Histamine 2 Blocker Drugs - Famotidine

Generic Name                                 

famotidine                                                                                                                                                                                                                                            

Strength

20 mg and 40 mg
Form

tablet

Special Authority Criteria

Approval Period

Treatment failure on prescription dose of, or intolerance to, ranitidine.

Indefinite

Practitioner Exemptions

Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:

  • Paediatric Cardiology
  • Paediatrics
  • Paediatric general surgery

Special Notes

  • Prescription dose of ranitidine for adults is considered to be 150mg twice daily or 300mg once daily.
  • Non-prescription use of famotidine is not eligible for PharmaCare coverage.

Special Authority Request Form