The cells of the stomach contain pumps that produce acid to aid in digestion. During a reflux episode, the stomach acid comes up into the esophagus. It is the acid that makes the reflux painful. Your doctor may prescribe one or more medicines to control the acid in your baby’s stomach. Reflux medicines used to treat infants typically fall into five (5) categories:
- Histamine H2-receptor antagonists (H2-Blockers)
- Proton Pump Inhibitors (PPIs)
- Prokinetic Agents
- (Acid) Neutralizers
- Cytoprotective Agent
1. Names of H2-Blockers (Generic, Brand):
- Cimetidine (Tagamet)
- Ranitidine (Zantac)
- Nizatidine (Axid)
- Famotidine (Pepcid)
What they do: Reduce the amount of acid the stomach produces. How they work: The chemical histamine causes certain cells of the stomach to produce acid by attaching to places on the cells called H2 receptor sites. H2-receptor antagonists attach to the H2 receptors and block the histamine from attaching to the receptors. This inhibits the productions of acid. H2 blockers work by blocking the primary signal receptors on the parietal cell and keep most of the signals to begin acid production from ever getting to the acid-producing proton pumps. H2 blockers do not neutralize stomach acid.
- they do not block all of the receptors and so the pumps can still be turned on and
- infants generally develop a tolerance for these drugs very quickly and so they usually become inneffective within a couple of weeks. Still, they are safe drugs and they certainly serve a purpose.
Click here and scroll to the bottom of page 12 (look for ‘Pediatric Use’ and then scroll to ‘Treatment of GERD and Erosive Esophagitis,’ p. 13) to read about (the highest) zantac dosing, by weight. You may find that your current dose of zantac may be increased. Research! Scroll through this ‘thread’ on the forum, too, for a discussion of zantac, axid and pepcid dosing.
2. Names of Proton Pump Inhibitors (PPIs) (Generic, Brand):
- Omeprazole (Prilosec)
- Omeprazole with bicarbonate (Zegerid)
- Lansoprazole (Prevacid)
- Esomeprazole (Nexium)
- Pantoprazole (Protonix)
What they do: Reduce the amount of acid the stomach produces. How they work: The cells of the stomach contain pumps that produce acid to aid in digestion. PPIs inhibit the production of acid from these pumps, reducing the amount of acid in the stomach. Regarding PPIs: Please research proper dosing, proper ‘form’ and proper administration. After being on the highest dose, by weight, of a H2- Blocker, it may be time to ‘move on’ to a PPI. If this is the case, KEEP your baby ON THE H2-BLOCKER UNTIL THE PPI ‘KICKS IN!” No one told me this! If you do not continue with the H2-Blocker, and you start a PPI, and the PPI takes two weeks to show it’s full effect, well, then IT’S AS IF YOUR BABY ISN’T ON ANY MEDS AT ALL!! Yes, I’m screaming! Because I learned this the HARD WAY; I was not told to continue the H2-Blocker (Zantac, in our case) and my baby shrieked/howled so much that he LOST HIS VOICE! Can you imagine? Pitiful!!
3. Names of Prokinetic Agents (Generic, Brand):
- Metoclopramide (Reglan )
- Cisapride (Propulsid)**
What they do: Keep the contents of the stomach from reaching the esophagus, reduce the amount of acid in the stomach. How they work: Prokinetic agents make the valve between the stomach and the esophagus shut tighter. They also make the contents of the stomach empty quicker. Side Affects: Reported in over 30% of patients. Include: nausea, diarrhea, nervous system side affects, drowsiness, restlessness, dystonic reaction, extrapyramidal symptoms Can have interactions with other medications. ** Propulsid is no longer available in the US.
4. Names of Acid Neutralizers:
- Liquid Cherry Supreme varieties (Used to be: Mylanta Cherry Supreme, mcs). Parents look for the variety that does not list aluminum as an ingredient.
Only antacids like Mylanta or Tums actually neutralize the acid. These are considered safe, even for newborns. Consult with your doctor.
5. Name of Cytoprotective Agent
- Sulcralfate (Carafate)
What it does: Helps protect and coat the lining of the esophagus, stomach and upper small intestine by shielding their exposure to stomach acid, so that healing can occur.
Until you can get him on the right dose of PPI, you might look into using sulcrafate (Carafate) it bonds to ulcerated areas in the stomach and esophagus and protects them from the acid, which allows them to heal. The trick is, it requires the presence of acid to become activated, and so if it works, then it means that the Prevacid is not stopping the acid from being produced. Once you have the right dose/form of PPI, then something like Carafate should not be necessary. If you do use Carafate, you shouldn’t do so within a few hours of any other meds, as it can lower absorbtion.
NOTE: The information on this page is not exhaustive and complete accuracy is not guaranteed. Please consult your doctor with any questions you may have regarding the treatment of your child.