Mixing instructions Zegerid OTC also RX

[Anonymous]

We only found Mylanta Cherry Supreme at CVS (their own brand). Mylanta stopped making that flavor, I think. We also tried the powder. Neither of those actually worked well for us and we ended up buying the Tums smoothies and pounding them into a powder and that worked best. I’m glad to see there is product available again for compounding. We have just started trying our little one off the medicine and she seems to be doing alright, though she’s still not the best eater (with or without meds). The zegerid/prilosec/tums combo did help us after the caracream was no longer available. My heart goes out to you and your little one. It’s such a hard thing to deal with! Best of luck and please don’t hesitate to ask any questions. I’m happy to help in any was possible as we are so grateful for all the help we got from this forum!

[hellbennt]

genalynee (& anyone else reading this):

have you posted your doctors- the good and the bad? please? thanks!

Looking

for GI: https://www.infantreflux.org/forum/forum_posts.asp?TID=660

there are recommendations for ped GIs in your area…

[Anonymous]

Where can I get a 20 ml oral syringe?

[hellbennt]

sounds odd…but try a vet (as in doctor for animals, lol)…

[hellbennt]

using the RX 20mg packets isn’t recommended but, if that’s what you have:

Posted: 04 August 2012 at 2:57pm

got the answer from Dr. Philips!

When using Zegerid 20mg packets:

20mg packets you add the contents of a 20mg omeprazole capsule – then you have a 40mg packet (essentially)

then follow instructions for the 40 mg packet:

using zegerid rx packets:

https://www.infantreflux.org/forum/forum_posts.asp?TID=14587&PN=1

[hellbennt]

went back further to find using the 20mg packets:

Posted: 20 November 2006 at 12:42pm

OK, I emailed Marci-kids and here was the response.

Here is what happened

We initially thought it would be best for young children to use the 20mg packet of Zegerid. Then, since we do research, we evaluated how well the children tolerated the Zegerid 20mg packet. We found that some children did not tolerate the 20mg packet – this was due to the amount of sodium bicarbonate.

The 20mg packet of Zegerid and the 40mg packet of Zegerid have the same amount of sodium bicarbonate per packet. That means that for any dose, the amount of sodium bicarbonate is 2 times more in the 20mg packet when compared to the 40mg packet.

We also knew that simply using the 40mg packet (which has half the bicarb) would not work because there is a certain amount of bicarb (or buffer) that is needed to neutralize the stomach acid so that the omeprazole can be absorbed (and not be destroyed by the stomach acid).

So this created a small problem, How to give the Zegerid so that enough buffer is given but so that children tolerated it.

This meant that when using the 40mg packet (which has less buffer) the amount given was not dependent on the mg of omeprazole but the minimum amount of buffer required to neutralize the stomach acid.

If your child tolerates the 20mg packet of Zegerid (which has 2 times more buffer per each mg of omeprazole) then you will end up with less mg of omeprazole.

You can also do this: If your child does not tolerate the 20mg packet then use the 40mg packet of Zegerid and follow these instructions:

1. Figure out the dose you need from the dosage calculator then give the same number of mg using the 40mg packets (remember the 40 mg packets contain 4mg/mL).

Now here is the important part:

2. Give the number of mL as you calculated you would need to give the amount of omeprazole for your child’s weight and age. Then add the same number of mLs of Mylanta Cherry Supreme.

In this way you will have enough buffer AND have the right number of mgs of omeprazole per each dose.

For example:

Your child is 2 months old and weighs 14lbs

According to the calculator for 20mg packet of Zegerid

Your child, who is 2 months old and weighs 6.4 kg, should receive a dose of 8 to 11 mg of Zegerid delivered 3 times per day for a total of 24 to 33 mg per day.

So the dose to give is approximately 10mg. If you were using the 20mg packet (2mg/mL) is 5 mL, this has enough buffer in it and the correct mg of omeprazole. This is fine if your child tolerates the 20mg packet with its extra sodium bicarbonate.

Let’s say you child does not tolerate the 20mg packets then you will need to use the 40mg packet

So use the same amount as indicated by the 20mg calculator : Again 10mg

This will be 2.5mL when using the 40mg packet (because it is 4mg/mL) – but this does not have enough buffer so add 2.5 mL Mylanta Cherry Supreme. Now you have 5mL of the combination.

See it is easy

Jeffrey Phillips, PharmD, BCPS

Associate Professor and Director of Research

School of Medicine

Department of Surgery

NW301 School of Medicine

DCO 96.00

University of Missouri

Columbia, MO 65212

[hellbennt]

using 20 mg packets:

Here’s how we mix ours…we have a large syringe (thanks to abbysmom!) and we mix 3 packets at a time with 20ml of water. This makes about 30ml total of medicine. I then squirt individual doses into little syringes with tip caps and put them in the fridge. I get those at Wal Mart. They are by the medicine dispensers, etc…it comes with two other medicine type things but I just throw those away. It’s about $1 for each little syringe w/ tip cap. The individual doses are good in the fridge for 3 weeks or at room temperature for 24 hours. I have enough syringes to mix about 4 days worth of medicine at a time, which is GREAT, because I’m not making it every day. The individual syringes are good for us because it’s easy to take a “dose” to daycare or when traveling/shopping, etc…

I’ve never mixed more than 3 packets at a time so I’m not sure how much water, but it’s roughly 6.5ml for every packet. Since your little one is getting 7-9mg per day I would probably round that to 10…that way you can squirt 5mL into each dose…works out evenly that way.

[hellbennt]

MIXING 40 mg Packets MIXING 20 MG PACKETS IS AT THE BOTTOM
Ok: Happy 2015! Here’s from Facebook:

“Sample Baby” = 6wks and 10lbs. that’s 4.5kgs

dose: 3 months: 1.5 mg/kg three times per day. one dose is 1.5 x 4.5 = 6.75mgs a dose.

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In this very thread (‘chain’/list of posts):
‘Mylanta:’

This is how Dr. Phillips is saying to mix the zegerid 40mg packets:
Zegerid 40mg packets, add 6.5mL tap water to 1 packet. This will make 10mL (40mg in 10mL),
Do this in an oral dosing syringe (20mL size syringe preferred).
Then add 10mL Mylanta Cherry Supreme* to the syringe. [see below!!]

Now you will have 20mL total volume and 40mg omeprazole. (2mg omeprazole per each mL)
This is stable in the refrigerator for 2 weeks. Shake before each dose. You can put the dose in the bottle of milk. Depends on age and weight. Must use at least 3.5mL per dose, three doses per day or don’t waste your time.

[*Mylanta: you can still find it, just not under the brand name mylanta 🙂 basically it’s the aluminum-free version of liquid antacid, usually named cherry supreme for some reason, probably because the variety of mylanta that didn’t contain aluminum was mylanta cherry supreme. MCS 🙂 Preferred Plus brand liquid cherry antacid has, Per Teaspoon (5mL): Calcium Carbonate 400 mg]

 Alternatively, use a Tums or CC powder in place of the ‘Mylanta Cherry Supreme alternate‘ – then add enough water to make 20mL total volume.

(TUMS info, below, updated July 2015, from TUMS website)

1 TUMS Ultra 1000  = 1,000mg of Calcium Carbonate (no milk or soy protein)

1 TUMS EXTRA = 750mg of Calcium Carbonate (no milk or soy protein)

1 TUMS SMOOTHIE = 750mgs of Calcium Carbonate (no milk and DO have soy…EXCEPT, the PEPPERMINT SMOOTHIES do NOT have soy)

1 TUMS REGULAR STRENGTH = 500mgs of Calcium Carbonate (no milk or soy protein)

1 TUMS KIDS = 750mg of Calcium Carbonate (no milk but do contain soy; the peppermint does not have milk or soy)

1 TUMS Chewy Delights = 1,177mg of Calcium Carbonate (have both milk AND soy)

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Denise Fragola Bibeault wrote: I do 5 packets at a time–with enough MCS for 4 packets & cal carb for 1. Straight cal carb seemed to make my ds too gassy, so I decided to mix. I just made a batch tonight: 5 packets of zegerid, 26 ml water, 1/4 teaspoon cc powder, another 16 ml water, 40 ml MCS. This is Dr. P’s recipe. Works great for my little guy, he’s been on it since July 2013. (We’re on a slow wean now) If you have any questions, let me know! Good luck!!
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I asked: What range of doses can you administer w/ this concentration?
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Denise responded: This is 2 mg/ml. I’ve given anything from 2 ml up to 7.5 ml doses. I considered changing it at 1 point to a 4mg/ml concentration, but I didn’t want to mess it up and I didn’t want to chance another acid battle…
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Kristin Fenlon: Ok ladies, I’m going to have to retread all this after I get a couple hours sleep as I’ve had none and get do confused with all the math when I’m alert & awake. & I’m 100 times worse in this fog. I did give one dose tonight based on what my sister gave her LO ‘s a few years back based on an email she received from Dr. Phillips. 40 mg zegerid + 16mls water + 1/4tsp cc (which I read somewhere on infantreflux.org). I gave 2.4 ml’s based on GI’s script but believe I should up it to 3.5 ml’s 3xs /day. He took it no problem. But if he ends up having gas issues can I use Denise Fragola Bibeault concoction for my LO Laura?
~~~~~~~~~~~~~~~~~
Kristin: Oh my goodness! My LO is a chunk! I just got on the scale w/ him & he’s 12 lbs! He goes to the pediatrician Friday so I’ll double check on that then. I think that’s pretty robust for a 7 weeker!?
~~~~~~~~
Denise: So he’s 12 pounds and under 3 months, that would be 1.5mg/kg…so he’s about 5.5 kg…that comes out to about 8.25 mg…usually you round up, so if it were my son, i’d do 9 mg 3x/day (that would be 4.5ml 3x/day). That’s according to the marcikids dosing.
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Kristin Fenlon: Wow! We are easing into it today to feel out what he can tolerate. Not as gassy with the cherry supreme we tried this morning. I will raise dosage next time. I so hope this helps him.
~~~~~~~~~~~~~~~~~~~~~~~~~
Denise: Great, good luck!
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CC MIX:
Denise: The CC mix would be 1 packet + 1/4 teaspoon CC plus16 ml water…i edited this, this is the correct mix for CC at 2mg/ml
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TUMS:
Denise: So this is from the files here about mixing with TUMS:
¼ (one fourth) tsp. of CC powder = ~750mg of calcium carbonate
· 1 extra strength TUMS or 1 TUMS QuikPac = 1000mg of calcium carbonate (I used the QuickPacs w/ my older son, but they don’t make them anymore)

· 1 TUMS Kids Smoothies (contains wheat & dairy) = 750mg of calcium carbonate but often have a better flavor for LOs.

Your LO is MSPI, so you’d have to use the extra strength tums, but if i remember correctly there are only certain flavors…let me see if i can find it–since 1 TUMS is too much cc, i’m guessing you’d have to mix 4 Zegerid packets at a time w/ 3 TUMS to get the right ratio of CC…
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Chrissy Ragulsky: With the Tums, I got a pill crusher (about $1-2 at pharmacy) and ground up the tums. Makes it dissolve WAY faster.
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MIXING 20 MG PACKETS IS AT THE BOTTOM
I was looking through old emails and this is from Dr. Philips
20mg packets you add the contents of a 20mg omeprazole capsule – then you have a 40mg packet (essentially)

[Anonymous]

Good Morning! I am starting OTC Ome/Zegerid mixed with Tums today. I was just wondering what other Mom’s out there have experienced with this. My DD took her last dose of compounded Prevacid (which she is not doing that well on) today and I am making the switch with her evening dose. Any experiences that can help me is appreciated. I’m just wondering if I she is going to revert back to really bad again before it gets better??

[hellbennt]

Thanks for joining & posting ! This forum used to be hopping! I hope someone answers your question! She shouldn’t revert – the ppi is already in her system – you’re just switching to a more effective delivery mode 🙂

[Anonymous]

Hi! Quick question: can I use cvs brand oneprazole? They were out of Prilosec and in desperate as my 6month old is screaming with feeds.

Also, is it preferred to use tums than cvs cherry supreme because of gas? How would u crush the tums? One tab is 750 mg
Thanks so much!!!!!

[Anonymous]

I’ve been reading through this because I really want to make my own medicine. My daughter 4 months 13 pounds takes Omeprazole first kit. I really hate how much it is and how it doesn’t work after two weeks. My current gi dr would never up her dosage so I’ve done so slightly on my own. We are going to a new gi dr Tuesday and I am going to ask him about this recipe and can I make it. My insurance doesn’t cover the kit and I hate that it has red dye in it. So my questions are:
1. How come the total recipe is only 19-20 ml and the first Omeprazole kit with .18mg of medicine is 90 total ml?
2. With this new medicine what would the dosing be?
3. Is it stronger than the Omeprazole first kit because it has both the zegrid and the Prilosec?

I’m currently giving my daughter 4mls 2x a day so would I keep it the same or drop it down? This site is literally saving my sanity. I would really like to make my own medicine so any input would be a HUGE help! Thanks!

[hellbennt]

@tnartowt

it all has to do with the MILIGRAMS the MGS of the med.

mLs are the liquid. Liquid can hold any # of mGs. Ex: you have a migraine pill that comes in 5 mgs. You dissolve it in 5 mls of water. Your friend has the same brand migraine medication only her dr gave her a 10mg pill. She dissolves hers in 5mls of water. You both have the same medicine & you both have 5mls of liquid solution. However, your 5mls are NOT equal. Your 5mls has less medicine in it than hers; your 5mls had 5mgs of med. *Her* 5mls has 10mgs of medicine.

[Anonymous]

Couple questions:
Why add the omeprazole (Prevacid) to the mixture? Prevacid is a long acting PPI and is required to be taken on an empty stomach? If we give it in this compound without concern for timing (empty tummy) isn’t it just a waste of medication not to mention making the compound taste horrible? Isn’t zegerid just another form of omeprazole with a buffer? Why both? Seems like zegerid alone should be sufficient and if not why did Dr.P not make zegerid alone not sufficient? why are we making a compound? I understand adding the calcium, but not doubling up on the omeprazole.

Also is it recommended to supplement probiotics since reducing stomach acid can disrupt the normal bacteria in the gut leading to a whole slew of other GI issues?

I have had my 5week old on this mix for 6 days, she is happier during the day but still has the 3am issues. The other thing we now are dealing with is lots of gas which is making her just as fussy. Using the gas drops and 4mg/ml concentration. She still pukes a ton, just not as upset about it.

Thanks for your help!

[Author]

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