So confused!

[Anonymous]

We were on 2 ml of zantac a day and my 11.9 pound son was showing signs that he was outgrowing his dose. So, we went to the doctor and he said we should up the dose of zantac to 3 ml a day and start him on previcid (15 mg solutab a day). He wants for me to stop the zantac after 2 weeks. We started that yesterday and he seems to be responding very well to the additional zantac. I know that the effects of zantac are temporary, but should I switch medications if the zantac does the trick? He seemed a little bit constipated by the previcid, so I am considering sticking to just the zantac until it truly loses its effectiveness. The doctor seems to be concerned about the fact that we increased the zantac by that much and thinks we should move on to a PPI. But, the dosage of the PPI is not even enough to be effective according to Dr. Phillips at Marci Kids. I am very worried about taking him off the zantac when the previcid dose is inadequate. My son seems to be doing fine on the new zantac dose, but I do not know how long that will last (he still has a lot of spit up, but does not seem to be in much, if any, pain). Has anyone had lasting effects with zantac? Is it a bad sign that we are having to up his dose like that? We are being set up with a specialist, but I do not know what to do until then. What would you all do?

By the way, I am posting quite frequently! I am sorry if it is bothering anyone. I am just very new to all of this and I am frustrated by all of the mixed answers out there! This site is a lifesaver.

[hellbennt]

I’m actually really good at math, lol, but the whole pounds & ounces gets me- so I’m going to guess you mean that your son is 11lbs & 9 ounces, so I’ll calculate for 11 & 1/2 lbs because that’s 11.5

so that’s 5.2 kilos

I’ll first calculate a high dose of prevacid, at a ‘conservative dose’, making it 3mgs per kilo

5.2 x 3 = 15.6 mgs of prevacid total for the day

so your dr isn’t THAT far off…

keep in mind that I just calcualted for less than what your baby weighs and also keep in mind that I calculated at a conservative dose

SO: you actually might want to try the prevacid, it can’t hurt…

as for the zantac, I’ll calculate for the highest dose at 10mgs per kilo

5.2 x 10 = 52mgs total for the day

zantac liquid is 15mgs/ml (check the bottle)

so that’s 3.5mls for the day total

again, your dr isn’t THAT far off, but there IS room to increase a bit, especially if your baby weighs more than what I calculated for

what I would do is to continue with the zantac, knowing you can increase it a bit, & I would also give the prevacid, making sure to give the zantac 4hrs serperate from the prevacid

I would make sure to give the solutab on an empty stomach and I would give it 2x a day

[Anonymous]

Why is the calculator on Marci Kids so different from this? Also, Dr. Phillips said that it was not a high enough dose to make a difference. I did mean 11 pounds 9 ounces, not 11.9- sorry!

[Anonymous]

Some babies are able to do well on doses lower than the marci kids dose. So I would try give it the good 2 weeks and if better but still not where you want him then I would push for a higher dose. We went from 7.5 mg daily to 7.5 mg 2x/day and now we are at 15mg 2x/day and that is what it took to get my happy baby, I however have a friend whose lo is only on 7.5mg/day and doing fine so every baby is different. So give it the ole college try as they say and see what happens. The Zantac will probably not do the trick the whole time. Good Luck.

[Anonymous]

I appreciate your responses. Interestingly, they contradict what the doctor at Marci Kids is telling me. Please read below and let me know what you think. Here is the dialogue that I have had with him:

My Question: I have an 11 pound, 2.5 month old baby with acid reflux. He has been on zantac since he was 6 weeks old. I would not characterize his reflux as severe since he is able to sleep at night, nap (poorly), and he is developing normally. However, I have heard him swallowing when not eating and he grimaces when he does so. I also have noticed that he has gotten more irritable and fussy in the last couple of weeks. He chokes easily on his formula and he coughs during feedings. He also spits up quite a bit. His spit up has an acidic smell to it too. His doctor put him on prevacid solutabs, 15 mg, one time per day. I read your dosing chart and if I am interpreting it correctly, he should be on 15 mg/ 3 times per day. Is this true even though he is not a severe reflux case? Does PPI dosing ever take into account the severity of the reflux?

Dr. Phillips Response:

The inhibition of acid, in acid reflux disease, requires that the acid be inhibited throughout the day.
Currently, your sons dosing only inhibits the acid in the morning hours.
This is a common error, dose children as if they are little adults – doesn’t work.

My Question: So, do you think that I should divide up his 15 mg tablet into two 7.5 mg tablets? Is there a possibility that two 7.5 mg doses will relieve his pain? I sincerely appreciate your input! It is so nice to have people out there that care.

Dr. Phillips Response:

No, there are two parts to a dosage regimen
Dose and Dosing interval. Both have to be correct.

[Anonymous]

I think that Dr. Phillips (a doctor of pharmacy, not a medical doctor) is meaning that a single daily dose of Prevacid is not enough to give 24 hour relief. When you asked if splitting up the 15 mg tablet into 2 – 7.5 mg doses, he says that likely won’t be effective either because the dose likely won’t be high enough.

In your discussions with Dr. Phillips did you tell him that your son is also on Zantac and seems to be getting some relief with it? Also, it’s important to note that all children are different. Some may do well on lower doses of a PPI (like Prevacid) while some require the higher doses that marci-kids recommends. Some may do well on Zantac and might never need to switch to a PPI. Then there are some that take Prevacid regularly and need a dose of Zantac in between doses of Prevacid in order to find relief.

I wish it were cut and dry, but unfortunately it sometimes is trial and error. If you feel your son is getting adequate control of his reflux symptoms on the Zantac alone, than I would suggest sticking with it. If not, I think switching to a PPI like Prevacid would be a good idea. If you do switch to Prevacid, I would try the marci-kids recommended dose since most reflux babies do best on that dose.

Good Luck!

[Anonymous]

I think that Sheri said it very well.

Dr. Phillips is a PharmD who does research for marci-kids on proton pump inhibitors in children. His response to you is an abridged version of what he outlines in his “note for doctors” link on the top left hand side of the page (at least it used to be there.). He explains his rationale there by talking about the pharmacokinetics of PPIs in children, though I’d be shocked in anyone but a pharmacist could understand it!

Marci-kids recommends agressive dosing of PPIs. They believe in starting high. This is just one approach. Many docs believe in a bottom up approach- starting low and moving up as needed within a different set of guidelines. Different aproaches work for different kids.

When we were going through this with Hailey, I desperately wanted our ped (whom I LOVE) to be in sync with the marci-kids recommendations. He believed in more conservative dosing of PPIs in accordance with NASPHGAN. We tried that approach, but it didn’t work for Hailey. In the end, she did need more aggressive dosing, and I had to take a leap of faith to decide what was right for her and to find a doc that would prescribe it. My daughter is now only on 15mg at night, and it seems to help her. But at one point we were on 42mg of prevacid when she was at her worst.

I personally wouldn’t disregard the prevacid altogether just b/c Dr. Phillips said it’s not enough. You can try it alone or with the zantac, and if given properly it still doesn’t work, then you can decide what to do from there. At that point, you can see if your doc will up the dose, or if you want to find a doc who will prescribe a higher dose.

Some babies do well on lower doses, others on higher. Hopefully you find one that’s right for your little one. Good luck.

[hellbennt]

I didn’t mean to make matters more confusing! I just wanted to show that your doctor isn’t so so far off- he’s not prescribing anything too ridiculously low- so maybe you can work with him-

I agree with sheri

In your discussions with Dr. Phillips did you tell him that your son is also on Zantac and seems to be getting some relief with it? Also, it’s important to note that all children are different. Some may do well on lower doses of a PPI (like Prevacid) while some require the higher doses that marci-kids recommends. Some may do well on Zantac and might never need to switch to a PPI. Then there are some that take Prevacid regularly and need a dose of Zantac in between doses of Prevacid in order to find relief.

&

lori

I personally wouldn’t disregard the prevacid altogether just b/c Dr. Phillips said it’s not enough. You can try it alone or with the zantac, and if given properly it still doesn’t work, then you can decide what to do from there. At that point, you can see if your doc will up the dose, or if you want to find a doc who will prescribe a higher dose.

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