Prilosec and Zantac

[Anonymous]

Please Help,

My 18 mth son Dillon was diagnosed with reflux as an infant and we’ve been struggling the past few months to get on the right medication and dosage.

Sorry I just realized this post will be long. I will start with some history first. He was vomiting on a daily basis before we increased his Zantac medication to 2.5 ml twice a day. At 15 mths, he weighed 21 lbs, 2.25 oz. His vomiting and general disposition improved for a period of 2 wks before things digressed and he began vomiting again. We then tried adding Domperidone but unfortunately, his vomiting increased and he began waking during the night and often was sick. We stopped the Domperdone after a 2wk period as things drastically went from bad to worse. His doctor then increased his Zantac to 3.5 ml twice a day.

At 17 mths, he weighed 22 lbs, 14 oz. At our next appt, his doctor added Prilosec 10 mg daily as his vomiting improved however he was still waking during the night. For a two week period, I was giving him Zantac 3.5 ml twice/day, 30 minutes before breakfast & dinner. I was crushing the 10 mg Losec tablet and mixing it in with some fruit just before dinner. (Regarding Losec, I’m from Ontario, Canada and unfortunately we’re only able to get the tablets. We did try compounding this medication when we first tried it months ago but the drug was not stable and effective in that form.)

At our follow up visit, our doctor recommended we stop the Zantac and continue only with the Losec although we were to increase this to 15 mg/day. At this time, Dillon is 18 mths and weighs 23 lbs. 1/2 oz. Well Dillon began waking at night, several times on some nights so I contacted the doctor last week who informed me I should not be giving him the Losec with fruit as that is an acid environment and Losec does not absorb well in fruit. I was told to restart the Zantac and give the Losec to him with milk instead.

This past week, he is vomiting daily again and his appetite has decreased. His sleeping at night has improved a little, some nights are better than others. We are now giving him the following medication and dosage:

– 3.5 ml of Zantac 30 min before breakfast

– 15 mg of Losec, crushed and mixed with small amount of formula (approx 3ml) just before breakfast (breakfast is infant cereal with formula + fruit and formula in bottle)

– 3.5 ml of Zantac 30 min before dinner

Questions:

1. I want to confirm that I’m giving the medication correctly i.e. can Zantac and Losec be given as noted and in the timeframes noted?

2. I’m concerned about over medicating him as this is the highest dosage of medication he’s gotten and he doesn’t seem to be getting better. Should I be concerned about his current medications & dosages?

3. I should point out that he is still only able to eat/tolerate pureed foods. We have a speech/language pathologist who is working with us to help Dillon learn to eat, chew & bite and be more comfortable with other textures and foods. He has recently started to eat some corn twists but he is very cautious and fearful so we obviously have a long road ahead. I’m very concerned about the negative/painful experiences he has had with eating, what can I do to help this situation?

4. Any other advice/recommendations?

Thanks so much, I really appreciate your help and feedback. I feel like we’re missing out on so much living through this and can’t emphasize enough how I look forward to reflux-free days ahead.

[Anonymous]

Sorry I have to keep this short as my little one is getting restless. I’m very sorry to hear that you are still having such a hard time. We are also in Ontario-TO…where are you guys? As for the meds… we too have been having a hard time with compounded meds. Which form of tablet are you using… is it the pink one or the white apo-omeprazole. Either way, it shouldn’t be crushed. The pink one can be dissolved so that the coating comes off and then given in a spoonful of something acidic like apples, 30 minutes before a full meal- this is needed to activate the drug. Putting it in milk will cause it to lose effectiveness. You can also get capsules… you just need to ask the pharmacist to special order them for you, but the rules for giving them still apply (in something acidic, 30 minutes before a meal). As you are in Canada, you could also try CaraCream…hopefully Joel will post his address about this where you could inquire further- it turns capsules into a suspension so that you don’t have to worry about the timing of the meds. This was not the answer for us as my little one would not take it properly, but many people have had success with it… also if your little guy will take Zantac (which tastes pretty bad) then he’ll probably take most meds fine. Hailey is very fussy that way… would never go near the Zantac. Good luck. Here’s hoping for reflux free days soon coming our way…

I just wanted to add that if I remember correctly, you should not give the losec and the zantac within 2 hrs of each other. Hopefully Laura will post her intro which has all the answers to these questions (and many more).

s&h’s mum2006-2-22 8:11:49

[Anonymous]

Thanks Lori for the info.

This is so frustrating, I don’t understand how there can be so many problems with these medications. We are using the pink tablet, the pharmacist actually suggested dissolving it in water however when I got home to try it, this actually didn’t work well. What am I doing wrong? How do you dissolve the tablet?

As far as mixing it with fruit, I was specifically told not to do that after a few weeks by the doctor we’re seeing at the feeding clinic in NYGH. I’ve also read conflicting info about needing to space these medications apart so I really don’t know what to think…I just know that we can’t go on like this. I really hope to hear from Joel.

BTW, we’re in Richmond Hill.

[Anonymous]

Small world gina, we’re in Thornhill (Bathurst & 7). We compound it right now but are having problems. We were told to dissolve it in water and give it that way. I’d love to talk to you further. I wonder if we’re actually seeing the same SLP for feeding, just started seeing her through home care yesterday. We’re also going to start seeing Dr. Berall at NYGH but don’t have our appointment until the middle of next month (I assume that’s who you see). I’d love to talk further… I wonder who your ped GI is and your ped…quite possible that we’re seeing the same people.

My email is [email protected] . Give me a shout and I’ll send you my phone number.

s&h’s mum2006-2-22 9:57:33

[Anonymous]

Hi Lori,

I just sent you an email.

[Anonymous]

First of all, welcome! I’m so glad that you have found this site.

There are so many people here with helpful information. Here
is the intro that Laura usually posts. It is long but full of really great
info, so try to read as much as you can.

https://www.infantreflux.org/forum/forum_posts.asp?TID=853&am p;am
p;PN=1&TPN=1

My name is Joel Andrews, and I work at the University of Missouri Hospital as
part of a team of physicians, pharmacists, and research scientists called the
Midwest Acid Reflux Children’s Institute or MARCI-Kids, whose whole purpose is
to help find better treatments for babies suffering from Gastroesophageal
Reflux Disease (GERD). The team is headed up by PharmD Dr Jeffrey Phillips. Please check out our webpage for a
lot of helpful information: http://www.MARCI-Kids.com.

My job is managing a laboratory that makes products for
reflux babies, but I also monitor this message board and help out folks when I
can. I myself am not a doctor, pharmacist or scientist, but I do my best to
relay information from the rest of the MARCI-Kids team to the public in a way
that is understandable. If you have any questions for me, you can either post
them here or send me an email: [email protected].

Now, as to your questions….

1. The form of Losec that you are using should NOT be crushed in any way. This will expose the drug to the acid in your child’s stomach and it will be destroyed.

2. You should NOT give an H2 blocker such as Zantac within 4 hours of a PPI such as Losec, as it WILL interfere with the PPI and make it ineffective.

3. The form of PPI that you are using should be administered on an empty stomach (2 hours after the last meal) and 30 minutes before a full meal.

4. Your son’s Losec dose is very low for his age and probably not doing him much good (especially in the form in which it is being administered). If he were on the right dose given in the right way, you probably would not have to give him any other drugs at all for his reflux. Most doctors are not aware that infants metabolize and eliminate PPIs at a rate 3 times that of adults. As a result, they need to be given higher doses with higher frequency. At your son’s age and weight, Dr Phillips would recommend that he recieve 10 mg of omeprazole (Losec) three times a day, for a total of 30 mg per day. PPIs are very safe drugs with virtually no side effects, and they can be safely dose in both children and adults at high levels without risk. If you need help getting your doctor to prescribe this, email me.

5. CaraCream and ChocoBase are flavored, buffered suspension agents designed for giving PPIs to infants and children. We make them here at the University of Missouri, but we can only sell them to customers outside of the US, due to a non-compete agreement with the makers of the drug Zegerid (which is not yet available outside the US). I think this would be a good fit for you, but I don’t want to advertise it any more here, so email me if you are interested in getting that as well.

I hope that some of this information is helpful and not just discouraging. Things will get better!

[Author]

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