Compound Prevacid

[Anonymous]

So I called and talk to pharmacist for about 10 min.. Lol

He said companies like Walgreens and cvs that compound use an unstable compound which he said I don’t have to worry about with ours.. And the mixture is 3mg per 1 ml so my dosage is actually 5.1 x twice a day and that was suggested by pediatrician… Then he said compound is not tune sensitive so I don’t have to give before 5:30 but to give before the meal which produces the most acid/troybles

[hellbennt]

ok you can believe him – in prevacid 101 (yes it looks like gobbelty gook- i need to sit down & fix it) there’s a link to HOW compounds should be made – see if he does it that way – anyway, 1.7 times 3 (it’s 5.1) 2 times a day is still low, but you’re the mama and need to figure out if you want to get it increased…

[Anonymous]

I think I need 3x a day and sorry for all the typos… I’m using my phone and doing this one handed while holding him in the other.. Thanks for all your help

[hellbennt]

How to tell your pharmacist (or tell your dr to write the RX to give the pharmacist) to make an immediate release compound of Omeprazole (Prilosec):

Omeprazole 4mg/ml Compound

60ml water
240mg Omeprazole
6600mg sodium bicarbonate
9000mg calcium carbonate powder
Must refill every 10-14 days
Do not add flavoring to bottle (you can get flavoring on the side and then flavor each dose as you administer it)
Minimum dose 1.75ml, ideally three times a day

This is recent! From Facebook:

Read this then read how to tell dr how to rx at 8.4%

Posted by Rachael T
September 21 at 2:50pm ·
Hi all! Ok, I just had a great chat with Dr. P trying to figure out this whole compounded Immediate release thing! I know there was kind of a debate going on here the other day, so I wanted to know the real answer (and not just what I had heard…lol). So here’s the skinny…a PPI compounded at a pharmacy with 8.4% sodium bicarb is immediate release AS LONG AS it has the right amount of PPI in it and is compounded at 2 mg/ml for Prilo/Omep and 3 mg/ml for Lanso/Prev. According to Dr. P there is a “standard” amount of PPI pharmacists are SUPPOSED to use BUT this doesn’t necessarily mean they are using it. He said he has seen everything as far as using the standard amount, too much, too little. If I understood him correctly, it should be 10 caps of the PPI (regardless of it being Omep/Lanso) per 100 mL. He didn’t seem to think mixing at home with baking soda was a good idea because the volume has to be dead on! Any higher than the 8.4% of sod bicarb and baby could get an upset stomach or develop Alkalosis, and too little wouldn’t protect the PPI from the stomach acid. So unless you have access to the exact ingredients and measuring devices a pharmacy has, don’t try this at home! Also, since you may be able to find out the exact # of capsules your pharmacy uses in your compound, I cannot guarantee using it as if it were IR is a good idea. That being said, do whatever at your own risk! Oh and I asked him about the 16.8% sodium bicarb thing and he said that would be too concentrated and would most likely cause stomach issues to the child….

Here’s From February 28th, 2015:
Everyone on earth needs 8.4%, it is simply about the number of mL you use if the 8.4%. If you use 16.8%, then you give 1/2 as many mL as you would if it were 8.4%

The key is, if you use 16.8%, then it is likely to make the child vomit (unless it is diluted with formula) because of the osmolality of the 16.8% is very high for the stomach mucosa. Also, how many mg of PPI is there in 1 mL ? This will dictate what the best conc of sodium bicarbonate to be used is

Older children do fine with 16.8% because they can be told to take it immediately followed by 8 oz water. Then they don’t have to take 20mL per dose of meds

 

From 2006

Pharmacies usually do not put enough buffer in the compounds to adequately protect the drug from degradation from the acid after the dose is given.

According to our research, if each dose is less than 7 mL, the compound must contain 16.8% sodium bicarbonate. And each dose, even at this level of buffering, must be at least 3.5 mL in order to provide enough buffering to protect the drug.

So in answer to your question, no, most pharmacy made compounds do not even start off as good as CaraCream or Zegerid because they do not usually have enough buffer in them.

If the compound were made with nothing but water, 16.8% sodium bicarbonate, and a PPI, and if it were mixed at a concentration of between 1.5 and 5 mg/mL, then it should be as stable and effective as Zegerid or CaraCream. But it will not taste very good at all. Also, as I said, I cannot legally recommend that anyone do this, as it would be in violation of the patents held by Santarus.

From the above link:
Ugh!  I hated having to deal with the compounding pharmacy.  They told us the same thing.  According to marci-kids research on this, unless each dose is going to be 7ml or more (which it rarely is at the doses we’re giving), then it needs to be made with 16.8 percent sodium bicarbonate.  (If you are giving 7ml or more each time then you can do 8.4 percent.) The concentration should be somewhere between 2-4mg/ml so that each dose has at least 3.5ml to ensure enough buffer.

Your dose is pretty low, so unless you have it made with the 16.8 percent sodium bicarb, there won’t be enough per dose to protect the drug.

Our compounding pharmacist told us that they followed the compounding association and did use 16.8 percent sodium bicarbonate, but they didn’t believe any of the other rules about flavourings etc.

I would suggest writing all the instructions out on how you want it prepared and ask them to humor  you and prepare it this way.  If they won’t do it, then I’d either see if marci-kids would contact them, or better yet, just go to another pharmacy.  When you do get it made, ask for a printout of all the ingredients used in the compound.  We did this, and found out that additional flavouring agents were being added to our supposedly unstable suspension.  In the end, it almost drove me batty trying to get the compound made properly.

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