Compound PPI – buffer confusion

[Anonymous]

OK – I am confused. A prior post indicated that (in addition to the correct bi-carb %) a compounded PPI should not be given in less than 3.5 mL as a smaller dose does not provide enough buffer to adequately protect the drug from being destroyed by the acid that is present in the stomach. I know the MArci-Kids website also says this about Zegrid.

I am using Caracream to compound my Prevacid. I don’t recall instructions that stated I needed a minimum dose volume of 3.5 mL. If our volume is less am I potentially degrading the prevacid and thus it is not as effective?

I believe Dr. Phillips has recommended adding Mylanta to the dose to increase the buffer. How does this help?

Sorry for the long & convoluted post – I am just trying to figure this out.

[hellbennt]

Lucky you with the caracream!!!

We LOVe it!!

Just ask marci-kids/dr philips how to use it- don’t worry about the other stuff

[Anonymous]

you dont need mylanta for caracream. and you dont need a min. of 3,5 ml. that applies to zegerid.

[Anonymous]

That is what I thought too – but I recevied this response from Dr. Phillips:

—–Original Message—–

From: Jackie Mohr

Sent: Thu 1/25/2007 9:46 AM

To: Phillips, Jeffrey O.

Subject: Ques re; meds

Dr. Phillips,

We are currently using prevacid 30mg capsules compounded with caracream for my daughter (she was unable to tolerate the Zegrid). I have a couple of questions that I hope you can answer:

1. With Zegrid the minimum volume per does was 3.5 mL due to the

buffer issue. I don’t see the same restriction for caracream. We are compounding at 3mg/mL and her dosage is 18 mg per day (divided 2 does of 3mL). Does a 3mL dose of caracream have enough buffer?

From: Phillips, Jeffrey O.

Sent: Thursday, February 01, 2007 9:09 AM

To: Jackie Mohr

Subject: RE: Ques re; meds

Add 2 mL Mylanta Cherry Supreme to each dose

She should get 12 mg three times per day.

You can also give the Prevacid 18mg twice per day and then at bedtime give Pepcid complete (Over the counter) 1/2 tablet dissolved in water. Dr Phillips

From: Jackie Mohr

Sent: Thu 2/1/2007 10:26 AM

To: Phillips, Jeffrey O.

Subject: RE: Ques re; meds

So the 3mL dose of caracream also requires an additional buffer of the Mylanta?

Yes just to be sure that there is enough buffer we like to use a minimum of 4.5mL total buffer per dose. Dr Phillips

[Anonymous]

omg now im really wondering! my son has been miserable lately maybe this is why!!
BUT I SPECIFICALLY HAVE A SHEET THAT DR PHILLIPS SENT ME WITH THE CARACREAM-SAYING TO GIVE 2.67 ML per dose

WHAT THE HECK?????????????????

ANYONE?

nataliachick72007-2-2 18:19:54

[Anonymous]

seriously i am freaking out this is going to drive me nuts, now marci kids is closed and i dont think they will answer over the weekend…this makes me so mad! if this is true then Trace has had a very good reason to be miserable, his meds arent working. i am so upset!! i cant believe i wasnt informed of this when Dr Phillips sent me the instruction sheet.

[Anonymous]

Natalia,

I get the feeling that Dr. Phillips’ research is ongoing, and therefore his recommendations are subject to change.

I thought Trace was doing well on the Prevacid? How long has he not been doing well? Maybe just try adding the Mylanta until you get in touch with Dr. Phillips. I know Trace couldn’t tolerate it before but maybe now that he’s older it won’t be a problem. Or, mabye the tums would work like you used to do with Zegerid.

[Anonymous]

no he is doing good, i mean eating pain free, but i posted yesterday about how he has been crabby and clingy lately….

[Anonymous]

nataliachick7 – I know what you mean about being frusterated. I am very confused now as well. My sheet did not indicate the minimum volume and when I used carcaream 2 years ago for my other dd, that wasn’t the case then either. I thought the whole point of caracream was it had an adequate buffer. Hopefully Dr. Phillips can shed more light on this for us. My dd can’t tolerate the Mylanta so that isn’t an option for us.

BTW – I notice you thicken Neocate – how much oatmeal do you use per ounce and what nipples have you found to work best?

[Anonymous]

Natalia,

Could he have an ear infection? I would think that if he’s been doing fine for quite some time on the Prevacid that he still would be…unless he’s outgrown his dose.

I hope Dr. Phillips can clear this up for both of you!

[Anonymous]

jackaloo wrote:

nataliachick7 – I know what you mean about being frusterated. I am very confused now as well. My sheet did not indicate the minimum volume and when I used carcaream 2 years ago for my other dd, that wasn’t the case then either. I thought the whole point of caracream was it had an adequate buffer. Hopefully Dr. Phillips can shed more light on this for us. My dd can’t tolerate the Mylanta so that isn’t an option for us.

BTW – I notice you thicken Neocate – how much oatmeal do you use per ounce and what nipples have you found to work best?

yeah i was using TUMS instead of mylanta when we were doing the zegerid, because of gas and diarhea issues.
maybe dr phillips has recently discovered the buffer issue? i dont know. this is frustrating though!
i thicken the neocate with about 1/2 tbspoon per ounce-i use the avent number 2 nipple. anything faster and he chokes.

[Anonymous]

ndrose wrote:

Natalia,

Could he have an ear infection? I would think that if he’s been doing fine for quite some time on the Prevacid that he still would be…unless he’s outgrown his dose.

I hope Dr. Phillips can clear this up for both of you!

yes i have thought of that…i dont know though. ugh this is confusing. i really dont think its that.

[Anonymous]

OK – here is the latest response I recevied from Dr. Phillips. Let me know if you hear anything!

—–Original Message—–

From: Jackie Mohr [

Sent: Fri 2/2/2007 2:49 PM

To: Phillips, Jeffrey O.

Subject: RE: Ques re; meds

When you say 4.5 mL buffer per dose, I am not clear as to what you mean. Does that mean the minimum volume dose should be 4.5mL or the total concentration of the buffer should be 4.5mL. If it is the latter – how do I know that the concentration of the buffer is 4.5mL?

From Dr. Phillips:

I mean that whatever the CaraCream volume is you should add enough Mylanta Cherry Supreme per dose to get to 4.5mL per dose

[Anonymous]

ok thanks for that info!!

[Anonymous]

Bizzarre! Like Christine said, I think that their research is ongoing. Are both you guys using the caracream Jr kits (or the regular bigger bottles).

We use the JR bottles. Dr. Phillips (and Joel) told me way back when we started using it that it had to be at least 3.5ml per dose. In fact, I had a big conversation with Joel back when I wanted to add another dose and the total wouldn’t be 3.5ml per dose. Dr. Phillips’ solution was for me to increase the total amount so that I could give 3 doses of at least 3.5mls each.

Lately, when I sent him an email telling him that Hailey wasn’t tolerating the CaraCream, was vomitting it back up due to the salt content, he told me that I would reduce the volume per dose, and top it up with the mylanta. Due to the nastiness of that taste (salty, caramel, cherry, milk) we couldn’t do that and have just stuck with it as it is.

It is confusing. I think that maybe they keep finding out new things or changing the formulation of the caracream because they make it from scratch. that’s all I can figure.

Hailey now only takes one dose at night, and it’s 7ml so I don’t worry about it anymore. I hope you guys can figure it out.

Natalia, can you try upping his dose? I wonder if maybe he needs a higher amount to control his acid. I know that you said he was on 60mg of omeprazole using zegerid, maybe he needs more prevacid to get relief as well.

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