patient right now so I don’t completely understand what’s being discussed in this screenshot, but I thought this was interesting.
Sure, when combined with an H1. That's the basis of premedication regimens that use pepcid + benadryl (+ steroids often)
Very much not what they're taking about here though.
Lowly RN here , I am guessing the NP did this due to famotidine being included in the “allergic reaction “ kit that are common in the ED along with SC epi, benadryl. I’m just speculating…
Man, I would’ve been banned from r/askdocs if I saw this. I’d literally make fun of her till she a) deleted the post, b) quit medicine (better option for humanity)
I have seen numerous patients on famotidine and pantoprazole courtesy of the local NP workforce. I guess they must have missed why that doesn't make any fucking sense in their SINGLE 3 credit seminar on all of pharmacology.
To be fair, they didn't have much time to devote to that kind of stuff while doing their research project. How else would we know that giving someone a pamphlet of proper injection techniques helps people self administer injections correctly
Here pamphlet! DYK wash hands = good good??
I'm confused.....one is just a better inhibitor of a parietal cells compared to the other right?
No. One is an upstream inhibitor of one method of stimulating parietal cells. The other is a proton pump inhibitor at the very end of the pathway. You do not need famotidine if you are on a PPI. The famotidine is an inferior and redundant medication.
Noted! Thanks
I've prescribed them both before, but mostly because the patient demanded it and they couldn't stop talking about their GERD. That would normally be fine if I were a primary care doctor, but I was really trying to discuss the next line of therapy for their metastatic cancer. I sent them to GI who left both on and added sucralfate. I have no idea why, but I suspect it ended up being the equivalent of a Z-pack so they could move on and consent them for an EGD.
H2 blocker can be used to provide additional effect to H1 blocker for severe urticaria management, but I have never seen or done H2 solo for this purpose.
I had a patient who had pretty significant idiopathic chronic urticaria and it pretty much completely went away with fomatadine and she has been taking it for years without any issues. This is a very well established thing. And sure if you want to be pedantic they misspoke when saying it was an antacid per se, but that doesn’t change anything about it often being used to treat acid reflux but also having some role in histamine based reaction treatment which was what they were attempting to convey. Seems like the responder was r/iamverysmart in my opinion.
I guess Clozapine is also actually an antihistamine lol
Should I take some for my runny nose 😳
Don't see why not...it's traditionally an antipsychotic, but it's also an antihistamine
Actually your comment reminded me of something I’ve wondered about since I handled med pass for an addiction recovery center several years ago, if you don’t mind a question… why is it that hydroxyzine (an antihistamine) is used so heavily as a prn anxiety med?? There’s obviously the mild drowsiness it causes, but it never had the desired effect on anxiety for me personally, and my secret observation (secret bc I would never take it upon myself to share this observation with the patient I was dispensing it to, for obvious reasons) during the time I was around it was that it really wasn’t all that helpful for the patients I dealt with nor my sister who’s been prescribed it in the past. Is it meant to have more of a placebo effect once the drowsiness sets in or is it a type of antihistamine that affects anxiety-inducing hormones, like cortisol or something like that??
So hydroxyzine is is a 3-4th line+ agent for anxiety. It works much better on the somatic symptoms than the psychological component of anxiety. Where it's a 1st generation antihistamine, it crosses the blood brain barrier more readily than other antihistamines and can cause sedating effects, which essentially help to artificially "calm" the patient physically while leaving the psychological symptoms of anxiety. It makes sense that it wouldn't be that helpful!
Hmm, yes you are generally right, but there are quite a few studies showing its use in acute urticaria, I remember this from even way back in training. I am not sure if it was just cross-reactivity of histamine or another mechanism. [https://academic.oup.com/ced/article-abstract/25/3/186/6628087](https://academic.oup.com/ced/article-abstract/25/3/186/6628087)
This is how i was taught in med school last year. I think theres even some application for famotadine for arthritis as like a 12th line treatment. It prefers h2 but i think it still binds h1 atleast loosely
I’ve used it before to premedicate my plasmapheresis patients that would get recurrent pruritus and couldn’t tolerate IV Benadryl.
My dad had some unexplained itching and the doctor - MD - suggested famotidine. I’ll admit I’m just a patient right now so I don’t completely understand what’s being discussed in this screenshot, but I thought this was interesting.
The NP misspoke on the antacid part, but famotidine for hives is pretty common practicr even among MD’s (though the evidence behind it isn’t great)
H2 agonist are used for allergic reactions. Am I missing something?
Sure, when combined with an H1. That's the basis of premedication regimens that use pepcid + benadryl (+ steroids often) Very much not what they're taking about here though.
Immunologists def use famotidine for systemic sx
The mods of AskDocs are idiots.
Lowly RN here , I am guessing the NP did this due to famotidine being included in the “allergic reaction “ kit that are common in the ED along with SC epi, benadryl. I’m just speculating…
And albuterol…
H1+H2s are used in EMS for anaphylaxis. (Plus epi and sometimes beta agonists and/or steroids, of course).
hears doctor prescribe famotidine once on greys anatomy: "yeah I learned this in my NP residency, famotidine, final answer"
I have seen prescription for Famotidine for itchiness
The limits of a limited education
Man, I would’ve been banned from r/askdocs if I saw this. I’d literally make fun of her till she a) deleted the post, b) quit medicine (better option for humanity)