This dose seems so high!

[Anonymous]

Hello, I’m brand new here. I plan to go over and post in the intro part in the next few days as well, but I have a question I want to post today and I only have a couple of minutes.

My son will be 12 months next week, reflux diagnosed at 5 months.

He’s been on Prevacid and has improved a lot, but the dose increases he is needing to stay on an even keel seem crazy!

I’m a pharmacist and have been showing our ped the info from the MARCI-kids sight on PPI dosing.

Anyway, he was getting symptoms back and the ped just okayed an increase again. He’s 20 pounds and he’s taking 1 & 1/4 tablets three times daily. (15mg solutabs.)

That works out to be 2mg/kg/day, whihc is way over the top of even the MARCI-kids dosing charts.

I try to be skeptical about whether the dose increase helps, but there is just no doubt. He’s actually napping longer than half an hour, eating much better, coughing less when he wakes up…

Have any of you needed a dose this high for your kids?

Thank You.

[Anonymous]

Although there may be another form of PPI (like Zegerid) that would work just as well at a lower dosage level, according to the doctors here at the University of Missouri, you really don’t need to worry about overdosing with PPIs. They are “pro-drugs”, which means that they remain in an inactive state until they reach the site of acid production, where they perform their work on the proton pumps in the parietal cells. PPIs also have a very short half-life. These two factors make it pretty much impossible for these drugs to affect any other areas besides the parietal cells, which is why they have virtually no side-effects – even when given at mega doses.

[Anonymous]

This is just a thought, and ONLY a thought and Joel, please tell me if

I’m totaly off base, if you think so. Because this just popped into my

mind, and I don’t want to mislead anyone…

I’ve often wondered about dosing needing to be higher (higher than

the researched values like on the MARCI-KIDS dosing) than expected and

pondering all the different, uncontrolled, variables we have present in our

daily lives. My dd most certainly recieved less medicine than I measured

out because she almost always was able to spit a little bit out. Or, more

commonly for a GERD baby, she would spit up what seemed like an awful

lot of her stomach contents only 10, 15, or 20 minutes after the dose was

given. And there was often the distinctive smell of minty Zantac

along with those messes. This is one of the main reasons I’m so looking

forward to giving her a PPI instead of Zantac, because with Zantac, I never

felt comfortable about trying to give her just that little bit more than her

dose actually was, to account for these common occurances. But I won’t

worry if she actualy gets a little more PPI every so often.

Obviously, as you are a RPh, you have probably already taken these

possibilites into consideration, or have found a way to overcome such

difficulties. So this is just a thought… Regardless of why, be it

physiological or through lost meds in spit up , if the higher dose

works and the lower dose doesn’t…I’d say the higher dose is right for

him. HannahLove2006-6-7 23:57:15

[Anonymous]

I’m actually not an RPh or a doctor. I just pass along any information that I am given from Dr Jeffrey Phillips Pharm.D. and Ped GI Dr Marcella Bothwell here at the University of Missouri. If they haven’t told me to say this or that, I don’t say it.

That said, based on what I have been told, some kids just need much higher doses of PPIs than others in order to take care of their symptoms. But as I said before, there is not much concern there about overdosing, because of the way that PPIs work. I’m not sure if she’s still around here much, but there is a mom named Christine on here who has needed to have her daughter on very high doses of first Nexium then Zegerid in order to alleviate the symptoms. The only reason that has really been offered to me for this is that different people absorb and metabolize these drugs differently.

Let me know if you need anything else.

[Anonymous]

Joel,

I knew you aren’t a pharmacist, AdamsMom is. Thanks for all you do.

I was wondering if reasearchers take human error into account with setting

dosage guidelines (be it low-balling or high-balling). I’m sure they don’t,

but it was just something that occured to me.

thanks

[Author]

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