MARCI-kids dosing question

[Anonymous]

I am wondering about the dosing charts and calculators on the MARCI-kids

site, and which to trust. My ds is 8 months old, and weighs 18 lbs. If I

follow the regular chart, he needs 24mg of omeprazole, divided into 3 doses

per day. If I use the dosing calculator, for 20mg packets of Zegerid, it says

he needs 21 to 30 mg per day. If I use the 40mg packets, it says he needs

42mg per day. I’ve heard to use the 40mg dosing calculator, but the 20mg

seems to agree more with the regular chart. Anyone know definitively what

the word is? And why would the Zegerid dosing be any different than the

omeprazole dosing if they are the same drug?

[Anonymous]

all i know is that marci-kids said that the 20mg calc was off.
i use the 40 mg calc and our GI said that is the correct dose for my son-42mg.
you can email them.

[Anonymous]

I have an email into MARCI-kids to ask about the dosing caluculator question and I will post their response when I get it.

Robin

[Anonymous]

OK, I emailed Marci-kids and here was the response. I have read it once and my head is spinning so see what you think

Here is what happened
We initially thought it would be best for young children to use the 20mg packet of Zegerid. Then, since we do research, we evaluated how well the children tolerated the Zegerid 20mg packet. We found that some children did not tolerate the 20mg packet – this was due to the amount of sodium bicarbonate.
The 20mg packet of Zegerid and the 40mg packet of Zegerid have the same amount of sodium bicarbonate per packet. That means that for any dose, the amount of sodium bicarbonate is 2 times more in the 20mg packet when compared to the 40mg packet.
We also knew that simply using the 40mg packet (which has half the bicarb) would not work because there is a certain amount of bicarb (or buffer) that is needed to neutralize the stomach acid so that the omeprazole can be absorbed (and not be destroyed by the stomach acid).

So this created a small problem, How to give the Zegerid so that enough buffer is given but so that children tolerated it.
This meant that when using the 40mg packet (which has less buffer) the amount given was not dependent on the mg of omeprazole but the minimum amount of buffer required to neutralize the stomach acid.
If your child tolerates the 20mg packet of Zegerid (which has 2 times more buffer per each mg of omeprazole) then you will end up with less mg of omeprazole.

You can also do this: If your child does not tolerate the 20mg packet then use the 40mg packet of Zegerid and follow these instructions:
1. Figure out the dose you need from the dosage calculator then give the same number of mg using the 40mg packets (remember the 40 mg packets contain 4mg/mL).
Now here is the important part:
2. Give the number of mL as you calculated you would need to give the amount of omeprazole for your child’s weight and age. Then add the same number of mLs of Mylanta Cherry Supreme.
In this way you will have enough buffer AND have the right number of mgs of omeprazole per each dose.
For example:
Your child is 2 months old and weighs 14lbs
According to the calculator for 20mg packet of Zegerid
Your child, who is 2 months old and weighs 6.4 kg, should receive a dose of 8 to 11 mg of Zegerid delivered 3 times per day for a total of 24 to 33 mg per day.
So the dose to give is approximately 10mg. If you were using the 20mg packet (2mg/mL) is 5 mL, this has enough buffer in it and the correct mg of omeprazole. This is fine if your child tolerates the 20mg packet with its extra sodium bicarbonate.
Let’s say you child does not tolerate the 20mg packets then you will need to use the 40mg packet
So use the same amount as indicated by the 20mg calculator : Again 10mg
This will be 2.5mL when using the 40mg packet (because it is 4mg/mL) – but this does not have enough buffer so add 2.5 mL Mylanta Cherry Supreme. Now you have 5mL of the combination.
See it is easy

Jeffrey Phillips, PharmD, BCPS

Associate Professor and Director of Research
School of Medicine
Department of Surgery
NW301 School of Medicine
DCO 96.00
University of Missouri
Columbia, MO 65212
573-882-8904
FAX 573-884-6336
phillipsjo@health.missouri.edu

[Anonymous]

Only a scientist would ramble off a lengthy and mind boggling explanation like that and end it with “see, it is easy.”

No offense to Dr. Phillips….

[Anonymous]

this makes a lot of sense ,i always knew about the not enough buffer in the 40 mg packs, i just never knew that the actual mg dose was different if you are using the 20 mg packs.

[Anonymous]

Robin, thank you so much for clearing that up! It does make sense (I don’t

know about easy, at least not at this point in my life, when I can hardly spell

my own name…)

[Anonymous]

Wow, I’m so glad that you all looked into this! My son HATES the Zegerid and we have had some serious trouble getting it into him. We’ve been using the 20mg packs and giving him 5 mls and it is a chore, but if we can just give 2.5 and then 2.5 of the Mylanta, it would be so much easier for him to take… and cheaper for us too! . Does anyone know if I have to get my prescription changed to get the 40mg. packs instead of the 20 or can I just request them at the pharmacy???

[Anonymous]

you gotta call the doc and ask for an rx for 40 mg packs.

[Anonymous]

Thanks for looking into it Robin. I couldn’t help but laugh when getting to the end of the whole confusing thing he ended off with “see, it’s easy”. I did get the point, though I found it far from easy to understand. Nice of him to give such a detailed reply though.s&h’s mum2006-11-20 17:3:46

[Anonymous]

Lori:

I think that is the longest response he has ever given me. Most of the time, they are very short responses – I’m glad he took the time to explain it, even though it is still a bit deep . As I read it for the 352nd time, it is getting a little clearer, still not easy, but clearer.

Robin

[Anonymous]

So can one conclude that all of the dosing calculators are correct–that it

just depends on the drug and formulation? I have read in several posts that

the 20mg one is supposedly wrong.

Also, when Dr. Phillips says “tolerate”, does that just mean that they can

keep it down? We haven’t had a problem getting Dominic to take the 20mg

packets, but I am noticing the runnier poop issue.

[Anonymous]

yes looks like the calcs are right!!!!

and yeah he told me some babies throw up the 20 mg packs because they are very salty.
glad your son can tolerate them 🙂

[Anonymous]

I can understand his explanation, but am I the only one who finds that kind of odd. In absolute terms, if the ideal dose of omeprazole is based on the pharmacokinetics of the medication based on the curve outlined in the dosing memo on their site, then the amount of drug in mg should be the same. I understand that b/c the 40mg packets are 4mg/ml instead of 2mg/ml and half the buffer, if you use them then you’ll need to give more mls in order to ensure enough buffer is consumed. But it doesn’t make sense to me that this would change how much of a drug should be recommended even if they’re doing it based on the amount of buffer required- I would think that they should recommend the same amount of drug, just a greater volume of overall solution.

We use the CaraCream JR kits (and it’s the same situation as compared to the CaraCream kits which are basically equivalent to the 40mg packets). Hailey doesn’t tolerate the JR kits- she vomits it up often due to the saltiness- but it’s the only thing that works so I keep giving it. I was told that we could use the CaraCream kits with twice the buffer (i.e like the 40mg packets) and top up with Mylanta, BUT the overall dose of medication recommended did not change.

I would ask Dr. Phillips this again to clarify, but I have bombarded the poor man with way too many questions already.

s&h’s mum2006-11-21 9:20:37

[Anonymous]

lori, okay now im confused!

“This meant that when using the
40mg packet (which has less buffer) the amount given was not dependent
on the mg of omeprazole but the minimum amount of buffer required to
neutralize the stomach acid.”

so i guess it means that with the 40 mg packs you have to give more mg to ensure you have an adeguate amount of buffer.
i dunno.

isnt a greater amount of overall solution equals to more mg?

nataliachick72006-11-21 10:35:21

[Author]

Posts