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1.2. Pediatrics

Maximum recommended pediatric H2RA daily doses for acute and maintenance therapy are summarized in Table 4. Dosages exceeding these recommendations will be reviewed.

Table 4. Pediatric Maximum Daily Acute Doses for Histamine H2-Receptor Antagonists: Monotherapy1-10
Drug Name Patient Characteristics Treatment Indication Maximum Recommended Dosage
cimetidine (generics) Greater than or equal to 16 years of age duodenal ulcer 1200 mg/day ^
  Greater than or equal to 16 years of age gastric ulcer 1200 mg/day
  Greater than or equal to 16 years of age gastroesophageal reflux disease (GERD) - nonerosive 1600 mg/day
  Greater than or equal to 12 years of age heartburn 400 mg/day
  Greater than or equal to 16 years of age hypersecretory conditions 2400 mg/day
famotidine (Pepcid®, generics) 1 to 17 years of age duodenal ulcer tablet: 40 mg/day*
suspension: 40 mg/day
  1 to 17 years of age erosive esophagitis (EE) tablet: 80 mg/day*
suspension: 80 mg/day
  1 to 17 years of age gastric ulcer tablet: 40 mg/ day*
suspension: 40 mg/day
  1 to 16 years of age GERD - nonerosive tablet: 40 mg/day*
suspension: 80 mg/day 
  3 months to 1 year of age GERD - nonerosive suspension: 1 mg/kg twice daily (maximum of 40 mg daily)
  Less than 3 months of age GERD - nonerosive suspension: 1 mg/kg once daily
famotidine (Pepcid®, Zantac 360°,  generics) Greater than or equal to 12 years of age heartburn 40 mg/day
nizatidine (generics) Greater than or equal to 12 years of age EE 300 mg/day in single or divided doses
  Greater than or equal to 12 years of age GERD - nonerosive 300 mg/day in single or divided doses

Legend:

  • ^ Patients who are heavy smokers with duodenal ulcers greater than 1 cm may benefit from cimetidine 1600 mg at bedtime
  • * dosing for pediatric patients weighing greater than or equal to 40 kg
Table 5. Pediatric Maximum Daily Maintenance Doses for Histamine H2-Receptor Antagonists1-4
Drug Name Patient Characteristics Treatment Indication Maximum Recommended Dosage
cimetidine (generics) Greater than or equal to 16 years of age duodenal ulcer 400 mg at bedtime
  Greater than or equal to 16 years of age hypersecretory conditions 2400 mg/day