Prevacid Zantac ?s

[Anonymous]

Evan is 4 wks old started on prevacid 2 days ago. He was on Zantac (0.4 ml 3x/day) for 9 days before. Ped GI put us on prevacid but didn’t tell us to continue Zantac. The past 2 days have been miserable… until I read some other posts re: overlapping for a while. I started this last night & the results were almost immediate. My questions are:

1) How long to overlap the Zantac & Prevacid? I plan on doing 2 out of the 3 daily doses of Zantac (& not within 4hrs of Prevacid). I don’t want him feeling miserable again.

2) We are doing 5mg (1.6mL) of Prevacid suspension (had to be compounded) 1x/day. Does this seem like a low dose? He’s 9.5lbs.

3) Our general ped hated that the Ped GI did the liquid (since it was a pain to fill & expensive). Said that if the prevacid is working he will switch us to solu-tabs. What would be an appropriate dose for that?

I’m not real sure about out Ped GI since he said he didn’t think the prevacid would help & that Evan might “just have colic”… I’m 99% sure it’s reflux since it was SO noticable w/o the Zantac the past 2 days.

Thanks!
Erin

[Anonymous]

Oh, also… Evan has always had ‘silent reflux’… rarely spits or vomits. Since starting the Prevacid he’s been spitting up after almost every feeding. Is this normal?

[Anonymous]

Sorry… one more question. I know you’re supposed to give Prevacid 30-60min before a feeding but w/ a 4wk old I’m finding that almost impossible. He nurses upon waking usually. How important is it that it’s given the 30-60 min prior? Does it make it less effective?

[Anonymous]

Erin,

(Erin is my DD’s name!)

From what I’ve read, the zantac and prevacid can overlap as long as needed, but at some point the zantac should not be needed because prevacid is allegedly so good at stopping reflux symptoms. My DD is 8 weeks old, weighs 10.5lbs and has been on prevacid for one week. I have been giving her one dose of 1.5ml of zantac mid-day between her prevacid doses. I skipped the zantac for the first time yesterday, and we had no problems. I was too scared to skip it until now because I didn’t want her to hurt again.

I don’t know anything about the liquid prevacid, but if you go to marci-kids.com and click “calculator” under “treatments” on the right hand side of the webpage, you will be able to calculate a good dose of prevacid solutab for your DS.

Shan

[Anonymous]

Hi Erin and Welcome. To briefly answer some of your questions. you should overlap them for about 2wks that is how long it can take for the prevacid to kick in. With the compounded prevacid you don’t have to wait the 30-60 min, but it may loose its effectiveness after 2wks as it isn’t very stable so you will need the doc to write the script for 2wk supplys. I know other moms will chime in about getting it made right. The solutabs are great but you do need to wait the 30-60 min before feeding with these. You might want to check out marci-kids.com to see correct doses for age/wt and for compounding information. Also check out Laura’s groupie intro stickied under this tab for additional great information. Glad you found us… this place saved my sanity.

[Anonymous]

Hi Erin and Welcome. To briefly answer some of your questions. you should overlap them for about 2wks that is how long it can take for the prevacid to kick in. With the compounded prevacid you don’t have to wait the 30-60 min, but it may loose its effectiveness after 2wks as it isn’t very stable so you will need the doc to write the script for 2wk supplys. I know other moms will chime in about getting it made right. The solutabs are great but you do need to wait the 30-60 min before feeding with these. You might want to check out marci-kids.com to see correct doses for age/wt and for compounding information. Also check out Laura’s groupie intro sticked under introduce yourself for additional great information. Glad you found us… this place saved my sanity.

[Anonymous]

Thank you for telling me to check out Laura’s info under the intro… lots of good stuff! Makes me leery even moreso that our dose(s) is too low.

[hellbennt]

hi & welcome! I’m laura &

what I would do is to fax your ped w/

1) the exact instructions of how to get the prevacid compounded correctly (not sure if the instructions tell you that you can ask for flavoring ‘on the side’ – you can- this way you can mix a little w/ each dose as you administer it so it doesn’t taste so bad)

compounding from lori: https://www.infantreflux.org/forum/forum_posts.asp?TID=7855&TPN=1

2) the contact info for the pharmacist (name & fax number)

3) ask for ped to please write out the script for you & fax it to the pharmacist

now, you say that ped didn’t want to do the liquid, so you could discuss that, etc. It’s easier when nursing to not have to time the meds; maybe if it’s written out by the ped you could ‘fight’ w/ insurance to cover it (more/better)? If you do switch to the solutabs it’s not the end of the world! Just giving you something to think about- and many find that it’s difficult to get the PPI compounded ‘properly. from Groupie Intro there’s a link called ‘prevacid 101.’ this should help some. You can also ask marci-kids about the possibility of getting caracream (you can learn more about that from prevacid 101, lol!)

to answer other questions, yes it does happen that silent refluxers turn into ‘spitters’, once medicated. one theory is that since it doesn’t hurt, then some babies don’t try & ‘fight’ it by swallowing it back down- they just let it out

as for how long to continue w/ the zantac: since your dose is low, I’d continue for as long as you need to- until you get the dose & form of medicated straightened/figured out

[Anonymous]

Thanks Laura for all that great info… I will finish up our 2wks of prevacid suspension & decide what we’ll do from there. Maybe it would be easier to do solutabs (w/ the 30-60min wait time) if we give before bedtime instead of 1st thing in the morning.

[hellbennt]

ah, but it helps to split the dose (prevacid) in to 2 or 3 doses, as babies have very fast metabolisms & the zip right through the medications(s)…

[Anonymous]

so should i be giving our current dose of prevacid (5mg or 1.6mL) in 2 doses? (0.8mL 2x/day)? i should be talking to ped GI today (re: upper gi results) & will discuss increasing the dose. may also discuss w/ ped.

[hellbennt]

you ‘should’ be giving in 2 doses- they don’t necessarily have to be split into two equal doses- so you could do 1ml at night if night time is worse- it was for jonah- and then .8ml in the morning-or however works for you

is your compound made w/ 16.8 percent sodium bicarbonate? The concentration should be somewhere between 2-4mg/ml so that each dose has at least 3.5ml to ensure enough buffer…

also in the meantime, I’d give the HIGHEST zantc for weight-10mgs per kilo: Zantac dosing- my/other’s question: https://www.infantreflux.org/forum/forum_posts.asp?TID=9539&PID=82914#82914

one more thing:

The Upper GI, (also called a barium swallow?) is good to look for structural abnormalities, it is *not* good to verify reflux: it is a snapshot in time if you were, so if baby doesn’t happen to reflux at that particular time of the test then a dr might be quick to dismiss you & tell you reflux isn’t there/isn’t bad- the way to show reflux is a ph probe, where the actual length (duration) & frequency (how often) of reflux episodes are recorded (I think actually the acidity is measured as well? Thus the ‘ph’ part of the test?)…

[Anonymous]

Thanks! I will start splitting up the dose… in the meantime I’m trying to figure out what to do w/ our Ped GI situation (our general ped doesn’t like him either).

I have no idea about the buffer… I’ve read all that info & am just thinking the solutabs will be easier than trusting the pharm to do it right (I have control issues – can you tell?!-lol). I know it’s harder to do the solutabs when nursing (sometimes on demand) b/c of the 30-60min wait but that might be the tradeoff. Also, I think they added flavor (it smells sweet) so I know that decreases it’s effectiveness as well.

I’ve increased his Zantac dose to 0.7 3x/day (I think the 10mg max is around 1mL 3x/day). I don’t get a refill until 7/4 so I’m scared to death of running out!

I know that the Upper GI is only intended for strutural abnormalities b/c our general ped explained & stressed that (he initally ordered the test b/c Evan has breathing issues… we were in the ER for not breathing @ 2 wks old). Anyway, I would assume the ped GI would as well, but I wouldnt’ count on it w/ the one we were given.

Thanks again for responding… I think I will post in the “introduce yourself” section (since I haven’t yet) & explain my Ped GI probelms… see if anyone can give me tips on how to handle it

[Anonymous]

Laura- when you say you can ask for the flavoring on the side- what exactly does that mean? How does the flavoring on the side come? a liquid that I would just add to the medicine (compounded Prevacid)?

If I’m able to get Zegerid, are there special instructions?

Thanks!

[hellbennt]

at this point, i would just try for caracream- now called bufferbabies:Caracream: https://www.infantreflux.org/forum/forum_posts.asp?TID=11191&PID=94236#94236

zegerid was created by the same folks who make caracream…

if you cannot get caracream/bufferbabies & are confident that you can get the prevacid compounded correctly, then yes flavor on the side means a flavored liquid/syrup that you add at the time you admininster the compound dose

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