(ni ZA ti deen)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Axid: 150 mg [DSC], 300 mg [DSC]
Generic: 150 mg, 300 mg
Axid: 15 mg/mL (480 mL) [contains methylparaben, propylparaben, saccharin sodium; bubble-gum flavor]
Generic: 15 mg/mL (473 mL, 480 mL [DSC])
Axid AR: 75 mg [DSC]
Brand Names: U.S.
- Axid AR [OTC] [DSC]
- Histamine H2 Antagonist
Competitive inhibition of histamine at H2-receptors of the gastric parietal cells resulting in reduced gastric acid secretion, gastric volume and hydrogen ion concentration reduced. In healthy volunteers, nizatidine suppresses gastric acid secretion induced by pentagastrin infusion or food.
Vd: 0.8 to 1.5 L/kg
Partially hepatic; forms metabolites
Urine (90%; ~60% as unchanged drug); feces (<6%)
Time to Peak
Plasma: 0.5 to 3 hours
1 to 2 hours; Prolonged with moderate to severe renal function impairment
35% to alpha-1 acid glycoprotein
Special Populations: Renal Function Impairment
Moderate to severe renal function impairment decreases clearance. Reduce amount and frequency of dose according to severity.
Use: Labeled Indications
Treatment and maintenance of duodenal ulcer; treatment of benign gastric ulcer; treatment of gastroesophageal reflux disease (GERD)
Part of a multidrug regimen for H. pylori eradication to reduce the risk of duodenal ulcer recurrence
Hypersensitivity to nizatidine or any component of the formulation; hypersensitivity to other H2 antagonists (cross-sensitivity has been observed)
Duodenal ulcer: Oral:
Treatment of active ulcer: 300 mg at bedtime or 150 mg twice daily
Maintenance of healed ulcer: 150 mg/day at bedtime
Gastric ulcer: Oral: 150 mg twice daily or 300 mg at bedtime
GERD: Oral: 150 mg twice daily
Helicobacter pylori eradication (off-label use): Oral: 150 mg twice daily (in combination with amoxicillin and clarithromycin [or bismuth, metronidazole, and tetracycline]) for 10 to 14 days (ACG [Chey 2007]; Graham 2003; Talley 1998).
Refer to adult dosing.
GERD (off-label use): Oral:
Children <12 years: 10 mg/kg/day in divided doses given twice daily; may not be as effective in children <12 years
Children ≥12 years: Refer to adult dosing.
Dosing: Renal Impairment
CrCl 20-50 mL/minute: 150 mg/day
CrCl <20 mL/minute: 150 mg every other day
CrCl 20-50 mL/minute: 150 mg every other day
CrCl <20 mL/minute: 150 mg every 3 days
Dosing: Hepatic Impairment
No dosage adjustment provided in manufacturer’s labeling.
A 2.5 mg/mL oral solution may be made with capsules and one of three different vehicles (lemon-lime Gatorade®, Ocean Spray® Cran-Grape® juice or V8® 100% vegetable juice). Empty the contents of one 300 mg capsule in a mortar. Add small portions of the chosen vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 120 mL. Label "shake well". Stable for 2 days refrigerated.Nahata MC, Pai VB, and Hipple TF, Pediatric Drug Formulations, 5th ed, Cincinnati, OH: Harvey Whitney Books Co, 2004.
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).
Nizatidine is stable for 48 hours at room temperature when the contents of a capsule are mixed in Gatorade® lemon-lime, Cran-Grape® grape-cranberry drink, V8®, or aluminum- and magnesium hydroxide suspension (approximate concentration 2.5 mg/mL) (Lantz, 1990)
Atazanavir: H2-Antagonists may decrease the serum concentration of Atazanavir. Management: Specific dose limitations and administration guidelines exist; consult full interaction monograph or atazanavir prescribing information. Consider therapy modification
Bosutinib: H2-Antagonists may decrease the serum concentration of Bosutinib. Management: Administer histamine H2 receptor antagonists more than 2 hours before or after bosutinib. Consider therapy modification
Cefditoren: H2-Antagonists may decrease the serum concentration of Cefditoren. Management: Concomitant use of cefditoren with H2-antagonists and antacids is not recommended. Consider alternative methods to control acid reflux (eg, diet modification) or alternative antimicrobial therapy if use of H2-antagonists can not be avoided. Consider therapy modification
Cefpodoxime: H2-Antagonists may decrease the absorption of Cefpodoxime. Separate oral doses by at least 2 hours. Monitor therapy
Cefuroxime: H2-Antagonists may decrease the absorption of Cefuroxime. Separate oral doses by at least 2 hours. Monitor therapy
Cysteamine (Systemic): H2-Antagonists may diminish the therapeutic effect of Cysteamine (Systemic). Monitor therapy
Dabrafenib: H2-Antagonists may decrease the serum concentration of Dabrafenib. Monitor therapy
Dasatinib: H2-Antagonists may decrease the absorption of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of H2-antagonists if some acid-reducing therapy is needed. Avoid combination
Delavirdine: H2-Antagonists may decrease the serum concentration of Delavirdine. Management: Chronic therapy with H2-antagonists should be avoided in patients who are being treated with delavirdine. The clinical significance of short-term H2-antagonist therapy with delavirdine is uncertain, but such therapy should be undertaken with caution. Avoid combination
Dexmethylphenidate: H2-Antagonists may increase the absorption of Dexmethylphenidate. Specifically, H2-antagonists may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption. Monitor therapy
Erlotinib: H2-Antagonists may decrease the serum concentration of Erlotinib. Management: Avoid H2-antagonists in patients receiving erlotinib when possible. If concomitant treatment cannot be avoided, erlotinib should be dosed once daily, 10 hours after and at least 2 hours before H2-antagonist dosing. Consider therapy modification
Fosamprenavir: H2-Antagonists may decrease the serum concentration of Fosamprenavir. Cimetidine may also inhibit the metabolism of the active metabolite amprenavir, making its effects on fosamprenavir/amprenavir concentrations difficult to predict. Monitor therapy
Gefitinib: H2-Antagonists may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or after administration of a histamine H2-antagonist, and closely monitor clinical response to gefitinib. Consider therapy modification
Indinavir: H2-Antagonists may decrease the serum concentration of Indinavir. Monitor therapy
Iron Salts: H2-Antagonists may decrease the absorption of Iron Salts. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Gluconate; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Monitor therapy
Itraconazole: H2-Antagonists may decrease the serum concentration of Itraconazole. Management: When this combination is used, the itraconazole should be administered with a cola beverage (8 ounces). Itraconazole oral suspension may be less sensitive to this interaction. Monitor patient response to itraconazole closely. Consider therapy modification
Ketoconazole (Systemic): H2-Antagonists may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer oral ketoconazole at least 2 hours prior to use of any H2-receptor antagonist. Monitor patients closely for signs of inadequate clinical response to ketoconazole. Consider therapy modification
Ledipasvir: H2-Antagonists may decrease the serum concentration of Ledipasvir. Consider therapy modification
Mesalamine: H2-Antagonists may diminish the therapeutic effect of Mesalamine. Histamine H2-Antagonist-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Consider avoiding concurrent administration of high-dose histamine H2-receptor antagonists with sustained-release mesalamine products. Consider therapy modification
Methylphenidate: H2-Antagonists may increase the absorption of Methylphenidate. Specifically, H2-antagonists may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption. Monitor therapy
Multivitamins/Minerals (with ADEK, Folate, Iron): H2-Antagonists may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be impaired by H2-antagonists. Monitor therapy
Nelfinavir: H2-Antagonists may decrease the serum concentration of Nelfinavir. Concentrations of the active M8 metabolite may also be reduced. Monitor therapy
Nilotinib: H2-Antagonists may decrease the serum concentration of Nilotinib. Management: The nilotinib dose should be given 10 hours after or 2 hours before the H2 receptor antagonist in order to minimize the risk of a significant interaction. Consider therapy modification
PAZOPanib: H2-Antagonists may decrease the serum concentration of PAZOPanib. Management: Avoid the use of histamine H2-antagonists in combination with pazopanib. Strategies to minimize the expected interaction between these agents (eg, dose separation) have not been investigated. Avoid combination
Posaconazole: H2-Antagonists may decrease the serum concentration of Posaconazole. Management: Avoid concurrent use of oral suspension with H2-antagonists whenever possible. Monitor patients closely for decreased antifungal effects if this combination is used. Delayed-release posaconazole tablets may be less likely to interact. Consider therapy modification
Rilpivirine: H2-Antagonists may decrease the serum concentration of Rilpivirine. Management: Administer histamine H2 receptor antagonists at least 12 hours before or 4 hours after rilpivirine. Consider therapy modification
Risedronate: H2-Antagonists may increase the serum concentration of Risedronate. This applies specifically to delayed-release risedronate. Avoid combination
Saquinavir: H2-Antagonists may increase the serum concentration of Saquinavir. Monitor therapy
Varenicline: H2-Antagonists may increase the serum concentration of Varenicline. Management: Monitor for increased varenicline adverse effects with concomitant use of cimetidine or other H2-antagonists, particularly in patients with severe renal impairment. International product labeling recommendations vary. Consult appropriate labeling. Monitor therapy
Velpatasvir: H2-Antagonists may decrease the serum concentration of Velpatasvir. Monitor therapy
False-positive urine protein using Multistix®, gastric acid secretion test, skin tests allergen extracts, serum creatinine and serum transaminase concentrations, urine protein test
>10%: Central nervous system: Headache (16%)
1% to 10%:
Central nervous system: Anxiety, dizziness, fever (reported in children), insomnia, irritability (reported in children), somnolence, nervousness
Dermatologic: Pruritus, rash
Gastrointestinal: Abdominal pain, anorexia, constipation, diarrhea, dry mouth, flatulence, heartburn, nausea, vomiting
Respiratory: Reported in children: Cough, nasal congestion, nasopharyngitis
<1% (Limited to important or life-threatening): Alkaline phosphatase increased, ALT increased, anaphylaxis, anemia, AST increased, bronchospasm, confusion, eosinophilia, exfoliative dermatitis, gynecomastia, hepatitis, jaundice, laryngeal edema, serum-sickness like reactions, thrombocytopenia, thrombocytopenic purpura, vasculitis, ventricular tachycardia
• Gastric malignancy: Relief of symptoms does not preclude the presence of a gastric malignancy.
• Hepatic impairment: Use with caution in patients with hepatic impairment; dosage adjustment recommended.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.
• Vitamin B12 deficiency: Prolonged treatment (≥2 years) may lead to vitamin B12 malabsorption and subsequent vitamin B12 deficiency. The magnitude of the deficiency is dose-related and the association is stronger in females and those younger in age (<30 years); prevalence is decreased after discontinuation of therapy (Lam, 2013).
Pregnancy Risk Factor
Adverse events have not been observed in animal reproduction studies; therefore, the nizatidine is classified as pregnancy category B. Nizatidine crosses the placenta. An increased risk of congenital malformations or adverse events in the newborn has generally not been observed following maternal use of nizatidine during pregnancy. Histamine H2 antagonists have been evaluated for the treatment of gastroesophageal reflux disease (GERD), as well as gastric and duodenal ulcers during pregnancy. Although if needed, nizatidine is not the agent of choice. Histamine H2 antagonists may be used for aspiration prophylaxis prior to cesarean delivery.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience headache or diarrhea. Have patient report immediately to prescriber severe dizziness; passing out; confusion; bruising; bleeding; black, tarry, or bloody stools; or vomiting blood (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.