Clicking here will take you to the “Selecting Treatment” page. This is where you learned about Diet (Breastfeeding and Formula Feeding) and Medicines.
So now you know a bit about the different medications used to treat acid reflux/GERD (from the Medicines page, link provided above). And, you’ve addressed possible dietary issues (protein intolerances, allergies). Now it’s time to learn about the dosing of these medications, so that you can discuss your baby’s situation with your doctor. And, it’s time to learn how to give, or administer, these medications to an infant. Many pediatricians are not comfortable with prescribing high doses of medication to infants. Since you’re here, and you’re learning a lot, it may just be time to get to a Pediatric Gastroenterologist, a ped GI. It can be difficult to get an appointment, so, at this point, make the appointment; you can always cancel it if your baby improves by the time the appointment comes up. Use the Directory, in the Menu! And, be sure to pay if forward! Contact Us with your reviews of all types of medical professionals!
Always check with your doctor and pharmacist!
I will post here the dosing for some PPIs, but make sure to always verify! Your pharmacist has a handy device called the ipharmacist. This is where they look up dosing. Dosing might change, so it’s a good idea to double-check! With H2 Blockers (dosing info for H2 Blockers), babies tend to ‘plateau.’ If the medicine was working and it seems to stop working, check the dose and see if it can be increased. These medicines are prescribed by your baby’s weight (and age), so if your baby has gained any weight since first being prescribed her current dose, it most likely can be increased. If your baby has gained weight and the dose is still effective, great! This is a good sign! If your baby is at the highest dose for his/her weight, s/he may have developed a tolerance to it and it no longer is as effective as it once was. Always question! I once went to the pediatrician and spouted off my knowledge of Zantac dosing (I was there for my non-refluxer’s ear infection) and she told me I was wrong! She whipped out her Physician’s Reference and showed me lower dosing than what I was telling people! It turns out, I was not wrong; pediatricians (can) go by their dosing and there very well may be another dose recommended for more severe cases. Check!
[WEIGHT-WEAN: when you look at the dosing chart, keep in mind you do not HAVE to increase baby’s dose with weight gain. If pain is an issue, and baby is due for an increase in her/his dose, then follow the dosing chart. From Lindsay Robinson Ames: “I was a Zegerid (rx) user with my baby and I will share our personal experience: I had to adjust her dosage, increase it, to get her reflux controlled. However, I didn’t need to increase her dose with weight gain, once her acid reflux was controlled. It’s considered a ‘weight wean.” Definitely increase the dose if your baby is still struggling with the reflux pain, but don’t feel you absolutely have to increase, just because baby had gained weight and “outgrown” the current dose. The longer you can go without increasing the dose the better the indicator that the reflux is being outgrown.]
Once you know the dose, then you need to figure out the FORM of PPI (how will you administer it?).
Immediate Release (IR) & Delayed Release (DR): Which one should you choose?
- With Immediate Release the administration of the medication is not dependent upon whether or not your baby has an empty stomach;
- With Immediate Release you may administer the medication at any time.
- With Immediate Release you do not have to worry about medicine being effective during the night; it IS effective at night.
- With Immediate Release you have to check to make sure that it really IS Immediate Release! Read below!
- With Delayed Release, you must administer on an empty stomach, followed by a ‘meal’ thirty (30) minutes later.*
- With Delayed Release the presence of food can significantly lower the absorption of the drug.
- With Delayed Release when using beads from a capsule, it is most effective to administer them with something acidic, such as a small amount of apple sauce or juice, pear purée or juice, or pedialyte.
- With Delayed Release the acidic ‘something’ that is needed is to help keep the pH of the stomach contents low enough to keep the coating of the beads in place. If the coating dissolves while the drug is still in the stomach, it is then vulnerable to exposure to pockets of acid and degradation. The coating is specifically designed not to come off until it reaches the higher pH environment of the duodenum (the first section of the small intestine). Here the drug is absorbed into the blood stream.
- With Delayed Release you must keep in mind that the medicine may not be as effective during the night. To find out more about this, see: Night Acid and Delayed Release vs. Immediate Release PPIs.
Immediate Release (administer at any time & not issue with night acid):
- Properly made compound is prescribed by doctor; finding a pharmacy to do this is near impossible 🙁 (you are better off looking at number 4 and 5 in this list). You may attempt to try to tell doctor/pharmacist how compound is to be made. A problem (sometimes) with pharmacy compounded PPIs is that they only use sodium bicarbonate. – which while a good buffer – tends to cause a lot of gas. And each dose should be at least 3.5 mL or more to provide enough buffer to neutralize the stomach acid so that the PPI (which does not have an enteric coat because it is now immediate release) is protected from stomach acid degradation. Also, sodium bicarbonate tastes like salt and slightly metallic and PPI (like omeprazole) tastes quite bitter on its own. Sometimes the pharmacy will add flavors and they are often fruit flavor and acidic and that reduces the stability of the omeprazole, or lansoprazole or esomeprazole, etc.
- Zegerid 40mgs packets are prescribed by doctor (there is still ‘more’ that must be addressed regarding this; you must add more buffer). How to Mix Zegerid Rx 40mgs packets
- Zegerid 20mgs packets are prescribed by doctor. The 40mg packets are preferable, however, if you must: How to Mix Zegerid Rx 20mg packets…
- A liquid is made from using OTC Zegerid, OTC Omeprazole and other OTC ingredients: Home Compounding Recipes Mixing OTC Zegerid and Rx Packets.
- First brand Kit is prescribed by doctor for pharmacist to use to make compound using either omeprazole or lansoprazole. This is a wonderful option IF it can be prescribed to be refilled every ten (10) days. This can be difficult, as most pharmacists believe that the First brand kits are stable for thirty (30) days and this just is not so (the company that produces the First brand kits states this). Here is a study to show that it the compounded PPI is stable for +/- 10 days: Stability of Extemporaneously Prepared Lansoprazole Suspension at Two Temperatures. Click here the link –> to find how Some do actually get the First Kits prescribed ‘properly.’
- Find pharmacist/pharmacy that will use sodium bicarbonate vials and PPI capsules (instead of them compounding it for you or using the First kit). Pharmacist can send you home with three (3) big vials (50 ml each) of sodium bicarbonate and the PPI capsules. You then open up the capsules and pour the beads into the sodium bicarbonate every ten (10) days. You do not need a separate prescription for the sodium bicarbonate. You can also flavor each dose separately, as needed. Try a local compounding pharmacy.
Delayed Release (administer on an empty stomach, followed by a ‘meal’ 30 minutes later* & take Night Acid into consideration):
- OTC capsules (not zegerid) are purchased and the beads from the capsules are administered (there may also be a tablet inside of the capsule with the beads; this gets discarded not adminiatered). Beads are administered with a small amount of something acidic (ex: small amount of apple sauce or juice, pear puree or juice, or pedialyte). There is Youtube video, at the very bottom of this page, showing (one way of) how to do administer the beads from a PPI capsule. You can also use your finger with the beads, dip/roll in purée and wash down with water in a syringe. Or, you can use a babyhood spoon with the purée, sprinkle the beads on top and wash down with water.
Hollie V.G. wrote: In case it helps anyone, we’ve been giving the Omeprazole beads to DD (11 months) on a spoon mixed with a little apple juice and then following up with a few more spoons of juice or some from a syringe. It’s been a lot easier than trying to get the beads in/out of the syringe.
- Prevacid Solutabs are prescribed by doctor; dose is mixed with enough water to administer comfortably. Some simply hold the piece of the solutab in the inside of the baby’s cheek until it dissolves. Lansoprazole dissentegrating tabs are available over the counter as well. Use as much or as little water as it takes to get this into baby. You can make a paste or something ‘looser,’ whatever works for you, use trail & error. You can use your finger, or a baby spoon ; get meds to back of mouth/base of tongue & have a syringe of water ready to wash it down.
- Nexium packets are prescribed by doctor. Dose is mixed with enough water to administer comfortably.Use as much of as little water as it takes to get the powder into baby – this can be a thick paste – use your finger or baby spoon – or whatever means necessary – to get into baby. You give on an empty stomach. You do not need ‘something acidic,’ like you do for the beads in a capsule, as the packets have the ‘something acidic’ built into them, the flavoring.
There is a YouTube Video, at the bottom of this page, showing how to use apple juice and PPI capsule beads
* It is more important to get the pumps on at the time the PPI gets into the bloodstream – hence the 1/2 to 1 hr prior to feeding (or eating) – the empty stomach aspect is more important than the aspect of waiting 30 mins then having a meal. (waiting the 30 minutes is ideal and some say it is better to wait 45 minutes with nexium)
Empty Stomach: Usually 2-3 hours after a meal, unless Delayed Gastric Emptying (DGE) has been diagnosed. A full meal: at least a few oz of formula.
30 Minute Rule: Proton Pump Inhibitors need to get to the pumps, so they are given an enteric coating (ex: the beads in the capsules) that will only be dissolved in a high pH environment. This coating protects the drug from the acid while it is in the stomach, until it can pass into the first section of the small intestine, known as the duodenum. In the more alkaline environment of the duodenum, the enteric coating is dissolved and the drug is absorbed into the blood stream and is carried to the proton pumps in the stomach lining, where it begins to block the proton pumps. The whole process takes 30 minutes.
What’s all this about Zegerid?
See above, “Immediate Release,” numbers 2, 3, & 4.
Zegerid has the drug Prilosec in it and it has buffers, so that it can be given with food. Why should you care about Zegerid? Because you can give the medicine at any time, even with food, and you don’t have to worry about timing it around an empty stomach. Links above. You also do not have to worry about Night Acid. See below.
OTC Prevacid and Apple Juice – How To
Simple and quick. I usually encourage people to do a test run using water (without the beads) to get familiar with how much to push the syringe in. There’s a little “pop” on the Tylenol syringes that can send meds shooting out if you’re not used to working with them and don’t cover the end.
NOTE: The information on this page is not exhaustive and complete accuracy is not guaranteed. Please consult your doctor with any questions you may have regarding the treatment of your child.