Important Supplements
Home Compounding Recipes
[Link to ORIGINAL PAGE SOURCE]
[Link to Dosing Page]
[Link to printable TUTORIAL for 2 mg/ml PPI Compounding]
[Link to printable TUTORIAL for 4 mg/ml PPI Compounding]
[Link to Home Compounding 101 with VIDEO]
A note about recipe choice…
Most of these recipes have at least two variations on how they can be made. In the majority of cases, the Calcium Carbonate recipe is the best option if there is one. 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.
Pepcid/Famotidine Home Compound with Calcium Carbonate Powder
Famotidine 80mg (20mg tablets x 4) or (10mg tablets x 8) — NOT “Pepcid Complete”!
1/4 teaspoon Now Calcium Carbonate Powder
10ml of water
Crush tablets
Mix with water
This makes an 8mg/ml solution
Keep refrigerated. Shake well before giving.
Pepcid/Famotidine Home Compound with MCS
Famotidine 80mg (20mg tablets x 4) or (10mg tablets x 8) — NOT “Pepcid Complete”!
10ml of MCS
Crush tablets
Mix with MCS
This makes an 8mg/ml solution
Keep refrigerated. Shake well before giving.
Both of the recipes above are stable for two weeks. Dosing information for Pepcid (famotidine) can be found here: infantreflux.org/dosing
Zantac Home Compound (stable for 1 day)
1 x Zantac/Ranitidine 75mg tablet
5mls Pedialyte or MCS* or water
Crush tablet
Mix with Pedialyte or MCS* or water
This makes a solution of 15mg/ml
Dosing is 10mg/kg divided 2-3 times a day
[classic flavors of Pedialyte are free of cow’s milk protein]
This recipe is only good for one day.
Zantac Home Compound (stable for 2 weeks)
4 x Zantac/Ranitidine 75mg tablet
20mls of MCS
OR
4 x Zantac/Ranitidine 75mg tablet
½ teaspoon Now Calcium Carbonate Powder
20mls of Water
This makes a solution of 15mg/ml.
Dosing is 10mg/kg divided 2-3 times a day.
Keep refrigerated. Shake well before giving.
Note: Zantac and Zegerid/Omeprazole must be given 4 hours apart if using both medications.
Zegerid/Omeprazole with Now Calcium Carbonate Powder
***Click HERE for a video tutorial & detailed explanation of how to make this recipe!***
1 x Omeprazole 20mg tablet (many prefer tablets as capsules can turn to sludge at the bottom of the bottle)
½ teaspoon Now Calcium Carbonate powder (equivalent to 1500mg of calcium carbonate, do NOT look at calcium only)
Add 20 mls of water for 2mg/ml (minimum dose should be 3.5ml to make sure there is enough buffer per dose)
OR
Add 10mls of water for 4mg/ml (minimum dose should be around 1.75ml to make sure there is enough buffer. (see flavoring below, to make with simple syrup)
Shake well
Add about 0.6ml of gas drops. Alternatively, just give gas drops before dosing. The gas drops are optional. They are the only ingredient that will not change the efficacy of the recipe if omitted. Some babies cannot tolerate them due to soy &/or corn derivatives.
Place in refrigerator.
Mix periodically over 3 hours.
Do not make more than a week supply otherwise it gets bitter tasting.
Keep refrigerated. Shake well before giving.
Pros: Most tolerated form. Less chance of ingredients that trigger an intolerance.
Cons: Bitter! Needs flavoring. See below for some flavoring options!
Now Calcium Carbonate is only available online.
Zegerid/Omeprazole with MCS* (aka CVS Cherry Supreme)
1 x Omeprazole 20mg tablet (many prefer tablets as capsules can turn to sludge at the bottom of the bottle)
Add 19mls MCS for 2mg/ml (minimum dose should be 3.5ml to make sure there is enough buffer per dose)
OR
Add 9.5mls MCS for 4mg/ml (minimum dose should be around 3.5ml to make sure there is enough buffer)
Shake well.
Add about 0.6ml of gas drops. Alternatively, just give gas drops before dosing. The gas drops are optional. They are the only ingredient that will not change the efficacy of the recipe if omitted. Some babies cannot tolerate them due to soy &/or corn derivatives.
Place in refrigerator.
Mix periodically over 3 hours.
Do not make more than a week supply otherwise it gets bitter tasting.
Keep refrigerated. Shake well before giving.
Pros: All ingredients available at local stores. May not need flavoring.
Cons: This is corn light, not corn free. Some babies may react to the Xanthan Gum in it if there is a corn or soy intolerance.
If you can’t find MCS, you can make this with liquid Rolaids.
1 x Omeprazole 20mg tablet (many prefer tablets as capsules can turn to sludge at the bottom of the bottle)
7.5 mls of Rolaids Ultra Strength Cherry Liquid Antacid
Add 11.5 mls of water for 2mg/ml (minimum dose should be 3.5ml to make sure there is enough buffer per dose)
OR
Add 2mls of water for 4mg/ml (minimum dose should be around 3.5ml to make sure there is enough buffer.
Shake well.
Add about 0.6ml of gas drops. Alternatively, just give gas drops before dosing. The gas drops are optional. They are the only ingredient that will not change the efficacy of the recipe if omitted. Some babies cannot tolerate them due to soy &/or corn derivatives.
Place in refrigerator.
Mix periodically over 3 hours.
Do not make more than a week supply otherwise it gets bitter tasting.
Keep refrigerated. Shake well before giving.
Zegerid/Omeprazole with Tums
1 x Omeprazole 20mg tablet (many prefer tablets as capsules can turn to sludge at the bottom of the bottle)
Add 19 mls of water for 2mg/ml (minimum dose should be 3.5ml to make sure there is enough buffer per dose)
OR
Add 9.5 mls of water of water for 4mg/ml (minimum dose should be around 1.75 ml to make sure there is enough buffer.
Shake well.
Add about 0.6ml of gas drops. Alternatively, just give gas drops before dosing. The gas drops are optional. They are the only ingredient that will not change the efficacy of the recipe if omitted. Some babies cannot tolerate them due to soy &/or corn derivatives.
Place in refrigerator
Mix periodically over 3 hours
Do not make more than a week supply otherwise it gets bitter tasting.
Keep refrigerated. Shake well before giving.
Pros: Ingredients available at any store. May not need flavoring.
Cons: Tums is made with corn starch. Do not use on babies with suspected corn intolerance.
(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)
Zegerid 40mg Prescription Packets with MCS*
(also comes as generic: omeprazole sodium bicarbonate 40mg packet)
1 x 40mg Zegerid Packet
10mls of MCS
6.5mls of water
This makes 2mg/ml
No need to add flavoring
Minimum dose must be 3.5mls
Stable for 2 weeks
Keep refrigerated. Shake well before giving.
Zegerid 40mg Prescription Packets with Tums
1 x 40mg Zegerid Packet
16mls of water
This makes 2mg/ml
No need to add flavoring.
Minimum dose must be 3.5mls.
Stable for 2 weeks.
Keep refrigerated. Shake well before giving.
Zegerid 40mg Prescription Packets with Calcium Carbonate Powder
1 x 40mg Zegerid Packet
¼ teaspoon of Now Calcium Carbonate Powder
16mls of water
This makes 2mg/ml
No need to add flavoring.
Minimum dose must be 3.5mls.
Stable for 2 weeks.
Keep refrigerated. Shake well before giving.
How to convert Zegerid 20mg Prescription Packets to 40mg Prescription Packets
If you have Zegerid 20mg packets, you will need to convert them to 40mg packets.
Do not double 20mg packets, as that will give you too much buffer in the form of sodium bicarbonate!
To convert your 20 mg Zegerid Prescription Packet:
Add 1 Omeprazole 20mg tablet/capsule to your 20 mg Prescription Packet
Choose one of the recipes above (the 40 mg Prescription Packet Recipes, using either MCS, TUMS or Calcium Carbonate Powder)
Follow the recipe you’ve chosen
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Dosing:
< 3 months – 1.5 mg/kg three times per day
3-6 months – 1.25 mg/kg three times per day
7 months to 2 years – 1 mg/kg three times per day
> 2 years – 1 mg/kg two or three times per day
5 years – 0.75 mg/kg two times per day
Flavoring ideas for OTC Zegerid Home Compound:
Torani Vanilla Coffee Syrup – (Note: corn light) We have to use the same amount as dose we are pulling up. So, if we pull up 3mls of meds, we need 3mls of syrup.
Liquid Sugar- We have to use the same amount as dose we are pulling up. So if we pull up 3mls of meds, we need 3mls of syrup.
Splenda – Yes it’s an artificial sweetener. Pro is that you can add to bottle of compound and not have to add volume when giving dose. We dose 1 packet/teaspoon per 20mls of 4mg/ml home compound.
Yummymeds – works for some babies alone or in combination. Flavor per dose. Do not flavor whole bottle.
Hershey Simply 5 Chocolate Syrup – free of all top 8 allergens, even dairy.
Homemade Simple Syrup: Mix 1 cup of water and 1 cup of sugar on the stove and heat until sugar is dissolved. Use to flavor medications or replace water in the home compounding recipes with this.
Supplies:
Medicine Bottle
3ml or 5ml Syringe
Measuring Spoon (if using calcium carbonate powder)
Bottle Medicine Dispenser (many love this!)
Ph Test Strips to test Spit Up/Saliva/Drool (Optional. Most adjust dose based on symptoms.)
Pacifier and syringe combo where you use the syringe to measure and put in pacifier to get meds into baby
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FAQs
Q: What is home compounding? Here is link to some Success Stories
A: Home compounding is when you mix your own medication to treat your baby’s reflux at home. When you home compound Zegerid/Omeprazole it becomes an immediate release PPI.
Q: What is an immediate release PPI? What is the difference between immediate release and delayed release?
A: An immediate release PPI is one that does not have to be timed around meals to be given. It also is a better choice for babies with delayed gastric emptying as it protects the PPI so that it can reach the duodenum to be absorbed.
Treating GERD w/ PPIs
PPI Administration (Immediate release and Delayed Release) & there’s link to DOSING CHART
This link explains some things re: PPIs
And, here’s more in this link
Q: Why is home compounding better than a compound I can get from my pharmacy?
A: Studies show that compounds are only stable for up to two weeks. Also, many pharmacies are not aware of the correct way to make PPI compounds to make them immediate release. There are also inactive ingredients and/or flavoring that your baby may react to in compounded medication. With home compounding, you control the ingredients your baby gets.
Q: What about my doctor? Why doesn’t my doctor know how to do this?
A: Many doctors are not familiar with all forms and variations of PPIs. Many are not ever familiar with the studies on proper dosing.
RESEARCH to REVIEW and SHARE w/ you Medical Providers regarding proper dosing: (1) https://www.infantreflux.org/research-references/ (2) https://www.infantreflux.org/research-articles-abstracts-references-ppis-gerd/ (3) https://www.infantreflux.org/ppi-dosing-memo-infants-young-children/
Q: Why can’t I use another PPI like Prevacid?
A: This recipe was created by a renowned PharmD and has been used by many parents over the past six (6) years with great success!
Q: Why is there a minimum quantity that has to be given?
A: In order for home compound to be immediate release, it needs a minimum amount of buffer (in the form of the sodium bicarbonate in Zegerid and the calcium carbonate) to protect the Omeprazole in the stomach so that it can get to the duodenum.
Q: How do I choose between 2mg/ml and 4mg/ml?
A: If you are using MCS* or Rolaids, it’s usually a good idea to start with the 2mg/ml concentration.
If using Tums or Calcium Carbonate powder, you can get away with 4mg/ml. The reason is that you need a minimum amount of buffer per dose.
Q: Why do I need a recipe to compound Zantac? Isn’t that available at my pharmacy?
A: It can take up to 2 weeks for a PPI to become fully effective. In the meantime, you can dose Zantac 4 hours away from your PPI to offer your baby some pain control. Zantac can also be used for breakthrough flares caused by teething, colds, vaccines, etc. Some babies will not take prescription Zantac because of the taste. Some babies don’t tolerate it well if there is a corn intolerance issue. Remember to dose Zantac 4 hours away from Zegerid/Omeprazolee (or any other PPI).
Q: I’m scared to make my own home compound of Zegerid/Omeprazole. Why can’t the pharmacist do this for me?
A: They can! Just ask the pharmacy to make it like this:
Omeprazole 4mg/ml Compound (to tell the pharmacist or try having the dr write the rx out this way)
60ml water
240mg Omeprazole
6600mg sodium bicarbonate
9000mg calcium carbonate powder
Must refill every 10-14 days
Do not add flavoring to bottle
Minimum dose 1.75ml a dose; dosing three times a day is ideal
Q: *What is MCS?
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
https://infantreflux.org/forums/topic/please-help-hellbennt/page/4/#post-72655
Mylanta can also be used for treating breakthrough flares from vaccines, teething, colds, etc.
Dose: 1ml up to 5 times a day. If you see loose stools, decrease dose.
Must dose 4 hours from any delayed release PPI. Can give at any time with an immediate release PPI or Zantac (or other H2 blockers).
Corn Free “MCS” (not to be used to the recipes above, but can be used to treat break though flares)
½ teaspoon Now Calcium Carbonate Powder
20mls water
Shake well.
Dose the same as MCS.
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