Low-dose aspirin is widely used for cardiovascular prophylaxis, but it may cause peptic ulceration and its complications, and oesophagitis. Proton-pump inhibitors may prevent such complications, but there are concerns about their cost, safety and possible interaction with clopidogrel. Famotidine is a histamine H2-receptor antagonist that may also be effective prophylaxis. Now a single-centre UK study has confirmed the effectiveness of famotidine.
A total of 404 adults attending cardiovascular, cerebrovascular or diabetes clinics at a Scottish hospital, taking aspirin 75–325 mg daily, and without ulcers or erosive oesophagitis on endoscopy, were randomized to famotidine 20 mg twice daily or placebo. At 12 weeks, gastric ulcers had developed in 3.4% (famotidine) versus 15% (placebo), duodenal ulcers in 0.5% versus 8.5% and erosive oesophagitis in 4.4% versus 19%. Four patients, all in the placebo group, were admitted to hospital with upper gastrointestinal haemorrhage. Adverse events were less common in the famotidine group.
Famotidine is effective in the prevention of gastric or duodenal ulcers or erosive oesophagitis in people taking low-dose aspirin.
Taha AS, et al. Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking low-dose aspirin (FAMOUS): a phase III, randomised, double-blind, placebo-controlled trial. Lancet 2009;374:119– 125; Hawkey CJ. NSAIDs and aspirin: notorious or FAMOUS.