Famotidine is widely available over the counter at low cost, does not interact with other medications and has been safely used for suppression of gastric acid production over a wide range of oral doses from 20 mg once daily to 160 mg four times daily. According to a small case study published in the journal Gut, oral famotidine is associated with improved outcomes in non-hospitalized patients with COVID-19.
Colorized scanning electron micrograph of an apoptotic cell (green) heavily infected with SARS-CoV-2 virus particles (purple), isolated from a patient sample. Image credit: NIAID.
Management of patients with COVID-19, caused by the SARS-CoV-2 coronavirus, poses a major challenge to the biomedical community, governments and global population.
Currently, most research focuses on vaccine development or pharmacological treatment strategies for hospitalized patients with COVID-19.
However, to reduce global morbidity and mortality, effective treatment strategies for non-hospitalized patients are required.
Famotidine, which belongs to a class of drugs known as histamine-2 receptor antagonists, may be a candidate medication for this.
“Our case series suggests, but does not establish, a benefit from famotidine treatment in outpatients with COVID-19,” said Cold Spring Harbor Laboratory’s Dr. Tobias Janowitz and colleagues.
The study involved 10 people (6 men; 4 women) who developed COVID-19 infection, all of whom happened to have been taking famotidine during their illness. Their ages ranged from 23 to 71 and they had a diverse range of ethnic backgrounds and known risk factors for COVID-19 severity, including high blood pressure and obesity.
The severity of five cardinal symptoms (cough, shortness of breath, fatigue, headache, and loss of taste/smell) as well as general unwellness as measured using a version of a 4-point scale normally applied to assess the severity of cancer symptoms (ECOG PS).
“The experience of a patient at one point in time is very valuable, but learning about the change in their experience over time is even more important,” Dr. Janowitz said.
“Change indicates if the patients’ condition is getting better or worse. A graded symptom score enables the physician and the patient to track symptoms using numbers.”
“You may call up your doctor and say, I have headaches and shortness of breath, and am only able to do the basics for self-care, which would be grade 3 symptoms,” he added.
“If you still had the symptoms two days later, but are now able to do light work, these symptoms would now be scored at grade 2.”
“This approach makes it very easy for you and your doctor to document that your symptoms are improving. The value of this approach from a research perspective is that experiences from many patients become comparable and can be pooled for analysis.”
Seven of the patients tested positive for COVID-19, using a swab test; two had antibodies to the infection; and one patient wasn’t tested but was diagnosed with the infection by a doctor.
All started taking famotidine when they were feeling very poorly with COVID-19, the symptoms of which had been going on from 2 up to 26 days at that point.
The most frequently used dose was 80 mg taken three times a day, with the average treatment period lasting 11 days, but ranging from 5 to 21 days.
All 10 patients said that symptoms quickly improved within 24-48 hours of starting famotidine and had mostly cleared up after 14 days.
Improvement was evident across all symptom categories assessed, but respiratory symptoms, such as cough and shortness of breath, improved more rapidly than systemic symptoms, such as fatigue.
Seven of the patients didn’t experience any side effects while on famotidine, and in the three who did, these were mild, and all but temporary forgetfulness were known side effects associated with taking the drug.
“While promising, the findings might have been affected by ‘the placebo effect,’ and/or hazy recall, added to which the number of case study participants was small,” the researchers said.
“And it’s not clear how famotidine might work: if it might incapacitate the virus in some way or alter a person’s immune response to it.”
“Clinically, we unreservedly share the opinion that well designed and informative studies of efficacy are required to evaluate candidate medications for COVID-19 as for other diseases.”
Nevertheless, they suggest their findings warrant further more detailed study, adding that a clinical trial, testing the combination of famotidine with the antimalarial drug hydroxychloroquine in patients admitted to hospital with COVID-19, is already under way.
“An outpatient study of oral famotidine that investigates efficacy for symptom control, viral burden and disease outcome and assesses the effects of medication use on long term immunity should be considered to establish if famotidine may be of use in controlling COVID-19 in individual patients while also reducing the risk of SARS-CoV-2 transmission,” the scientists said.
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T. Janowitz et al. Famotidine use and quantitative symptom tracking for COVID-19 in non-hospitalised patients: a case series. Gut, published online June 4, 2020; doi: 10.1136/gutjnl-2020-321852
This article is based on texts provided by Cold Spring Harbor Laboratory and BMJ.
Source link: https://www.sci.news/medicine/famotidine-mild-moderately-severe-covid-19-cases-08509.html
