A Case of Epigastric Pain and Gastrointestinal Bleeding in a Hypertensive Patient- Clinical Insights

A Case of Epigastric Pain and Gastrointestinal Bleeding in a Hypertensive Patient- Clinical Insights

The most likely reason for the reduced dose of famotidine in this patient is the presence of renal insufficiency (Option D). Famotidine, a histamine-2 receptor antagonist (H2 blocker), is commonly used for managing peptic ulcers and gastroesophageal reflux disease (GERD) by suppressing gastric acid production (Balouch et al., 2023). However, its elimination is predominantly through the kidneys.

In this case, the patient’s elevated creatinine level of 4.5 mg/dL indicates significant renal impairment, far beyond the normal range of 0.9-1.3 mg/dL. Creatinine is a reliable marker of renal function, and its heightened levels suggest compromised kidney function. When renal function is impaired, the clearance of drugs, including famotidine, is reduced. Consequently, a standard dose may lead to drug accumulation, increasing the risk of adverse effects (Takita et al., 2020). Therefore, a dose adjustment is crucial to align with the patient’s renal capacity and prevent potential toxicity.

Considering the patient’s clinical scenario, marked by persistent epigastric pain, tarry stools, and the presence of a large gastric ulcer revealed through endoscopy, effective acid suppression is paramount. As a suitable choice, famotidine necessitates careful dosing adjustments to ensure optimal therapeutic benefits while mitigating the risk of harm in the context of renal insufficiency (Balouch et al., 2023). Consistently, while other factors such as anemia, hypertension, age, and hypersensitivity to omeprazole are relevant aspects of the patient’s medical history, they do not directly impact the metabolism or clearance of famotidine. Anemia, observed with a hemoglobin level of 9 g/dL, is a consequence of gastric ulcer rather than a determinant of famotidine dosage (Takita et al., 2020). Hypertension, age, and hypersensitivity to omeprazole are not specific factors influencing famotidine metabolism.

In summary, the primary reason for the reduced famotidine dose is the patient’s renal insufficiency, as reflected in the elevated creatinine levels. This consideration aligns with the pharmacokinetics of famotidine, highlighting the importance of personalized dosing in patients with compromised renal function to optimize therapeutic outcomes and minimize the risk of adverse effects.

References

Balouch, B., Vontela, S., Yeakel, H., Alnouri, G., & Sataloff, R. T. (2023). Role of Famotidine and Other Acid Reflux Medications for SARS-CoV-2: A Pilot Study. Journal of Voice, 37(3), 419-425. https://doi.org/10.1016/j.jvoice.2021.01.007

Takita, H., Scotcher, D., Chinnadurai, R., Kalra, P. A., & Galetin, A. (2020). Physiologically‐based pharmacokinetic modeling of creatinine‐drug interactions in the chronic kidney disease population. CPT: Pharmacometrics & Systems Pharmacology, 9(12), 695-706. https://doi.org/10.1002/

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A 72-year-old man was admitted to the hospital because of persistent epigastric pain and tarry stools. The patient had been suffering from hypertension for 5 years and was being treated with hydrochlorothiazide and losartan. History was significant for a serious hypersensitivity reaction to omeprazole taken 1 year ago for heartburn. Pertinent laboratory results on admission were red blood cell count 3.5 × 106/mm3 (normal 4.5−5.5 × 106/mm3), hemoglobin 9 g/dL (normal 14−16 g/dL), creatinine 4.5 mg/dL (normal 0.9−1.3 mg/dL). Endoscopy disclosed a large gastric ulcer. Therapy with famotidine was started, but the standard dose was reduced by one-half. Which of the following was the most likely reason for the use of a reduced dose of famotidine in this patient?

A Case of Epigastric Pain and Gastrointestinal Bleeding in a Hypertensive Patient- Clinical Insights

A. The patient’s anemia
B. The patient’s hypertension
C. The patient’s age
D. The patient’s renal insufficiency
E. The patient’s hypersensitivity to omeprazole

Please provide rationales and references for your selected answer choice.

Best,