Switched from Zantac to Prilosec today…

[Anonymous]

Reiker had maxed out at his Zantac, and his Ped said that it would only get worse so she suggested that we try Prilosec.

I know you guys are the ultimate for making sure that his dosing is correct since I have no idea how to use the dosing calculator on MARCI-kids…

His Rx bottle says Omeprazole 10mg/5Ml Susp, the pharmasist DID tell me that it needed to be refridgerated and that it was only good for 30 days even though there is enough in there to last more than a month because it will destabilize or whatever after that amount of time.

Reiker weighs 10lb 8oz, and it says 1.6mL 1x a day for a week and then up to 2x a day after that.

Is that correct for his size?

I see on the MARCI-Kids site that he needs to have this at least 30min before a meal…can he have it further ahead than that? Like for example, we know that he takes his last bottle for the night between 10-10:30pm. Would it be ok to give it to him at like 8:30pm? He usually takes a bottle at 7pm as well.

[Anonymous]

UGH. some pharmacists are full of it…

k….the compound has to be between 2-4 mg/ml in order to be stable. in needs to be made at least every 14 days.

it cannot have any flavorings of any kind. it needs to be made with 16.8% sodium bicarb.

and you also need to give a minimum of 3.5 ml at a time in order for there to be enough buffer to prevent the drug from degrading in the stomach.

you do not have to time compounds with meals, they are immediate release.

but…your compound is likely to be unstable already.

i would print this first page off and take it to the pharmacy and have them make it exactly like it says:

https://www.infantreflux.org/forum/forum_posts.asp?TID=4505&a mp;a mp;KW=pharmacy+compounded

also…the dose is super duper low…but at this point i would work on a proper compound and then work on getting the right dose…bc if your compound is unstable…it wont work even if you do have the correct dose, kwim?

i know this is annoying and frustrating, be persistant and do your research….read as much here as you can as well as marci-kids…they are great resources!

good luck!

nataliachick72007-6-13 22:42:1

[hellbennt]

forgot to add: keep giving zantac, 4hrs seperate from PPi for 2 weeks at least as it can take that long to see effect of PPi

10 & 1/2 lbs (right? 16oz is 1lb so 8oz is 1/2 a lb?) is

4.8kilos

max zantac is 10mgs/kilo

4.8 x 10 = 48mgs

48/15 (liquid zantac)= 3.2 mls a day total, divided up into 2 or 3 doses however you ‘want’ to

this is posted one or 2 down, from link above, but I’ll put it here just in case:

& this is important as well:

adding this from Lori

s&h’s mum/Posted: 31 May 2007 at 9:20am | IP Logged :

Ask for a printout of all the ingredients and amounts put into the compound. If you see any flavourings (simple syrup, sweet syrup, sweetener, bitter stop, stevia powder, oraplus, flavouring) then you know it’s not being made correctly. Then look for the amounts of bicarb and mg/ml as per the description in Natalia’s link[the information found in the previous/above posts]. I’ve yet to find a pharmacy who makes it correctly. It works for some, but never did for us.

& here’s more: https://www.infantreflux.org/forum/forum_posts.asp?TID=5284&a mp;a mp;a mp;a mp;a mp;a mp;TPN=2

hellbennt2007-6-14 8:11:57

[Anonymous]

I’m personallly not a big fan of compounds, only b/c like Natalia said, they can be tricky to make so that they work well. The problem is that the compounding pharmacies only have basic studies on stability, in that they only consider the pH when deciding if the compound is stable or not. Marci-kids did a whole bunch of research on how to make these compounds so that they’re stable AND effective. They found that if there was flavouring, the meds degraded within a few days to a week at most if refrigerated. The indicators they used to determine whether or not the drug was stable was more then just PH like the pharmacy. Then in terms of effectiveness, they found that in order for the meds NOT to be destroyed when they came into contact with the stomach acid, there had to be at least 16.8 percent sodium bicarbonate (for doses less than 7ml per dose), and that each dose had to contain at least 3.5ml in order to ensure that there was enough buffer per dose to protect the drug. The combination of this math, along with the typical infant dosing, meant that the compound needed to be made between 2-4mg per ml to get the other requirements in place.

We had a terrible time with compounds, only because none of the pharmacists I went to believed these things to be true, and Hailey’s reflux was out of control. The compound never worked for her from 2-10 months, but we’re in Canada and had no other options available at the time for a baby.

You’re lucky in that you have zegerid (which I never used, so can’t really comment too much on that, but I know that others have used it) and prevacid solutabs. The advantage to the zegerid/properly made compound is that it doesn’t need to be given on an empty stomach and a meal times 30 minutes later, whereas the solutab does.

If you do decide to go with the compound, I’d make sure to:

1. Have it made in 2 week doses only. They’ll say that prilosec is stable for a month if made unflavoured, but many people have found that it doesn’t work well after 2 weeks even if that’s true.

2. Get it made between 2-4mg/ml (yours is 5mg/ml) so that each dose is at least 3.5ml and made with 16.8 percent sodium bicarbonate.

3. Get them to prepare it without ANY flavourings whatsoever (including stevia powder, bitter stop, simple syrup, sweetener, ORA PLUS, or any other flavours including banana).

4. Shake the bottle EXTREMELY vigourously so that all the sediment that is on the bottom, which is the buffer, is mixed well into the solution. Sometimes it’s really hard to get it off the bottom, and it’s also hard to see, because they put it in a tan bottle so you can’t really see it there. But that’s the buffer, so if you don’t mix it then the med won’t work well.

5. REFRIGERATE!!!

6. Ask for a printout of all the ingredients put into the compound. We were told that Hailey’s suspension was unflavoured, only to find later on that they were adding all kinds of sweeteners to an otherwise unflavoured suspension that was rendering it ineffective.

Sorry if I sound like a pessimist, but I’m really biased when it comes to compounds. We went to the best compounding pharmacy in the city, and they swore up and down that it was being done right. 8 months later and a wicked feeding aversion and we found out that wasn’t true. We were later told by the GI at the hospital that he’s always been skeptical of compounds for that reason. But like I said, I’m biased b/c of this. I know that some people have used compounds and haven’t had problems.

As for his dose, yes it’s on the low side if you’re using marci-kids as a guide. The twice daily dose of 15mg is a bit better and I’d probably start there, and then see if you can go up if you need to.

Good luck.

[Anonymous]

Thank you ladies.

I’ll go refill his Zantac Rx today since he’s about out of it, we’ll try the Prilosec, and if things seem to be going awry then (hopefully) I’ll be able to print off this stuff (my computer died, and my temp one doesn’t hook up to my printer ) and take it in to the pharmacy.

[Anonymous]

Hey Mel, hope it works for you. Good luck. BTW, I’ve got a carseat question for you, but I posted it in a separate thread so as not to hijack.

[Anonymous]

I also called his Ped and left a message about possibly trying Zegerid. The nurse is supposed to call me back later this afternoon after she discusses it with the Ped because they’ve never used Zegerid before, just the Prilosec.

[Anonymous]

tell them zegerid is prilosec compounded-only its a stable compound with peach flavor.

[Author]

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