Prevacid help again?!

[Anonymous]

Does anyone have a link to the thread that discusses proper compounding of Prevacid? The marci-kids website seems to only endorse Zegerid. I called my pharmacy that specializes in compounding and he didn’t know what I was talking about!!

[Anonymous]

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.

1. Make sure that your pharmacist does not put any kind of flavoring agent in the compound.

2. 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.

3. 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.

[hellbennt]

Prevacid 101(last post on the page): https://www.infantreflux.org/forum/forum_posts.asp?TID=1936&a mp;PN=0&TPN=1

[Anonymous]

yeah, and make sure you get it made every 2 weeks, not monthly, or it will loose stability.

[Anonymous]

Hi there. We had Hailey on compounded prilosec for many months, mainly because we are in Canada and did not have any other options available at the time. During this time, I found that NOT A SINGLE pharmacy that we went too knew how to prepare the compound effectively. We went to a very reputable place and they swore that they were making it correctly- At it’s worst, we were giving 20mg a day, and it was being compounded at 20mg/ml so we gave 0.5ml at a time!!!! They told me that was fine. The compounding “rules” on this site are based on the research that marci-kids did- they tested these compounds to see what criteria had to be met for them to remain stable, and to have enough buffer to protect the medication. Unfortunately, these findings have not yet made their way to the pharmacies, and so few pharmacies actually know how to make these meds correctly. This is why I don’t like compounds. If you do decide to go this route, the best bet is to tell them exactly how you want it made, and then ask for a printout of all the ingredients that were used. Good luck.

Here’s a copy of a reply I gave to another member about this topic:

s&h’s mum Senior Member Joined: 30 October 2005 Location: Canada Online Status: Online Posts: 3674

Posted: 07 April 2007 at 2:12pm | IP Logged We got Hailey’s meds compounded at a very upscale compounding pharmacy with the best reputation in the whole city. They swore up and down that they knew how to compound the meds correctly and cited things from the compounding association about stability and pH. I assumed that they knew what they were talking about. After months of not knowing why my child wasn’t getting better, I found this site. I was mortified when I read about the correct way to make a PPI compound. I learned the hard way that some babies will do okay even if their meds aren’t compounded well, but others that really need the acid control will do horribly until the meds are made/given properly. I don’t want to sound pushy. I just hate to see other people go through the horror that we did with the PPI compound. A properly made compound should be made: 1. without any flavourings WHATSOEVER! (This includes things like sweet syrup, simple syrup, stevia powder, bitter stop, or other obvious flavourings- even banana. Our pharmacy told us that the compounding association felt that banana had a neutral pH that would not degrade the meds, but this IS NOT TRUE!). Adding flavourings will cause the drug to degrade within a few days. 2. with at least 16.8 percent sodium bicarbonate (not calcium carbonate) unless the dose is 7ml or greater. 3. at a concentration between 2-4mg/ml such that each dose is AT LEAST 3.5ml per dose. If each dose is smaller then 3.5ml then there will not be enough buffer per dose to protect the med when it reaches the stomach acid. 4. in no more than 2 week doses at a time. A properly made prilosec suspension is stable for this long if kept in the fridge, and prevacid is even harder to keep stable. The pharmacy will probably tell you that the prilosec suspension is stable if kept in the fridge for a month, but they are only talking about pH. If you do use a prilosec suspension, make sure to SHAKE the bottle vigorously to get ALL the sediment off the bottom of the bottle. Often a brown bottle will be used, and you can’t see all the sediment that is still on the bottom. The sediment is the buffer, and if it’s not evenly distibuted, then the meds will not work well. Also, I would personally ask the pharmacist for a printout of ALL the ingredients that are going into the med. Our pharmacy told us that Hailey’s suspension was unflavoured. I finally asked for a printout of the ingredients, and found that they were including stevia powder, bitter stop, and simple syrup, all of which were degrading the med. This information is based on the studies performed on compounded meds that were conducted by marci-kids. The compounding pharmacy has not conducted the same tests, and so they often do not have this information. Another option, is to try zegerid (which I have personally never used). It is a stable prilosec suspension, so you don’t have to worry about whether or not it is being made properly. Good luck.

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