PPi and H2 blocker?

Shelby –

I Forgot to suggest that you break up the medicine dose if your not already doing so. That worked wonders for us too. .. I did 3/4 of Sophia’s dose at night and 1/4 of it in the am. Heres an article from Medscape.com on notcurnal breakthrough and medicinal dosing:

Control of Nocturnal Acid Breakthrough With Bedtime H2-Receptor Antagonist Therapy Peghini and associates[15] initially reported that most individuals on twice-daily PPI therapy exhibited nocturnal acid breakthrough. One case report described an asymptomatic patient with Barrett’s esophagus receiving omeprazole twice daily who had nocturnal acid breakthrough during 48% of the monitoring period.[39] This breakthrough was associated with 23.4% esophageal acid exposure. Addition of ranitidine 300 mg HS in addition to twice-daily omeprazole decreased nocturnal acid breakthrough to 22.7% and esophageal acid exposure to 0%. As a follow-up to this study, 12 normal asymptomatic volunteers taking omeprazole 20 mg twice daily were given supplemental 20 mg omeprazole, 150 mg ranitidine, or 300 mg ranitidine at bedtime.[19] An additional dose of omeprazole 20 mg at bedtime significantly decreased nocturnal acid breakthrough from 48% to 31% (P< .005). Alternatively, a morning dose of omeprazole 20 mg plus bedtime ranitidine 150 mg or 300 mg further reduced the nighttime breakthrough to 5% and 6% of the monitored interval (P< .01), respectively. This study confirmed earlier findings that nocturnal acid breakthrough is prevalent, with 90% of normal patients having gastric pH < 4 for more than 1 hour during the nighttime interval, even when receiving twice-daily PPI therapy. The effectiveness of ranitidine in decreasing this breakthrough supports the hypothesized role of histamine in nocturnal acid secretion and confirms the well-known efficacy of H2RAs in controlling nocturnal acidity, as had been demonstrated during the era of duodenal ulcers. In a similar study of normal subjects[40] taking omeprazole 20 mg twice daily (morning and before the evening meal) and placebo at bedtime vs omeprazole 20 mg before breakfast, placebo at dinner, and 150 mg ranitidine at bedtime, twice-daily omeprazole provided superior acid control vs omeprazole taken with breakfast and ranitidine taken at bedtime. From these findings, it was concluded that ranitidine at bedtime does not totally eliminate the need for twice-daily dosing of omeprazole for refractory GERD. However, data from our laboratory support the additive effect of ranitidine at bedtime to the antisecretory effects of omeprazole.[18,41] In this study, designed similarly to those reported from Philadelphia, even a small OTC dose of ranitidine (75 mg) proved as effective as a second bedtime dose of omeprazole for control of nighttime gastric acidity. Although it is undoubtedly true that our choice of bedtime omeprazole dosing was suboptimal for acid control, many patients do receive a bedtime dose of PPI in clinical practice, either due to physician ignorance or their own choice of dose timing.

Ranitidine IS Zantac so if you really want to try it, maybe printing this article out or finding other references to show your doc would be very helpful – that always worked well with my doctor.

~Liz

lovemysophia2006-12-12 15:2:15

Yes it is! Thanks for posting that. Myles used to wake up at 4 am nearly every morning. Now I wonder if it was due to breakthrough acid.

shelby i just noticed Justices bday ticker is off. i know he is older than 7 months. just wanted to let you know….
and what a cute pic of him!!!

nataliachick72006-12-12 16:33:51

have u ever done the prevacid? if so how was he on it? and i know what you mean about family, it gets me soooo fraustrated! everyone would tell me let him cry it out. But guess this, they all thought it was from his binky! They thought they he was crying at night and waking up from naps because he didnt have his binky in his mouth(pacifier). I would try and try to tell them that that isnt it! and they wanted me to take the binky away!! I was like no way!! once in a while it will get him to actually be quiet, why would i ever want to get him even more upset?! They just dont get it, they think that the same things that applied to their children will apply to ours. They wont know unless they have a reflux baby… thats all there is to it.

maybe say something like now Justice is on the highest marci kids dose and it is no longer working so you want to try prevacid-but with marci kids dosing for his weight and age.
i bet you can get caracream from dr phillips and get prevacid capsules. that is what we did but Trace couldnt handle the prevacid.
that way you dont have to time around meals like you would have to with the solutabs, i just think thats a big pain in the butt.

i would do the diet, cause trace wasnt imoroving at first on the ppi until i tried neocate.

second, you need a prescription for the 30 mg prevacid capsules. tell the doc the marci kids dose. then dr phillips will tell you how to mix it.