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January 27, 2006 at 9:39 am #159
Anonymous
InactiveHi- can someone please be specific on finding two items on the website 1) on what article to take in to my ped GI to show research on what compound of prevacid to use ?
2) I also cannot find hte does chart per age/weight for prevacid on the website that everyone is referring to- nor thje sodium bicarbonate and 2ml suspension that Joel has said would be appropriate for our daughter (14 weeks, 12lbs, 4 ounces).
Please help- my ped GI is calling me back and I’m sure not going to adjust anything without a proper explanation. Also- Joel, I sent an email- hoping Dr Phillips can help explain this directly to my ped GI.
Our daughter is frankly doing really poorly- back to full screams while eating, sleeping little, whiney when not sleeping, stiff as a board all the time now.. we’re not getting much sleep either..
laurava01 2006-1-27 9:41:3 January 27, 2006 at 10:07 am #161InactiveLaura,
I do not have a study to give you that will tell your doctor which PPI to use or how to properly compound it. What I can give you are articles which support the need for higher doses of PPIs in infants suffering from GERD. I can also tell you the dose of either omeprazole (Zegerid or Prilosec) or lansoprazole (Prevacid) that Dr Phillips would recommend for your baby, based on the chart found on the MARCI-Kids site.
At your child’s age/weight, Dr Phillips would recommend a dose of between 20 and 25 mg of either omeprazole or lansoprazole, split into three doses per day.
I would recommend that you try to get a prescription for Zegerid, which is an immediate release form of omeprazole that can be given without regard to meals (unlike the Prevacid or Prilosec capsules, tablets or Solutabs). Zegerid is a true liquid suspension that you can mix up easily at home. If you do get a prescription written for it, please let me know and I will tell you more about how best to mix it up for infants (or you can just go to the MARCI-Kids site).
Here are the journal references that I mentioned above:
Clinical studies showing that higher PPI doses are
required to achieve healing in pediatric patients.Gunasekaran TS, Hassall EG. Efficacy and safety of
omeprazole for severe gastroesophageal reflux in children. The Journal of
Pediatrics 1993;123:148-154.Hassall E, Israel D, Shepherd R, et al. Omeprazole for
treatment of chronic erosive esophagitis in children: a multicenter study of
efficacy, safety, tolerability and dose requirements. The Journal of Pediatrics
2000; 137:800-807.Litalien C, Theoret Y, Faure C. Pharmacokinetics of Proton
Pump Inhibitors In Children. Clin Pharmacokinet 2005; 44 (5): 441-466.American
Journal of Gastroenterology Vol. 100, No. 9,
Suppl., 2005Proton Pump Inhibitors
in Children < 12 months of age.Thomas P. Iarocci, M.D.,＊
Hiangkiat Tan, M.S., Joseph Singer, M.D.,Barron John, Pharm.D., Edith Pilzer, M.D., Dinesh Patel, M.D., Alan
Bakst, Pharm.D. HO, HealthCore, Inc, Wilmington, DE; Children’s Center
for Digestive Healthcare, Atlanta, GA and TAP Pharmaceuticals, Inc.,
Lake Forest, IL.
Clinical study of pharmacokinetics of omeprazole in children
Andersson T, Hzassall E, Lundborg P, et al. Pharmacokinetics
of orally administered omeprazole in children. American Journal of
Gastroenterology 2000; 95:3101-3106.Pharmacokinetic study showing the relationship
between lower age and higher dosing requirments in pediatric patients: younger
children require higher and/or more frequent doses due to shorter PPI
half-life. The first author is employed at Astra (company that makes Prilosec.)Review of PPI use in children: safety, efficacy, and dosing information
Israel DM, Hassall E. Omeprazole and other proton pump
inhibitors: pharmacology, efficacy, safety, with special reference to use in
children. Journal of Pediatric Gastroenterology and Nutrition. 1998;
27:568-579.Specifically states
that on a per kilogram (weight) basis, children require higher doses of
omeprazole than adults due to different pharmacokinetics of omeprazole in
children. Discusses at length the use of buffered PPI suspensions in children
as a preferred dosage form.Abstracts by Jeffrey Phillips,
PharmD, describing use of ChocoBase and CaraCream in pediatric patients;
includes some dosing information:Phillips JO, Bettag ME, Parsons DS, Wilder B, Metzler MH. Use
of flavored lansoprazole or omeprazole suspensions in pediatric GERD. [Abstract
A1292] Gastroenterology 2000; 118: 5904.Phillips JO, Parsons DS, Fitts SW. Flavored lansoprazole
suspension in pediatric GERD. [Abstract] Journal of Pediatric Gastroenterology
and Nutrition 2000;31:S181. [Abstract No. 707].If you have any more questions for me, please post or email: [email protected]
January 27, 2006 at 10:13 am #163InactiveI know I’ve posted this question before, but does anyone else have trouble viewing the MARCI-kids website. When I look at it, all of the information seems to overlap…hard to read! Not sure what the problem is.
January 27, 2006 at 10:26 am #170InactiveWhat browser are you using Lori?
January 27, 2006 at 10:33 am #171InactiveHi Joel- thank you- can you please provide the link to the chart that ou are referring to? Is it that pdf on the dose one? It comes out very small to read and upon reading it close up- I don’t see a recommended dose.
Thank you, Laura
January 27, 2006 at 10:37 am #173InactiveAre you talking about this page: http://www.marci-kids.com/dosing.html
The dosing is based on the chart labelled “Pediatric Dosing for Lansoprazole” and “Pediatric Dosing for Omeprazole”.January 27, 2006 at 12:29 pm #180InactiveSorry if this makes me seem like a technological idiot. We’re using Microsoft Internet Explorer (is that a browser????). It’s fairly new software as well. Don’t have any problems on other sites, but when I go to the Marci Kids website, the coloured sides with the choices overlap the middle part where the information comes up and you can’t read a lot of what’s in there.
January 27, 2006 at 12:32 pm #181InactiveHi Joel- yes, I am talking about that link- on that page I find the following- which refers to age and weight- but there is no chart with age and weight- that is what I am trying to find- I am underlining the part that states there is such a chart but I cannot find it anywhere on the site..
Pediatric Dosing for Lansoprazole
Dosing dependent on age & weight-see chart below.Age Dose per day (mg/kg/dose) < 3 months 1.5 to 1.75 mg/kg three times per day 3-6 months 1.25 to 1.5 mg/kg three times per day 7 months to 2 years 1 to 1.25 mg/kg three times per day > 2 years 1 mg/kg two or three times per day > 5 years 0.75 to 1 mg/kg two times per day January 27, 2006 at 1:17 pm #185InactiveSorry, it’s not really clear there and I need to ask our web person to change that. When it says “mg/kg”, it means milligrams of drug per kilogram of your child’s weight. To get your child’s weight in kilograms, just divide the pounds by 2.2.
For example:
For a 12 lb, 3 month old baby on Prevacid, Dr Phillips would recommend a dose of between 1.25 and 1.5 milligrams per kilogram, three times per day. 12 lb is equal to 5.5 kg. Multiply that by 1.25 and 1.5 to get a range of between 7mg and 8mg, given 3 times a day for a total of between about 20 and 25 mg per day (Dr Phillips generally rounds to the nearest 5 mg). Does that make sense?
Lori, I will ask our web person what might be the issue with viewing the site. Thanks for letting me know!
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