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Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Famotidine and omeprazole are medications commonly used to treat a number of digestive problems. Whether you are experiencing a duodenal ulcer or symptoms of gastroesophageal reflux disease (GERD), your healthcare provider may recommend a drug like famotidine or omeprazole. These drugs work in similar ways to decrease acid production in the stomach. Although they’re usually found over the counter (OTC), famotidine and omeprazole can also be prescribed by a healthcare provider.
Antacids like Tums (calcium carbonate) are often tried first before starting something stronger, such as an H2 blocker like famotidine or a proton pump inhibitor (PPI) like omeprazole. Fortunately, famotidine and omeprazole are generic medications that are widely available. While they are both acid reducers, they differ in how they work and how they’re used.
What are the main differences between famotidine and omeprazole?
Famotidine
Famotidine is also known by its brand name, Pepcid. It is classified as an H2 blocker or H2-receptor antagonist. Famotidine works by blocking the effects of a substance called histamine to decrease acid production in the stomach.
The effects of famotidine can be felt within one hour and can last up to 12 hours, depending on the dose taken. Famotidine tablets are often taken once or twice daily for digestive problems.
Omeprazole
Omeprazole can be purchased as a brand-name drug called Prilosec or Prilosec OTC. Unlike famotidine, omeprazole is classified as a proton pump inhibitor (PPI). It works by directly blocking proton pumps in the lining of the stomach to stop acid production.
The effects of omeprazole can be felt quickly within one hour after taking it. However, its antisecretory effect can last up to 72 hours, which is much longer than that of famotidine. Omeprazole is usually taken once daily.
| Main differences between famotidine and omeprazole | ||
|---|---|---|
| Famotidine | Omeprazole | |
| Drug class | H2 Blocker | Proton Pump Inhibitor (PPI) |
| Brand/generic status | Brand and generic version available | Brand and generic version available |
| What is the brand name? | Pepcid | Prilosec |
| What form(s) does the drug come in? | Tablet Tablet, chewable Powder for oral suspension |
Capsule, delayed-release Tablet, delayed-release Powder for oral suspension |
| What is the standard dosage? | Duodenal ulcers: 40 mg once daily or 20 mg twice daily for up to 8 weeks GERD: 20 mg twice daily for up to 6 weeks Erosive esophagitis: 20 mg or 40 mg twice daily for up to 12 weeksDosage depends on the condition being treated |
Duodenal ulcers: 20 mg once daily for up to 4 weeks GERD: 20 mg once daily for up to 4 weeks Erosive esophagitis: 20 mg once dailyDosage depends on the condition being treated |
| How long is the typical treatment? | Up to 6 or 8 weeks or longer | 4 to 8 weeks or longer |
| Who typically uses the medication? | Adults, children, and infants | Adults, children, and infants |
Conditions treated by famotidine and omeprazole
Famotidine and omeprazole can be prescribed to treat GERD, duodenal ulcers, and stomach ulcers. Both medications are also FDA-approved to treat erosive esophagitis (EE), or inflammation of the lining of the esophagus. Erosive esophagitis is often caused by GERD.
Prescription famotidine and omeprazole can also be used to treat hypersecretory conditions, such as Zollinger-Ellison syndrome, systemic mastocytosis, and multiple endocrine adenoma syndrome. Hypersecretory conditions are characterized by excessive acid production that can be temporary or permanent.
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Over-the-counter (OTC) versions of famotidine and omeprazole are often used to relieve occasional or frequent heartburn. Acid reflux, which occurs when stomach acid gets backed up into the esophagus, is a common cause of heartburn.
Omeprazole is FDA-approved to treat Helicobacter pylori, or H. pylori, infections in combination with antibiotics. The bacteria that cause this infection attack the lining of the gastrointestinal system, which can result in peptic ulcers. Treatment typically includes omeprazole combined with the antibiotics amoxicillin and clarithromycin. In some cases, high doses of famotidine may be used to treat H. pylori in combination with antibiotics.
| Condition | Famotidine | Omeprazole |
| Gastroesophageal reflux disease (GERD) | Yes | Yes |
| Duodenal ulcers | Yes | Yes |
| Stomach ulcers | Yes | Yes |
| Heartburn | Yes | Yes |
| Erosive esophagitis | Yes | Yes |
| Hypersecretory conditions | Yes | Yes |
| H. pylori infection | Off-label | Yes |
| Barrett’s esophagus | Off-label | Off-label |
Is famotidine or omeprazole more effective?
Both famotidine and omeprazole can be effective drugs for treating GERD and other digestive conditions. However, omeprazole is a more potent and longer-acting drug than famotidine.
One clinical trial directly compared 20 mg of omeprazole once daily to 40 mg of famotidine once nightly in 60 patients with duodenal ulcers. After two to four weeks of treatment, healing rates were higher with omeprazole than with famotidine. Researchers concluded that omeprazole is more effective than famotidine for rapidly healing duodenal ulcers.
Randomized clinical trials have shown that PPIs are more effective in treating duodenal ulcers than H2 blockers. PPIs were found to significantly increase ulcer healing compared to H2 blockers. No significant differences were found between the PPIs that were studied, which included Prevacid (lansoprazole), Protonix (pantoprazole), and Aciphex (rabeprazole).
In people who take blood thinners, such as clopidogrel and aspirin, a PPI or H2 blocker may be used to prevent ulcers. One systematic review found that PPIs were superior to H2 blockers in preventing gastric ulcers. The studies in the review compared PPIs, such as Prilosec (omeprazole) and Nexium (esomeprazole), and H2 blockers, such as Pepcid (famotidine) and Zantac (ranitidine).
It’s important to seek medical advice from your healthcare provider before taking famotidine or omeprazole. The more effective drug is ultimately the one that works best for your condition.
RELATED: Pepcid vs Zantac
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Coverage and cost comparison of famotidine vs. omeprazole
Most Medicare Part D plans and other insurance plans will cover generic famotidine tablets. Famotidine can cost an average cash price of around $40 without insurance coverage. If you’re looking to save on the cash price of famotidine, you may be able to use a SingleCare famotidine coupon. With a SingleCare famotidine coupon, you could pay as little as $3.
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Omeprazole delayed-release capsules are covered by most Medicare and insurance plans. The average retail cost of omeprazole is around $100 for a typical supply. For generic omeprazole capsules, you may be able to use a SingleCare coupon card to lower this cost. With a SingleCare omeprazole coupon, you may be able to reduce the price to around $2.
| Famotidine | Omeprazole | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare? | Yes | Yes |
| Standard dosage | 20 mg tablets (quantity of 60) | 20 mg capsules (quantity of 30) |
| Typical Medicare copay | $0–$21 | $0–$19 |
| SingleCare cost | $3 | $2 |
Common side effects of famotidine and omeprazole
The most common side effects of famotidine are headache, dizziness, constipation, and diarrhea. The most common side effects of omeprazole are headache, stomach aches, diarrhea, flatulence, nausea, and vomiting. Omeprazole may be more likely than famotidine to cause certain gastrointestinal side effects, such as flatulence or gas.
Serious side effects include allergic reactions to any of the ingredients in these medications. Allergic reactions can include rash or trouble breathing. Seek medical attention if you experience serious adverse effects.
| Famotidine | Omeprazole | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Headache | Yes | ≥1% | Yes | 7% |
| Dizziness | Yes | ≥1% | Yes | 2% |
| Constipation | Yes | ≥1% | Yes | 2% |
| Diarrhea | Yes | ≥1% | Yes | 4% |
| Stomach ache | Yes | <1% | Yes | 5% |
| Nausea | Yes | <1% | Yes | 4% |
| Vomiting | Yes | <1% | Yes | 3% |
| Flatulence | No | – | Yes | 3% |
This may not be a complete list. Consult your doctor or pharmacist for possible side effects.
Source: DailyMed (famotidine), DailyMed (omeprazole)
Drug interactions of famotidine vs. omeprazole
Famotidine and omeprazole may need to be avoided with drugs that depend on stomach acid for absorption. These drugs include antiretrovirals, such as atazanavir and rilpivirine, and antifungals, such as ketoconazole and itraconazole. Taking famotidine or omeprazole can decrease the absorption of these drugs and decrease their overall effectiveness.
Famotidine can also interact with tizanidine, a muscle relaxer that is processed by the CYP1A2 enzyme in the liver. Famotidine can increase levels of tizanidine in the body which can lead to low blood pressure (hypotension), slow heartbeat (bradycardia), or extreme drowsiness.
Unlike famotidine, omeprazole can interact with drugs that are processed by the CYP2C19 and CYP3A4 enzymes in the liver. These drugs may include tacrolimus and warfarin, among other drugs. For example, omeprazole can prolong how long it takes for warfarin to leave the body, which can increase the risk of abnormal bleeding. Taking omeprazole with the immunosuppressant methotrexate can lead to methotrexate toxicity due to decreased clearance of methotrexate. In addition, drugs that induce or inhibit the CYP enzymes can decrease or increase blood levels of omeprazole, leading to reduced effectiveness or an increased risk of side effects.
Famotidine and omeprazole may interact with other drugs not described here. It is important to tell your healthcare provider about all medications you take before starting treatment with famotidine or omeprazole.
| Drug | Drug Class | Famotidine | Omeprazole |
| Atazanavir Rilpivirine Nelfinavir ledipasvir /sofosbuvir Fosamprenavir |
Antiretrovirals | Yes | Yes |
| Erlotinib Dasatinib |
Chemotherapy | Yes | Yes |
| Ketoconazole Itraconazole |
Antifungal | Yes | Yes |
| Tizanidine | Muscle relaxer | Yes | No |
| Tacrolimus Methotrexate |
Immunosuppressant | No | Yes |
| Warfarin | Anticoagulant | No | Yes |
| Rifampin | Antibiotic | No | Yes |
This may not be a complete list of all possible drug interactions. Consult a doctor with all the medications you may be taking.
Warnings of famotidine and omeprazole
Severe GERD symptoms or ulcers may be a sign of gastrointestinal cancer in some people. Additional testing and monitoring may be needed for people who don’t respond to treatment with a PPI or H2 blocker.
Famotidine should be used with caution in elderly people or those with kidney problems. People of older age or with kidney problems may experience higher blood levels of famotidine. As a result, famotidine use could lead to an increased risk of CNS (central nervous system) adverse effects, such as confusion, delirium, and hallucinations.
Unlike famotidine, omeprazole and other PPIs can increase the risk of osteoporosis and bone fractures when used long-term. In addition, omeprazole use, especially in a hospital setting, may lead to an increased risk of Clostridium difficile-related diarrhea and other adverse effects. One study found that proton pump inhibitors are associated with greater risks of serious adverse effects like pneumonia and C. diff infections in critically ill patients. The study took data from 71 hospitals and compared the safety of PPIs and H2-blockers.
Overall, omeprazole tends to have more warnings and precautions associated with it compared to famotidine. Consult a healthcare provider about other possible safety concerns with H2 blockers and PPIs.
Frequently asked questions about famotidine vs. omeprazole
What is famotidine?
Famotidine is an H2 blocker medication used to treat GERD, duodenal ulcers, and stomach ulcers. It is also FDA-approved to treat hypersecretory conditions like Zollinger-Ellison syndrome. Famotidine is the generic form of Pepcid and is usually taken once or twice daily for six to eight weeks or longer.
What is omeprazole?
Omeprazole is a proton pump inhibitor (PPI) that is FDA-approved to treat certain digestive conditions, such as GERD and gastric ulcers. It is also used to treat H. pylori infections. Omeprazole is known by its brand name, Prilosec or Prilosec OTC. It is often taken once daily for four to eight weeks or longer.
Are famotidine and omeprazole the same?
Famotidine and omeprazole are not the same. Although they treat similar gastrointestinal problems, they are different drugs. Famotidine is an H2 blocker and omeprazole is a PPI.
Is famotidine or omeprazole better?
Omeprazole is considered a more effective drug than famotidine. Omeprazole also lasts longer than famotidine, with effects that increase after taking it every day. This cumulative effect is not seen with famotidine. However, omeprazole may have more adverse effects associated with its use, such as an increased risk of osteoporosis and gastritis with long-term use.
Can I take omeprazole and famotidine together?
There are no drug interactions between omeprazole and famotidine. In some cases, omeprazole and famotidine may be used together on a daily basis. While PPIs are usually sufficient to treat digestive disorders like GERD, some people may need extra treatment to manage and control acid production at night. For people who experience symptoms at night, famotidine may be a useful treatment option in the evening.
One study found that combining famotidine and omeprazole was more effective for acid control than famotidine or omeprazole alone. Researchers concluded that the long-acting effects of omeprazole could be complementary to the relatively fast-acting effects of famotidine. Still, more studies are needed to determine whether combining omeprazole and famotidine is appropriate.
Can I use famotidine or omeprazole while pregnant?
Famotidine is in pregnancy category B, while omeprazole is in pregnancy category C. In other words, famotidine may have less risk of causing harm during pregnancy compared to omeprazole. Despite being in pregnancy category C, studies have shown that omeprazole may be safe for pregnant women. Consult your healthcare provider when choosing a treatment option while pregnant or breastfeeding.
Can I use famotidine or omeprazole with alcohol?
Alcohol does not interact with the way famotidine and omeprazole work. However, alcohol may increase the production of acid in the stomach, which could lead to worsened digestive symptoms. It’s best to limit yourself to drinking alcohol in moderation or avoiding alcohol altogether, especially if you notice an increase in symptoms or side effects.
What is the safest acid reflux medicine?
Everyone responds to medications differently. Therefore, the safest acid reflux medicine is the one that works best for you with the least amount of side effects. When compared to famotidine, omeprazole may have an increased risk of adverse effects, such as osteoporosis, especially when used long-term.
Is it ok to take Pepcid every day?
Pepcid is typically taken on a daily basis for up to six, eight, or 12 weeks at a time. The duration of treatment depends on the condition that is being treated. Talk to your doctor to find out how long you should be taking Pepcid. Consider lifestyle changes in addition to medications to help relieve heartburn that occurs more frequently.
What is the fastest-acting heartburn medicine?
Antacids usually work the fastest for treating heartburn symptoms. Antacids like Rolaids (calcium carbonate and magnesium hydroxide) can neutralize acid within 30 minutes of taking them. Compared to famotidine, calcium carbonate was found to have a faster onset of action. While they give quick relief of heartburn, antacid effects do not last for the whole day. H2 blockers and PPIs last longer and are reserved for more chronic digestive conditions like GERD.
