Actions: competitive inhibition of histamine at H2 receptors of the gastric parietal cells; inhibits gastric acid secretion, gastric volume, hydrogen ion. Indications: duodenal and gastric ulcers; esophageal reflux; reduction of gastric volume; increasing gastric pH; prevention of acid aspiration pneumonitis during surgery; prevention of stress ulcers.
Dose (adult): 50-100 mg/dose IV every 6-8 hrs; continuous infusion: 6.25 mg/hr (150 mg over 24 hrs) titrated to gastric pH >4.0 for prophylaxis or >7.0 for treatment; max daily dose: 400 mg/day. Dose (ped): 2-4 mg/kg/day IV divided every 6-8 hrs; continuous infusion: 1 mg/kg/dose for one dose followed by infusion of 0.1-0.125 mg/kg/hr (or 2.4-3 mg/kg/day); max dose: 400 mg/day. Dose (neonate): 2 mg/kg/day IV divided every 6-8 hrs; continuous infusion: 1.5 mg/kg/dose load followed by 0.04 mg/kg/hr (or 1 mg/kg/day). Clearance: renal elimination (70% unchanged). Adverse effects: may cause headache, GI disturbance, malaise, insomnia, sedation, arthralgia, hepatoxicity.
Comments: adjust dose in renal failure.
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