Nizatidine

(nye-ZAT-ih-deen)

Axid AR, Axid Pulvules,  Apo-Nizatidine

Class: Histamine H2 antagonist

 Action Reversibly and competitively blocks histamine at H₂ receptors, particularly those in gastric parietal cells, leading to inhibition of gastric acid secretion.

 Indications Treatment and maintenance of duodenal ulcer, gastroesophageal reflux disease (GERD, including erosive or ulcerative disease) and benign gastric ulcer. Prevention of heartburn, acid indigestion and sour stomach brought on by consuming food and beverages.

 Contraindications Hypersensitivity to H₂ antagonists.

 Route/Dosage

Duodenal Ulcer (Active)

ADULTS: PO 300 mg at bedtime or 150 mg bid for up to 8 wk; maintenance: 150 mg at bedtime.

Benign Gastric Ulcer (Acute)

ADULTS: PO 300 mg at bedtime or 150 mg bid.

GERD

ADULTS: PO 150 mg bid.

Moderate-to-Severe Renal Insufficiency

Dosage adjustment recommended.

Acid Reduction

ADULTS: PO 75 mg with water ½ to 1 hr before consuming food and beverages that may cause symptoms.

 Interactions

Aspirin Increased salicylate levels in patients taking very high doses of aspirin (3.9g/day). Ketoconazole Effects of ketoconazole may be reduced.

 Lab Test Interferences False-positive tests for urobilinogen with Multistix may occur.

 Adverse Reactions

CV: Cardiac arrhythmias. CNS: Headache; somnolence; fatigue; dizziness. GI: Diarrhea; constipation; nausea; vomiting; abdominal discomfort; anorexia; cholestatic or hepatocellular effects. GU: Hyperuricemia unassociated w/gout or nephrolithiasis. HEMA: Thrombocytopenia; eosinophilia. HEPA: Hepatocellular injury; elevated AST, ALT and alkaline phosphatase concentrations. DERM: Exfoliative dermatitis; erythroderma; rash; pruritus; urticaria. OTHER: Gynecomastia; sweating; fever.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Elderly: May have reduced renal function; decreased clearance may be more common. Hepatic impairment: Use drug with caution; decreased clearance may occur. In patients with normal renal function and uncomplicated hepatic dysfunction, nizatidine disposition is generally normal. Hepatocellular injury: Abnormalities appear to be reversible after discontinuation of drug. Renal function impairment: Decreased clearance may occur; reduced dosage may be needed.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Give twice daily after breakfast and at bedtime, or if once daily, give at bedtime.
• Do not administer within 1 hr of antacids.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess baseline AST, ALT, and alkaline phosphatase levels.
• Monitor liver function test results, CBC, BUN, and creatinine levels.
• Assess for constipation and encourage increased fluid intake.
• Assess for fatigue, somnolence, skin rashes, and diaphoresis

 Patient/Family Education

• Advise patient to take medication after breakfast and at bedtime if prescribed for twice-daily regimen or at bedtime if prescribed for once-daily dosage.
• Caution patient to stay active and to increase fluid and roughage in diet to prevent constipation.
• Instruct patient to take missed dose as soon as possible, and caution not to double doses.
• Advise patient to avoid cigarette smoking, which increases gastric acid secretions and therefore decreases effectiveness of nizatidine therapy.
• Instruct patient to report the following symptoms to physician: Abdominal pain, coffee-ground emesis, tarry stools, extreme fatigue, or weakness.

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