May 7, 1015

Keeping this here for safe-keeping: the First Omeprazole (Prilosec) is 2mgs/ml and the First Prevacid is 3mgs/ml

(these are notes to accompany Dosing and Administration of PPIs)

Here is a study to show that it (the compounded PPI) is stable for +/- 10 days: Stability of Extemporaneously Prepared Lansoprazole Suspension at Two Temperatures. Print this if needed for your doctor!

First Brand (from the Fb group Infant Reflux: Support for Gerdlings)
Julie:
Those who use First brand do you refill and pay for it twice a month to ensure it’s stability or is it possible to make half at a time? I haven’t had any luck yet getting the kit unmixed or half mixed but I was wondering how other parents handle it. Thanks for sharing your experiences!

Ashley: We use this brand and have a RX to fill every 14 days and discard any remainder. I pay for it twice a month. It would be half the cost if I only filled once monthly. They will only dispense mixed.

Julie:  Thank you Ashleyl! So with the rx you were able to get insurance to cover some of the cost of both batches?

Ashley: Yes because it’s written for a 14 day supply. If your RX is written for 30 day refills, insurance would not approve early refills at 14 days. Ask your provider for a 14 day supply and insurance should cover.

Julie: Thanks so much!

Christine: So mine is written for a 30 day supply, but the scrip is written for 8ml instead of the 4ml we give our daughter. So same thing really as the 14 day supply, but for whatever reason my insurance wouldn’t ok the 14 day supply.

Jenni: We pay for every other refill

Julie: Thank you Christine! Thank you Jenni!

Alicia: We have been using First omeprazole suspension for about 4 months now…while it does last longer than the 7-10 days of a regular compound, we have still found that the bottle doesn’t stay effective for more than about 2 weeks (even with shaking very well before dosing and keeping refrigerated). Just this last time, I tried to stretch it to 3 weeks, since I think my little one’s reflux is starting to improve a bit (it’s supposed to last a month so the insurance won’t cover our second prescription each month) and the result was a very unhappy super refluxy little baby for the last 3-4 days we used it. Got it filled again and she is back to herself after just a couple days.

Jenni: Alicia so do you just ask the pharmacy to bill your insurance for one kit and then you pay for the second?

Alicia: Yes exactly. My pediatrician actually said they would write it as a 2 week prescription to try to help us with the insurance coverage, but the pharmacist told me because it comes to them as a monthly kit, they have to bill it as a monthly prescription no matter what the Rx from the doctor says. Maybe you will have better luck with your pharmacy though. Either way, I just keep getting the doctor to call in more refills and the pharmacy will fill it for us with no question since they know we are having issues with it not lasting as long as it should. Just frustrating that we have to pay out of pocket that second time each month, but worth it because it really does help our daughter with her reflux.

Kaye: It breaks down after about 12 days for us. We had our surgeon write is so she used the whole 150 mls in 2 weeks (5mls 2x a day). Then they have to fill it twice a month and the insurance pays for it that way. We actually only give her 4 mls 1x a day.

Alicia: Kaye that is really helpful to know! When our Rx was increased initially, they just put it in a 150mL kit instead of the 90mL smaller kit. I assumed they would use a bigger kit again if we had the dr write it for double the dosage. Glad to know this is an option!

Jenni: They make a 300ml kit.

Raquel: We agree the the first compounded kit does not last past 2 weeks. We finally got our pharmacist to agree to give us the 150 milliliter bottle compunded. And the other 150 milliliter bottle unmixed or just with the kit so we could mix it ourself after 2 weeks. Our gi had to write the script for 300 milliliters per month to make this happen. Hope this helps some of you.

Aidan: The good news about a 300 mL bottle is that because you have so much extra, you can use it to dose bigger, if you choose, while you get the details of meds worked out (whether/how to home compound). Next time, you can request that your prescription be filled with a 90 mL bottle, rather than a 300 mL. That is a simple pharmacy request; you won’t have to involve your doctor for that part. Also, the cost per-90 mL bottle isn’t any higher per-mL than what you bought; it won’t be more money that way. If you end up sticking with a smaller dose, you’ll spend less, but may need to home compound to have effective meds after the REAL expiration of that bottle, in 8-12 days. But the better move would probably be informing your doctor of your baby’s need for a higher dose and requesting an appropriate prescription. If they won’t do it, time to find a second/third/specialist opinion! Once you’ve got a prescription in a higher daily dose (if that’s what your baby needs), that 90 mL bottle will be used up within its effective days, rather than losing its potency before your insurance will refill.