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Pepcid better than Prilosec when taken with low-dose aspirin, trial finds


NEW YORK The FAMOUS trial, reported in an article in Online First and in an upcoming edition of The Lancet, has found that Pepcid (famotidine) is effective in the prevention of stomach and upper intestinal ulcers, and damage to the gullet, The Lancet noted in a press statement earlier this week.

Low-dose aspirin (75mg to 325mg) is one of the most widely used drugs in the world. Increasingly, it is being bought over the counter or prescribed for its anti-clotting activity in the heart and brain, and in patients with diabetes. Despite the benefits of aspirin use, its rise has been accompanied by a rise in gastrointestinal complications, such as peptic ulcer bleeding, perforation and sometimes death. Such proton-pump inhibitors as Prilosec OTC (omeprazole) can prevent such ulcers but there have been concerns about cost, safety and risk of interaction with clopidogrel, another anti-clotting drug that is prescribed often with aspirin.

In the FAMOUS trial, researchers studied the effect of famotidine, which has a different mechanism of action to PPIs and belongs to a group of drugs called H2-receptor antagonists. The researchers found that stomach ulcers had developed in 3% of patients given famotidine compared with 15% given placebo. Upper-intestinal or duodenal ulcers were found in just one patient (0.5%) in the famotidine group compared with 17% of those given placebo. Gullet ulcers occurred in 4% of famotidine patients compared with 19% of placebo patients. And there were fewer adverse events in the famotidine group (9 vs. 15 placebo).

"Famotidine is effective in the prevention of gastric and duodenal ulcers, and erosive oesophagitis in patients taking low-dose aspirin,” concluded lead author Ali Taha, Crosshouse Hospital, Kilmarnock, England. "There is little doubt that aspirin and other anti-clotting drugs are very useful in the prevention of heart, brain and other vascular diseases, hence their increasing use world-wide. Patients on such drugs should continue using them as advised by their family doctors or hospital specialists. However, everybody should be aware that aspirin use can also be associated with a variety of gastrointestinal or digestive system problems, which sometimes can be serious. The results of this research widen the options for the prevention of such problems particularly when more than one clotting drug is required."

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