Antihistamines

P

Purple

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U.K. Where to buy pepcid/famotidine

Hi all, we want to try famotidine as a treatment for Long Covid but I have discovered that Boots does not stock it, yet it seems to be an OTC medication in the UK (sold as Pepcid). Does anyone know where to buy it? Thank you
 
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Posting this for thoroughness:

Clinical update on COVID-19 for the emergency and critical care clinician: Medical management July 2022, Long et al

3.8. Controversial and experimental treatments

In the initial period of the pandemic, several medications were theorized to be effective against COVID-19. These include chloroquine (CLQ) and hydroxychloroquine (HCQ), colchicine, convalescent plasma, famotidine, fluvoxamine, ivermectin, and vitamin and mineral supplements. Most of these were based largely on perceived successes in initial case reports and case series, but subsequent trials found inconsistent efficacy and concerns for increased risk of adverse events.

3.8.4. Famotidine

The proposed mechanism of action for famotidine centers on competitive inhibition of two essential SARS-CoV-2 protease enzymes that allow for viral docking [136,137]. However, in-vitro studies are inconsistent, and this theory has been disputed [136,137]. Retrospective analyses early in the COVID-19 pandemic found that small populations given famotidine had a reduced risk of intubation and death [[136], [137], [138], [139], [140]]. Several of these analyses were limited by significant heterogeneity in formulations and dosing of famotidine, including some patients already taking the medication prior to hospitalization [136,138]. Additionally, several studies employed famotidine at more than double the standard dose or simultaneously used intravenous and oral formulations, prompting concerns for increased side effect risks [137,139]. Subsequent larger trials and meta-analyses demonstrated no reduction in mortality [[141], [142], [143]]. Current IDSA guidelines state that famotidine should not be used solely to treat COVID-19 disease [10].

4. Conclusions

The COVID-19 pandemic has led to over 5.9 million deaths. A variety of therapies have been investigated for the medical management of COVID-19. Steroids, antivirals, IL-6 antagonists, monoclonal antibodies, and kinase inhibitors have demonstrated utility in certain patient subsets. Prophylactic anticoagulation in admitted patients demonstrates improved outcomes. Aspirin in outpatients may also be associated with improved outcomes, but data are controversial. Other therapies including CLQ and HCQ, colchicine, convalescent plasma, famotidine, ivermectin, and vitamins and minerals are controversial, with no evidence in rational medical literature to support their use.
 
Thanks for this. My rationale is more to do with recent trials that have been started looking at a combination of H1 and H2 antihistamines for long Covid. Pepcid is theoretically available OTC but I can't find a legitimate place to buy it.
 
A pharmacist told me about three years ago that you need a prescription to buy famotidine over the counter. I'd had it on prescription and had developed the same symptoms again, and wanted to check I couldn't just buy it before I saw the GP. She said an OTC trial was once done, but the med was discontinued.

You might be able to obtain it via a private prescription, I suppose. There are legitimate online pharmacies that offer these for some treatments. It would mean, though, that a cheap tablet became an expensive one.

I've used online pharmacies to buy soluble potassium for when my muscles lose power, and the pharmacists seemed thorough but helpful. Even though this is an OTC med, they asked questions before they made the sale, and I'm sure the pharmacies weren't cowboy outfits (not least because Sando-K is the sort of treatment few would bother to fake due to lack of profit potential!).

I'm not commenting on the famotidine theory, just passing on that there are online pharmacies dispensing genuine products.
 
From the BNF - British National Formulary :
Exceptions to legal category
Exceptions to legal category For famotidine

Famotidine can be sold to the public for adults and children over 16 years (provided packs do not contain more than 2 weeks’ supply) for the short-term symptomatic relief of heartburn, dyspepsia, and hyperacidity, and for the prevention of these symptoms when associated with consumption of food or drink including when they cause sleep disturbance (max. single dose 10 mg, max. daily dose 20 mg).
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Source : https://bnf.nice.org.uk/drugs/famotidine/

Just because the BNF says that something is legal to sell to the public doesn't mean that pharmacies are obliged to sell to the public.

Edit : It might be worth shopping around at other pharmacies, particularly ones which are independent and unconnected with the big chains.

There are other drugs available in the h2-receptor antagonist class that might be easier to source without prescription, but I haven't tried to buy any since ranitidine was withdrawn from sale a few years ago.

https://bnf.nice.org.uk/search/?q=h2-receptor antagonists
 
Purple said:
Thanks for this. My rationale is more to do with recent trials that have been started looking at a combination of H1 and H2 antihistamines for long Covid. Pepcid is theoretically available OTC but I can't find a legitimate place to buy it.
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H2 antihistamines are difficult to get hold of even in hospitals. I have twice been in hospital with doctors wishing to prescribe H2 antihistamines but they weren't available from the hospital pharmacy.
 
Arnie Pye said:
Just because the BNF says that something is legal to sell to the public doesn't mean that pharmacies are obliged to sell to the public.
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Or that manufacturers are obliged to make it—the med that was part of the trial, part of the Pepcid brand, was discontinued according to the pharmacist. At the time I didn't go into why as I knew my GP would prescribe it, but it might have been poor sales.
 
Moved posts from
Diagnosis of mast cell activation syndrome: a global “consensus-2”, 2020, Afrin et al

Warning: anecdotal

I've been mostly bed bound for the last couple of years. Enough energy to do daily tasks and even small workouts, but the PEM has ruled.

A couple of weeks ago I had a cold. Normally I refuse to use any medication, but I took one diphenhydramine. I was full of energy and almost high for more than 8 hours. The drug isn't supposed to last anywhere near that long. I looked up MCAS because I had a lot of the symptoms.

I decided to follow the protocol from what I could get off the shelf. An H1 and H2 inhibitor every 2 hours plus Quercetin. Note that even with a diagnosis the final test is "Does that seem to help?"

Suddenly I've been able to read, concentrate for several hours. I wake up in the morning with energy and ready to go. After more than 8 years of suffering the results are astounding.

Note that I also got my cholesterol specialist to switch me to pravastarin which is part of Patterson's protocol. In general, the idea is to tamp down the immune system cytokine reaction

In general having been through many of these "cures" I am highly skeptical. I understand that it might be nothing more than a very temporary energizing that leads to a big crash.

All the antihistamines are off the shelf. Don't use the mixed ones with decongestants since they can raise blood pressure.

Still monitoring and continuing. If nothing else it may be a good temporary option for when I really need it
 
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Also anecdotal, but I started taking antihistamines (an H1 and an H2 inhibitor), thinking it might help with some gut issues. It didn't help my gut, but it absolutely did improve my general capacity and increase my threshold for PEM — especially for mental concentration. I went from only being able to work an hour or two a day to being able to work more or less full-time again, though of course with some limitations. I am also more able to cook and do other light physical activities.

The effect has been quite strong with Allegra and Pepcid, the higher doses available, twice per day. I tried stopping both for a couple weeks and definitely felt worse. I'm now about three months in. It seems like a fair number of people with Long Covid have found similar results.

I don't really have other MCAS symptoms other than the very general ones (fatigue, headache, etc) and I'm not at all convinced by the MCAS theory, but the antihistamines do really seem to be doing something for me. That might be related to mast cells or it might be something else entirely.
 
The best web resource I've found is

https://www.mastattack.org/2014/10/mcas-treatment/

I've pointed to the treatment page but the rest of the site has some well written material also.

One doctor who seems to treat it a fair bit has some blogs that also describe drugs and dosing

https://hoffmancentre.com/12-tips-living-mast-cell-activation-syndrome/

He has detailed symptoms listed under the +tabs

https://hoffmancentre.com/treatments/mcas/

I was struck by how long I'd had some of the symptoms. Most recently I took off a wedding ring due to a nickel allergy, then realized I'd had the same problem with a belt buckle years ago. For the longest time I've a really recurrent forearm itch that almost seemed to a isolated to a particular spot each time. It was like being stabbed with a pin every 20 seconds. I tried just about every topical itch medication available without success. Another was a delayed swelling reaction to bee stings (no anaphalaxis, just swelling, so histamine response type IV which even most doctors seem to ignore). Beta blockers also cause severe leg swelling, again, over the course of many days.

Doctors despise self diagnosis (often rightfully so). In this case, the drugs are all available over the counter. In addition, since the symptoms are so general, the final test is to try the histamines and see if they work.

While diphenylhydramine isn't typically used first, it does have the advantage of being able to break through the blood brain barrier. so I can see how my reaction to it was the strongest. Mast cells are born in the bone marrow but travel everywhere. In my case, I've had difficult to control high blood pressure, high cholesterol and slowly failing kidneys for quite some time. Being a science guy, I've been taking my blood pressure once a day for a long time, so it will be interesting to see if the numbers come down. I've also got cholesterol and kidney tests coming up in the next few weeks. Again, regardless of how I feel, if the numbers back me up I'll be far more eager to believe my self-diagnosis.
 
darrellpf said:
Another was a delayed swelling reaction to bee stings (no anaphalaxis, just swelling, so histamine response type IV which even most doctors seem to ignore).
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I was not aware that mast cells and histamine had anything specific to do with type IV hypersensitivity to nickel, which is supposed to be mediated by T cell responses?

The mast attack website seems just to be a patient who has copied the anecdotal musings of Dr Afrin. As far as I know nobody much in the medical world takes him seriously other than private practitioners.
 
i am trying to find infgormation on maximum doses. are there any resoures tat describe h1 and h2 inhibitor every 2h?

the only thing i found was hoffman saying that they can be increased to 3x the otc rec dose, without specifying.
 
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Samuel said:
i am trying to find infgormation on maximum doses. are there any resoures tat describe h1 and h2 inhibitor every 2h?

the only thing i found was hoffman saying that they can be increased to 3x the otc rec dose, without specifying.
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If you scroll down to MCAS in this article, you'll see the dosages that Paul Glynne recommends: https://www.medscape.co.uk/viewarticle/draw-expert-opinion-optimise-care-long-covid-2022a1001lla ; Also, this study of antihistamines and Long Covid gives dosages: https://jim.bmj.com/content/70/1/61
 
In general, the H1 inhibitors are found as over the counter allergy medication. The H2 inhibitors are the ones that can be found in over the counter heartburn medication.

Please take care to look up the ingredient given on the box to be sure they belong to that drug class. For instance, heartburn medication may also be calcium or proton pump inhibitors. You can do a Google search for the inhibitors to show both their brand name and drug name.

Stick to standard dosing on the packaging. If you don't have noticeable improvement in a few days then they probably won't work for you. It is also a good idea to try a low histamine diet... It is better to naturally restrict histamines from getting into your system, saving the drug routine for occasions when you need it.

Most practitioners seem to recommend one H1 and one H2 every 12 hours. Even though they may favor certain drugs, I have seen them recommend trying other drugs in the same class if a particular one doesn't work for you.

I also note that diphenylhydramine crosses the blood/brain barrier.

I've had really good success. My biggest caution is that often even when some of these reported solutions do work, the may have a short term stimulation effect that ends up deeper into a longer term crash.
 
I used to buy famotidine very cheaply here before I had it prescribed by my GP - https://www.biovea.com/uk/product/detail/1982/acid-controller-maximum-strength-125-tablets

You can buy H2’s anywhere, just google. Fexofenadine seems to be the favoured but cetirizine is very very cheap, you can buy boxes of amazon but check interactions with other drugs.

H1 and H2 combination with a low histamine diet made a difference to many “ME” symptoms for me. If I stop taking them for just a few days which I have during periods when they were difficult to get hold of during the pandemic, I can’t walk around the house and my speech returns to being stuttered and disappears completely in some cases. The H2 helps with gut motility. This regime has also really helped with pain and migraine. Migraines were unbearable, daily and included face pain which got worse as the day wore on which I could never understand. Now I get it as the “histamine or mast cell bucket” would fill up. Fibromyalgia is often misdiagnosed as MCAS apparently. I can well believe that from my experience.

It took a year of this regime to regain normal speech and build up strength, but the changes we slow to work and I wonder if people don’t give these long enough, but also it was much easier for me as I was so sensitive. It would be more difficult for someone less sensitive I would imagine.

Finding triggers helped too. For me they were heat, cold (retrieving food from the freezer sometimes tricky) chemicals - anything from some household cleaners to washing up liquid and hand cream, washing powder, deodorant. I was so sensitive, but I became very unwell. Stress, activity, avoiding fermented foods, foods high in histamines. And keeping windows closed as I am very affected by diesel and smoke. When I could leave the house car journeys would trigger me because friction can activate mast cells.
This is a good site - https://tmsforacure.org/symptoms/symptoms-and-triggers-of-mast-cell-activation/

Adding in mast cell blockers and the advice from mast attack facebook page, website and here - https://www.lymedisease.org/lyme-sci-mcas-agony/ (Not all of it) and using the very informative and supportive facebook groups. As above quercetin but it doesn’t help everyone, for instance if you don’t tolerate salicylates and high dose vitamin C if you are ok with that, really helps and helps after reactions.

I am still having seizures but they aren’t as painful or frequent and with less paralysis, so if you have those or if you come across anyone who does - using liquid cetirizine helps to stop them. I was so thankful for that advice as they were so bad I thought my jaw would crack on some occasions.

I was misdiagnosed with FND and left with nothing, so if I hadn’t have done this myself, dread to think where I would be now as my symptoms became slowly worse. Very thankful for the knowledge in our community and private Doctors who can prescribe mast cell blockers. I now have them on prescription and my GP is supportive of this diagnosis.

Many people seem to poo poo MCAS without even looking at any of the research which would be comical if we weren’t suffering so much and this wasn’t such an easy fix.

Merryn Crofts had MCAS. I wonder if the sickest among us have it very severely. I wish it was taken more seriously and treated on the NHS.

I recently had an allergist diagnose me with non specific chemical reactions who denied MCAS but their colleagues diagnose it, just I had been unlucky - “that’s not a normal allergic response” (really!?) - my body swells up, so I am definitely having an allergic response, and the ambulance crews measure my blood pressure as it jumps around all over the place, so that isn’t something I am in control of, and I have improved with the protocols the private Doctors have given me, which I started myself when the NHS abandoned me as an hysterical woman - but MCAS isn’t a thing

MCAS has an ICD 10 code D89.40 since 2016.
https://www.aapc.com/codes/icd-10-codes/D89.40

It takes a long time but hang in there.
 
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Binkie4 said:
H2 antihistamines are difficult to get hold of even in hospitals. I have twice been in hospital with doctors wishing to prescribe H2 antihistamines but they weren't available from the hospital pharmacy.
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There was an issue with ranitidine - “The recall includes all prescription and over-the-counter ranitidine drugs as ongoing investigations uncovered levels of N-Nitrosodimethylamine (NDMA), a probable human carcinogen, increase over time. The FDA has requested all ranitidine (Zantac) products be pulled from the market immediately, according to a statement” April 2020.

It was beginning to be recalled in 2019 so if it was around this time then hospitals would have had supply issues. Now it’s fine and Cimetidine and Famotidine have replaced it, but I hear they are going to start manufacturing it again with the carcinogenic causing agent removed.
 
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Thank you for the explanation @Arisoned. I think we have a small stock at home of ranitidine that is several years old. We should get rid of it and replace it.

The first time I experienced a problem with supply of H2 antihistamine in a hospital was at the end of 2019 after I had been admitted following experiencing anaphylaxis.

The second time was in 2021 after having a severe reaction to a Pfizer vaccine. The junior doctor dealing with me said her Consultant had suggested she go round each ward in the hospital to see if they had any stock since there was none available from the pharmacy. I didn't wait. It would have taken hours. Presumably this would have been old stock.
 
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