Sarah Camp, March 2020

How to Home Compound

What is a home compound?

As you have probably learned through your research by now, PPIs are the most effective treatment for GERD. There are a few choices when it comes to giving a PPI to an infant or young child: liquid compound, dissolvable tabs, packet of powder, or even beads. The most popular of these is a pharmacy compound; this is the easiest method to use to administer, and it also seems to be the type preferred by physicians. (Click here for more info about different forms of PPIs)

A home compound is still a liquid PPI. Instead of a pharmacist creating it from either a kit (such as FirstBrand) or completely compounding it from powder, home compounding involves purchasing your own materials over the counter and combining them correctly to make the right dosage.

Why compound your own PPI at home?

Home compounds are always immediate release (see below for details).
They are cheaper than pharmacy compounds.
Pharmacy compounds begin losing effectiveness after about 10 days (source), but most pharmacies and insurances will only refill every 30 days; home compound can be made fresh as often as needed.
You control the ingredients. This is especially important if your child has allergies/intolerances/sensitivities.
You can properly dose and discuss/share with your doctor.
Pharmacy compounds may be made incorrectly with the wrong amount of buffer, which would make them less effective.

What’s all the fuss about immediate release?

Immediate release PPIs have additional buffer instead of an enteric coating (the hard coating around delayed release beads or the glue-like coating on tablets). This buffer neutralizes acid that is already present in the stomach to keep a safe environment for the drug to not break down. Immediate release has several advantages over delayed release:

IR can be given at any time, regardless of food. (It cannot be given too close to acidic foods, such as juice, fruit purees, etc.). The rule for delayed release PPIs is to give them on an empty stomach, usually at least 2 hours after finishing a meal. You must then wait 30-45 minutes after administering them, and follow with a feeding. Furthermore, if you wait too long to eat, the PPI won’t be effective then either (see more).
IR is more effective than delayed release; it turns on more proton pumps in the stomach, which can then be blocked by the drug.
IR combats the nocturnal acid dump, which delayed release does not do as well. Furthermore, the last dose of delayed release needs to be given at or before 5:30 P.M. IR has no such timing restrictions.
IR can be absorbed directly into the bloodstream beginning in the stomach instead of having to travel to the intestine first.
The added buffer in IR acts as an antacid too, which provides fast relief to the stomach and esophagus.

Click here for excerpts from published research about Immediate Release PPIs.

Home Compounding Tutorial

Recipe for this video and the steps below was found here.

Click here to download a picture tutorial of the 2 mg/ml recipe that you can print/save.

Maddie T. provided us with another super detailed picture/description tutorial for the 4 mg/ml home compound! Click Here to download!

Whether you are unable to send them a link to this page or they do not have electronic communication, either of these documents would be a phenomenal resource to take with you when telling your doctor about home compounding.

All recipe variations for home compounding are located on this page.

Ingredients:

Zegerid 20 mg capsules
Omeprazole 20 mg tablets
NOW Calcium Carbonate Powder
Gas drops (*optional* — this is the only ingredient that can be omitted without compromising the recipe)
Sugar
Water

Materials:

Pill crusher, grinder, or mortar & pestle
Container to store in (ex: breastmilk storage container OR Glass dropper bottles, syringe adapters & caps)
Syringe(s)
1/2 teaspoon
Small knife
Safety pin
Paper towels
Pot + stove
1/2 C measuring cup

Instructions:

***Pro tip–use a container that has a SCREW-ON top. I use a breast milk storage bottle. Once I tried something that had a snap-on cap & the pressure from shaking made it pop open & spew all over my kitchen.

I would start your simple syrup first. Combine water & sugar both in pot, then put on stove on low.

Then, get your Omeprazole tablets prepped. Personally, I put my pills in the SOAKING wet wet paper towel (like it was making a mess on my counter it had so much water coming off of it lol). I let them sit while I do some of the other tasks.

Get your Zegerid and use a safety pin to poke a hole in the end. I find that the fatter end that doesn’t have writing on it is easier to puncture. Take a really small, sharp knife and cut from that hole (I just make a line going from the hole to one side, then the hole to the other side if that makes sense). You just need to open up a little more wiggle room to dump out the powder. Powder goes into whatever you plan to mix the whole thing up in, shake, etc.

Once you do that, go give your sugar water a nice stir (it probably won’t be dissolved yet).

Get CC powder and 1/2 tsp measuring spoon. Get a nice big scoop, then use your little knife to level out the top of the spoon (scrape off the extra on top). Put that scoop in the container with your Zegerid.

Go back to the stove & give your simple syrup another stir.

When you are ready to peel & rub the coating off the tablets, I would use a small, very sharp paring knife to peel one of the edges, then the rest should slide off pretty easily. You want to get all of the color off, AND the glue-y material that’s underneath. Once you are done with the tablets getting the coating off, I would put them on a dry paper towel to get rid of any residual stickiness.

By this point I’m guessing your syrup will probably be done, maybe even the step before. When all the sugar is dissolved, turn off stove & remove pot from heat. It needs to cool off a little bit while you finish your other tasks.

Grind up the Omeprazole tablet(s) to a fine powder using whatever pill tool you have (grinder, crusher, or mortar and pestle), then add that to your container.

The last step before you’re done is to measure your syrup! I just stick my finger in there to make sure it isn’t hot enough to burn me anymore. Get a big syringe & measure exactly how many mls of syrup you need into your compound!

Voila, immediate release PPI!

Shake it SUPER hard. Make sure there aren’t any clumps stuck to the bottom or anything like that. Then, stick in fridge & set a repeat alarm for 15 minutes to keep shaking for the next three hours.

The medication lives in the fridge after this because it needs to stay cold. If you leave it out on the counter for 15 or 20 minutes not a huge deal. If you left it in your car in the heat for 15-20 minutes in the sun/summer heat, probably a different story. If it gets warm, it becomes a lot more bitter & can become less effective over time.

It’s normal for the mixture to separate out a little bit between uses in the fridge. Just shake it well before you draw it up in your syringe.

When you take the lid off, pour the extra liquid back into the container, then rinse the lid and shake the water off in the sink. If not your hands, the container, and your fridge will end up a sticky mess! You can combat this by getting going to the links above to buy a medicine dropper container & buying the syringe adapter + flat screw-on lids. This is the closest thing you’d get to how you buy liquid meds for babies over the counter or at the pharmacy. Another option is to rinse out a bottle of medicine you already have for your baby like Benadryl, Tylenol, Motrin, etc.

One of the great things about the home compound is that you can even give it *inside* a small bottle with formula or breast milk, as long as you know baby will finish all of it. If you need other ways to give the medicine, you can try a Medi-Nurser or an Accu-Dose Pacifier.

How can I make a larger batch?

If you wish to make more medicine at once, you can increase the amounts in the recipe to double, triple, or more your batch. The most important thing to remember here is to multiply each ingredient by the same number.

For example, if you want to make 4 times the amount in from the video above (which is 2 mg/ml), your recipe would be:

4 Zegerid
4 Omeprazole
4 x 1/2 tsp (=2 tsp) NOW Calcium Carbonate Powder
4 x 20 ml (=80 ml) water or simple syrup
4 x 0.6 ml (=2.4 ml) gas drops

What if I want to make 4 mg/ml instead of 2 mg/ml?

Some people prefer this method so they have less liquid to deliver. We definitely recommend considering this once Baby is at 10 mg or above. 5 ml of the 2 mg/ml home compound starts getting to be a LOT of liquid to have to get Baby to take at once.

It there anything else I can do to make this process faster?

Yes! Instead of making the simple syrup fresh each time you make the medicine, make one big batch of simple syrup at a time. You can do this by heating 3-4 cups of water on the stove, and adding 3-4 cups of sugar (1:1 ratio), and stirring until dissolved. Store in a container and refrigerate for up to one month. DO NOT reheat the simple syrup when mixing a batch of medication. It will combine with the powders just fine cold, and the consistency/amount of water is compromised when reheated.

How do I know how much home compound to give?

To answer this question, follow the steps below:

Using Omeprazole, calculate proper dose in mg.

You can use the medication calculator here to help you with this, or see our PPI dosing page for a breakdown of amounts per age range and do the calculations on your own.
*Thank you to Veronica Mulik for creating the Medication Dosing Calculator!

Research for PPI dosing can be found below.
PPI Dosing Memo
Excerpts from published studies about PPI dosing
Links to article abstracts
List of research references
Calculate how many ml of home compound you need to equal the amount of mg found in step #1.

We have a Home Compound Calculator that can be used! If you are working on a device (laptop or desktop) with Microsoft Excel, you can download this file instead and edit the blue boxes inside the file itself. This will not work on mobile devices.
*Thank you to Sarah Allen for creating the Home Compound Calculator!

You can also calculate the dosing yourself by following the steps below:
If you have made a 2 mg/ml recipe (as shown in the video) by adding 20 ml of water or simple syrup per recipe, then you take the mg that baby needs and divide that number by 2. That is how many ml baby gets per dose.

If you make a 4 mg/ml recipe (not shown in video) by adding 10 ml of water or simple syrup per recipe, then you take the mg that baby needs and divide that number by 4. That is how many ml baby gets per dose.
Remember minimum dosing.

There is a discussion in our forums (you’ll have to scroll down a fair amount on this page) but minimum dose is mentioned specifically at least twice. One of the times, it’s in bold. If you give below minimum dose for compounds (even the pharmacy compounds!), the medication may not be effective, and it definitely will not be immediate release.

NOW Calcium Carbonate or Tums Recipe Minimums

For the 2 mg/ml recipe, the minimum dose is 3.5 ml.

For the 4 mg/ml recipe, the minimum dose is 1.75 ml.

MCS Recipe Minimum

For both the 2 mg/ml AND the 4 mg/ml recipe, the minimum dose is 3.5 ml.

A note about recipe choice…

In the majority of cases, the Calcium Carbonate recipe is the best option. It is the purest/least additive. It is also corn-lite. If you KNOW your child does not have a corn issue, the Tums recipe may be fine. It’s all about trial and error. The MCS recipe should only be used for a very short time/in the event that you’re unable to find either NOW Calcium Carbonate powder or Tums. This recipe can cause diarrhea and stomach cramping if given too often/too long. It’s something to only consider if you’re really in a pinch.