Prilosec compounding

[Anonymous]

I’m back!

We were doing great with continuing to increase dosage of Zantac. Had a few weeks of normal baby. It was wonderful. But now we have maxxed out on Zantac dosage and have no choice but to try a PPI again. We had tried Prevacid solutabs at 5 months old and it was a disaster so now we are trying Prilosec. No good result yet – in fact at first he was worse so I put him back on full dosage of Zantac until the Prilosec kicks in. So here are the questions:

I am reading that there is a concern about compound not being stable for more than 2 weeks. Can you get just a 2 week supply at a time to ensure that it is “fresh”?

I also read to get it unflavored. I am really concerned about spending $100 on medicine and having Tyler refuse to take it. He is really really good about Zantac (he seems to almost like it! – yuk) and that tastes terrible and he will eat anything so I think that he would be OK, but still. My pharmacy made it with apple banana. They said that they can make it with just about anything that I want. If I do need flavor is there a flavor that is less dangerous than another? I asked about chocobase and they said that they do not use that specific brand but that they can make it chocolate if I want it that way. Is chocolate better? If there is a better flavor than another I may ask them to compound without flavor and get the flavor seperate incase he won’t take it without.

My Ped GI will not prescribe Zegerid. Is there another option other than compounding? Can I get Prilosec in a powder and mix it with one of his foods since he is on solids?

I already know that his dosage is too low at that is a battle that I will have to continue to fight. He gets 2.5 ml 2 times a day (2mg/ml) so he is only getting 10 mg and he is 19 lbs 8 oz

The 2 doses per day of Prilosec – do they need to be a certain number of hours apart – like does it need to be 12 hours for 2 times a day? I ask because of the need to balance the Zantac dosage with the Prilosec dosage and keep 4 hours apart until the Prilosec kicks in at a correct dosage. Here is what I would like to do based on Tyler’s worse reflux times.

6:30 (Wake up) – 1.9 ml Zantac

7:00 Bottle

8:30 Cereal and Fruit

11:00 (Wake up from morning nap) – 2.5 ml Prilosec

11:30 Bottle

1:30 Cereal and Veggie

3:30 (Wake up from afternoon nap) – 1.9 ml Zantac

4:00 Bottle

7:30 (Bedtime) – 2.5 ml Prilosec and Bottle

11:30 (he takes this in his sleep) – 1.9 ml Zantac

The thing is the Prilosec dosages will only be 8 1/2 hours apart. Is that OK?

Thank you again

[Anonymous]

Hi,

Yes, you should space the ppi drug and the H2 blocker, or zantac, apart, some say only two hours apart, others say as many as five hours apart. The ppi is hte more effective drug, (unless your compound is bad!) and should be given preference, or preferential treatment in terms of getting it into their system, although the zantac and mylanta can give more immediate relief.

http://www.marci-kids.com has great info on this.

We ran into the problems you are talking about….had a LOT of trouble with compounds from a great pharmacy….My first ped gi refused to rx zegerid, too. We switched docs cuase the med situation was so bad. Zegerid has been wonderful for us. You may want to make sure your insurance covers it before you further push for it. I printed info from marci kids and took it into my doc, and it was our ped who rx’ed it for us while we were in between ped gis. If they are telling you it’s the same as prilosec that’s NOT TRUE. You can ask questions specifically about zegerid that RefluSol will answer on this forum and that is info you can take to your docs, as well. RefluxSol works for the pharmacist who invenetd Zegerid, before it was sold to the company who currently markets it as Zegerid. I hope this helps!

[hellbennt]

CARACREAM!!!!!!!!!!!!!

find a pharmacy that uses the company FLAVORX to flavor compounds for children- most walgreens use it, I do believe.

Then, once you’ve located the pharmacy, get in touch w/ joel (or anyone probably) from marci-kids. they will instruct the pharmacy how to use caracream.

YAY

[Anonymous]

Oh, I forgot….you can split hte ppi dose in the best way for you, more in the evening, less in teh am, vice versa, or some docs even suggest breakinug the dose into three small doses so the baby gets it throughout the day (then that complicates giving zantac, but you have to play around with these things to see what works for you). Young babies metabolize the drugs so quickly that they need a steady stream, this 12 hour business doesn’t work well with them!!

And yes, sadly, it’s really important to do the unflavored thing. At lest it was for us, I don’t know if anyone out there has had a good exerience wiht the flavoring issue.

Also, are you giving the ppi drug on an empty stomach, and then waiting 30 minutes before feeding the baby? THis is REALLY important and they don’t always tell you this. Empty stomach means 1.5 to 2 hours since the last feeding, preferably two hours. So, add this to your timing schedule and it makes things a nightmare!!! BUt it does really help with the effectiveness of the meds. Please keep asking questions and I’m sure the others will have plenty of suggestions for you, too.

[Anonymous]

Laura is right….I just didn’t think they could make it anymore…I would DEFINITELY go for her idea!!!

[Anonymous]

Ok I am confused. Based on some posts from this site I thought that you could not get Caracream anymore unless you were already using it or outside the US?

[Anonymous]

Help

Do you not need to wait 30 minutes before feeding with any compound or is it just caracream that gives you that luxury.

I thought that it was just the solutab or any enteric coated powder or anything that you needed to wait. I thought that when it was compounded that you did not need to wait but now I am not sure.

Thanks

[hellbennt]

I think it’s w/ any compound that is compouned PROPERLY that you do not have to wait.

the real problem is finding a pharmacist who will humour you and compound the PPI the way you direct him/her to. it IS possible!

however, joel recently informed me the new info about caracream that I posted above. it’s worth a shot!!! you’re right is was NOT available in the US, but for some reason right now there’s some sort of loophole type situation? so I say check it out…

[Anonymous]

All PPI’s EXCEPT Zegerid need to be given 30 minutes before feedings. Zegerid is coated with sodium bicarbonate, so it fights acid as it goes down and does not need food to activate it.

[hellbennt]

ok, I have to tell you that caracream is the PREDECESSOR to zegerid, so it ALSO acts in the same way as Zegerid

As for other compounds, PLEASE check the links

~laura

[Anonymous]

Shelly,

Just a word of caution – we did the Zantac + Prilosec thing as well while we waited for the Prilosec to kick in. About 4 days into the routine Tess got super constipated. She actually cried when she had to poop and nothing would come out. I immediately stopped the Zantac. It took another couple of days before she could actually pass a stool. The Prilosec seemed to be working just fine so removing the Zantac from the equation didn’t matter. Hopefully this won’t happen to Tyler but I just thought I’d warn you.

Karen

[Anonymous]

Yep, same thing started happening to Hannah when we added a PPI to the

Zantac. Still working on that one…but I had thought it was because we are

just starting to seriously give solids…so it might have something to do with

that as well…

who knows!? There always seems to be a “it could also be…” scenario

[Anonymous]

I’m still confused about how to get caracream!!!! I talked to our

Walgreens, and they checked it out… initially they thought that they could

get it, but then they called us back and said that they can not order

caracream based on some sort of policy…..

We have called every pharmacy in our area – no luck! And Isaac still

sometimes throws up the Zegerid due to taste…. I feel like we are never

going to know if a PPI will even work for him b/c we can’t seem to get

them in him consistently. The Zegerid is soooooooo much easier than

the Prevacid…..but it just tastes horrible to him. I also noticed that if he

eats right after the zegerid, he throws up, but if we can get it in him, and

then wait a bit, he is fine.

So was the constipation from the PPI/zantac combo? I thought it was

more common to have looser stools…. Isaac’s have been looser since

PPI…..

[Anonymous]

For Tyler he seemed to go back and forth between dry poop and runny stool. It seemed as if the gas was the thing that was causing him to wake up and scream. I have no idea if it was the 2 things combined causing it because I did not try the Prilosec without the Zantac. I could tell that they Prilosec alone was not working because when the Zantac would start to wear off his reflux was bad and when I gave him the Zantac it got better. Zantac does cause constipation for some and Tyler is on Lactalose everyday to treat it. But when on the PPI the Lactalose did not seem to make a difference. We did the PPI and Zantac combo for 3 days. Day 1 & 2 he had dry poop and day 3 explosive runny stool. All 3 days he screamed and farted and burped more than usual. After we stopped the Prilosec he still had runny stools for 2 days – but he was not longer farting and screaming and he burped normal.

The increased Zantac seems to be working. He is sleeping better and has had a few good days. He is napping shorter and waking up earlier than usual but not screaming or upset – just not as interested in sleep which is normal for an 8 month old. I just dread the day when the Zantac wears off again.

[hellbennt]

ok:

ask the pharmacy if they use FLAVORX brand flavorings

then, FORGET THE PHARMACY for a moment

and CONTACT Joel andrewsjj@health.missouri.edu

he is RefluxSol here

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