I couldn’t remember the link, but I had saved the info to my computer:
Compounded PPIs
Proton Pump Inhibitors – or PPIs – are probably the safest and most effective drugs that are currently available for treating GERD in infants. Usually pediatricians and pediatric gastroenterologists will prescribe PPIs such as Prevacid or Prilosec in the form of a compounded liquid suspension made by a pharmacy. This form is advantageous because it is generally easier to administer to infants, who cannot easily swallow pills, capsules or granular forms of medicine.
However, for a number of reasons, Dr Phillips and the MARCI-Kids team at the University of Missouri do not generally recommend the use of such compounds. We have done very extensive research on the stability of these compounds in an effort to find a liquid form of PPI that would keep its stability for a greater length of time. In the course of our research, we have found that an overwhelming majority of the PPI compounds made by pharmacies lose their stability within 5 to 7 days.
The main reason that these compounds lose stability is that a flavoring is added to them. There are very few flavoring agents that can be added to a PPI compound that will not cause a loss in stability over time. For this reason, if you are getting a PPI compounded at your pharmacy, we strongly recommend that you ask your pharmacist not to add any sort of flavoring agent to the mixture.
In response to this problem of stability, Dr Phillips developed a flavored, immediate-release form of omeprazole (the same drug that is in Prilosec), which forms a true liquid suspension that is very easy to mix and administer to infants, and which will remain stable in refrigeration for up to 21 days after it is mixed. This drug is called Zegerid, and it now sold by Santarus Inc. For more information on dosing and mixing Zegerid for infants, visit http://www.marci-kids.com.
If you are either unable to get a prescription for Zegerid for your child or you would like to continue using the compounded PPI that you are currently using, here are some recommendations for how you should ask that your pharmacist make the compound so that it will remain stable for longer.
- Make sure that your pharmacist does not put any kind of flavoring agent in the compound.
- Make sure that the concentration is between 2 mg/mL and 4 mg/mL. This means that for every milliliter of suspension, you are giving between 2 and 4 milligrams of drug.
- Ask that your pharmacist make the compound with 16.8% sodium bicarbonate if the total volume of each dose is less than 7 mL. If the total volume of each dose is greater than 7 mL, ask that your pharmacist make the compound with at least 8.4% sodium bicarbonate. We also do not recommend that you give less than 3.5 mL of a PPI suspension at any concentration. This is because doses smaller than 3.5 mL do not provide enough buffer to adequately protect the drug from being destroyed by the acid that is present in the stomach.
It is important that the pharmacy does not add flavoring to the compound as it will almost certainly cause it to lose its stability much more quickly. It tastes pretty awful this way, I know, but it’s better than the alternative.
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