Pepcid, Zantac, PPI?

[Anonymous]

Okay, so Alexandra has been doing really well on Pepcid. However, it is a compound and I’m starting to worry that it’s less effective as the month goes on. Last month, we noticed a dramatic difference in her about a week before the prescription was due to be refilled. I called the ped and he upped her dose a little (from 0.5 to 0.6 twice a day) and tried to convince me to switch to zantac. Her prescription is due to be refilled in 8 days and she has been on a downhill slide since Sunday evening. She is really fussy, not sleeping well (for her-compared to Kaelyn, she’s still doing great), and arching constantly. Tonight, she was an absolute mess. Then I gave her mylanta and she was all smiles within half an hour. Of course, she also passed a ton of gas in that half hour. So, of course, I don’t know if it was the mylanta that helped or if finally passing all of that gas solved the problem, or maybe the mylanta helped her get the gas out of her system.

Anyway, I figure that I have three options. Pepcid seems to be a good choice for her 3 weeks out of the month. Insurance will let me refill her prescription after 3 weeks, so I could just refill every 3 weeks instead of once a month. However, the copay is $50 so that’s a really expensive option. Plus, she fell apart with 10 days left in the month, so that doesn’t completely solve the problem. I could go ahead and try zantac. She doesn’t fight food or meds the way that she used to, so maybe she’d take it even though it does taste awful. Or, I could push for a PPI, but I’m not sure that I can convince the ped to go for that when pepcid has been working. What do you think?

[Anonymous]

arent pepcid and zantac basically the same?j/w

[Anonymous]

The good thing if you decide to try Zantac is that it doesn’t have to be compounded but it does taste horrible. Taylor gags on everything so we didn’t even try zantac we went for the prilosec even though it tastes horrible too. If the pepcid worked, I would try the zantac and avoid the compounded medications unless you ask for prevacid which Kaelyn was on. How’s Alex doing elsewise? Is she taking in more with the reglan? We just started Taylor on Reglan about a week ago too, she is still taking in only 2-3oz every 4 -5 hours but she is taking it much faster than before most feedings. I just can’t wait until she grows up and out of this DGE and slow intestinal motility, reflux thing!

[Anonymous]

Lori (S & H’s mom) posted something a while back about Zantac coming in a newly flavored form. Hopefully she will jump in with the info.

Robin

[Anonymous]

I think that I’m going to call today and ask for zantac. I really think that the pepcid works for Alex, it’s just that the compound loses its effectiveness before the month is over. So, I guess I’ll try a different H2 blocker before I start pushing for a PPI. Fortunately, the copay for zantac is a lot lower, so I won’t feel like I’m throwing my money away if it doesn’t work (I don’t mind doing whatever it costs to help her, but it certainly is nice when you can avoid spending more than you have to.)

My other concern with a PPI is that I’m sure that the ped will want to do prevacid solutabs since they worked for Kaelyn. However, in retrospect, the solutabs were part of the problem with her allergies. Since we are still concerned about Alex having some of the same allergies, I would like to avoid the solutabs. So, not only would I have to convince him to do a PPI, I’d have to convince him to try zegerid or caracream.

Sue, she is doing really well other than this issue. She’s spitting up a lot more than she was before, but she’s usually a happy and content baby (so different from Kaelyn!). She still doesn’t have a whole lot of interest in eating, but when she does decide that she wants a bottle, she will usually take the whole bottle in a reasonable amount of time. We even got her up to 4 oz at a time. So, she’s taking in around 20 oz a day. It’s not enough to catch her up, but she’s holding her own with her weight. She is consistently right below the third percentile. The reglan makes me really nervous, but it really does seem to have made a difference for her. Is Taylor doing any better?

[hellbennt]

kim,

you can always mix the zantac in with some mylanta to mask the taste- we did this for a while…

also as was mentioned, there are zantac efferdose type tables now available, I do believe?

[Anonymous]

We used Axid instead of Zantac it has a banana or fruit flavor. Our only problem was it was a higher copay than Zantac. We also had our Zantac flavored for a while it was grape and it almost masked the peppermint. Good Luck

[Anonymous]

I am nervous about the Reglan too. She keeps on lip smacking but my husband said she was doing that before we had her on the reglan, and I think he is right. She too is spitting up so much more but she is happy spitting up. We haven’t started baby cereal yet hopefully she likes the solids better and have a better intake of calories. The problem now that we are having is her constant nasal congestion. We are seeing the allergist tomorrow for some testing, I can’t wait!Alexis’s mom2006-10-4 11:19:5

[Anonymous]

Hi Kim,

Condratulations! on Alexandra.

Won’t she be on or could she be on some type of food stuff soon. What I am thinking is prevacid capsules, opened (yep I know all those little beads everywhere) in some applesauce. I know she would be to little to take a big amout but maybe you could get the dose down with a 1/2 ts. or less. Thus you have the PPI needed, but hopefully without allergy.

Just a thought…I know you have been down the long road once already. .

Hope all else is well, Take care,

Susan

[Anonymous]

Thanks for all the ideas! The ped called in zantac today. He only has her getting 1.2 ml a day of 15 mg/ml which only works out to be 18 mg. It seems a little low to me, but we’ll see how it goes. We had it flavored grape and she seemed to take it okay tonight. I hope it works!

We are going to wait for a while to intro solids, so most of the other options aren’t open to us for a couple more months. I’m definitely keeping them in mind for the future.

Does anyone know if the efferdose tablets have wheat or dairy in them? I’m thinking that they’d be a great option, but I don’t want to take any chances.

Sue, I hope that the allergist appointment goes well. Alex has had lots of issues with nasal congestion as well. The ped claims that every time we’ve thought she was congested, it was actually laryngomalacia, but a lot of the times there was actual congestion, so I know it’s more than that.

[Anonymous]

Kim, glad to hear that she took the zantac. Just wondering when you called the pepcid a “compound”, if you meant that it’s made by grinding the powder and creating a suspension, or just that it’s a liquid? I’m asking b/c when I was doing all that research to get pepcid here for Hailey, I did tons of reading (computer search only) but read that in the US you don’t need to get it “compounded” b/c it’s actually premade as a liquid that’s available at the pharmacy. Here, if we want liquid pepcid, we need to get the pills ground into a powder and then compounded into a liquid.

In the US, you also have pepcid “oral disintegrating tablets” available to you, which are a quick dissolve like solutabs, though I don’t know about the ingredients, size, or flavour.

As for the zantac efferdose, I found the following information for you on their site:

What are the ingredients of the ZANTAC 25 EFFERdose, other than ranitidine?
In addition to ranitidine, each individual tablet contains the following inactive ingredients: aspartame, monosodium citrate anhydrous, povidone and sodium bicarbonate. Each tablet also contains sodium benzoate. Phenylketonurics: ZANTAC EFFERdose contains phenylalanine 2.81 mg per 25 mg of ranitidine.
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I’ll attach the site link if you want to check it out yourself:

http://www.zantac.com/healthcareprof/index.html

Good luck. I’m glad to hear that she’s doing a bit better.

[Anonymous]

Thanks, Lori. I asked the pharmacist and they said that the pepcid was a compound. When I first had the prescription filled, they told me to keep an eye on her because it might start to have problems towards the end of the month. I didn’t know that they had a tablet like that. If the zantac doesn’t work I may have to check it out.

That website was really helpful. It also confirmed my suspicion that her dose is too low. Even if she hasn’t gained any weight since her last checkup (a month ago), she is 4.5 kg which would mean that her dose should be 22.5 mg – 45 mg.

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