Monday, December 15, 2008

Great reflux tips

I forgot about this website, it's a great resource for reflux, doing some research I discovered that maybe we weren't dosing Kaitlyn enough on her reflux meds and the fact that she probably wasn't getting much of the medicine (in solutab form).

I had always heard that Zantac rarely really works for reflux for kids...

Here is some REALLY great Reflux info that I wish I had read more about with Kaitlyn: Thought I'd share. All of this info is from the following website:

1. Regarding h2 blockers (meds like Zantac):
"Tolerance to H2 blockers can occur with prolonged administration; that is, the medication will no longer inhibit acid production, even if the dose is increased. Although your child may feel better at first, the symptoms will often return within one or two weeks, even after increasing the dosage.:

Regarding PPI's (Prevacid, Prilosec)::
Proton pump inhibitors (PPIs) are chemical compounds that irreversibly inactivate the pumps that produce stomach acid.

1.Zegerid powder for oral suspension is the only commercially available immediate-release suspension that is FDA-approved. It is helpful for pediatric use because it is a true suspension that contains no enteric-coated granules that are difficult for young children to ingest. Parents therefore don’t have to worry about their child chewing the granules, which would expose the PPI to stomach acid and reduce the effectiveness of the drug.

2. H2 blockers will prevent PPIs from working if they are taken too close together. For this reason, H2 blockers should not be given within 4 hours of giving a PPI.In-depth look: PPIs work by directly inactivating the acid- producing pumps in the parietal cells, but they can only have this effect if the pumps are actively secreting acid. Because H2 blockers prevent the activation of pumps, they can actually inhibit the ability of a PPI medication to have its effect when they are given at the same time (together). However, giving a PPI in the morning and at midday and then an H2 blocker at bedtime can allow these two classes of medicines to work together (since they are not in the bloodstream/body at the same time).

3. PPIs are often under-dosed in children (see PPI Dosing Information). Because it has been found that children metabolize PPIs more quickly than adults, we recommended administering them 3 times a day for children under 2 years old.

4. If you are currently giving your child a compounded suspension of a PPI such as Prevacid made by a pharmacy, you should know that there is a good potential for the medication to become inactive (and therefore ineffective) in a much shorter time period than your pharmacist may be aware. The loss of activity is related to the effect of the flavorings added by the pharmacies. The flavorings cause the PPI to become unstable and break down so it can no longer inhibit acid secretion. Laboratory testing has shown that the majority of such compounded, flavored preparations become inactive within a week.

In addition, many pharmacies do not add enough buffer in their suspensions to protect the drug from degradation by stomach acid. This is particularly a problem if the child is receiving a very low-volume dose—less than 3 mL, for example—because the amount of buffer likely won't be enough to protect the PPI from degradation by stomach acid.

5. PPI drugs have an effect on the production of acid that is related to the amount of drug that is absorbed into the body. This amount of drug is known as the AUC or area under the curve. So, when planning out a drug regimen with a PPI drug, the best thing to do is to try to achieve the AUC that is known to inhibit enough acid in 24 hrs to reduce damage and reduce symptoms. In other words, you have to give enough PPI--and frequently enough--to get the desired effect. If a PPI is underdosed, the child will continue to suffer from acid reflux and the symptoms may be misdiagnosed. The most revered author in the treatment of reflux in children states in his excellent recent review, “...the most common error in PPI prescribing in children is underdosing. In fact, if the diagnosis in a child is GERD, and there is poor response to PPI, the likely problem is either that an insufficient dose has been used or that the patient is not taking the medication.” -Eric Hassall*

6. Is it possible to give too much PPI?The short answer is no. Fortunately, PPI drugs are very specific in where they work in the body. They are only active in a very specific place – that is the acid secreting cell, parietal cell. Since PPI drugs only work on the acid secreting cell the chance of side effects is very, very low–even if you give 3 times more than your child needs. In fact, PPI drugs are known as prodrugs because they are not active as they pass from the bloodstream to the acid secreting cell. PPIs become active only when they pass into the acid secreting portion of the acid secreting cell, where the pH drops to about 1.

The Marci-kids website has a great dosing calculator on their dosing chart


skeybunny said...

That is great information. Thanks for sharing. I hope Kaitlyn had a great first day at her new school

Sarah (Evan's Mom)

Jodi said...

Thank you so much. We are currently dealing with Olivia's reflux and a pediatrician that will not increase her Prevacid from 15 mg. We have an appointment in January with a GI specialist. Thank you for arming me with this information that I can take to the appointment.

Anonymous said...

Thank you so much Liz for your information!My child has been suffering a lot with reflux from birth!She has a feeding tube last 25 months!She just started to take one ounce of puree food by mouth in each feeding and she takes 30 minutes to finish that tiny amount!
She feels very uncomfortable after taking one ounce of food,looks like she gets full easily and can't take any more.I asked the doctors but nobody has the answer!
You are very smart and do lot of research so can you please give some idea why she gets full with tiny amount when she is 30 months old?She doesn't open her mouth big and take very tiny bit and can't clean the spoon,never feels hungry even if I don't feed her whole day.
Can you give some idea about any test or any medicine that can help her with eating and she gags hundreds times with one ounce of food,doctors don't know what to do.
I wish you good luck with your children!

Anonymous said...

Liz,I just posted a comment few minutes ago about my child's reflux as an anonymous,forgot to tell about the medicine she takes.She takes 15 mg prevacid but is not working I guess!Thanks!

liz.mccarthy said...

kids don't like to eat when they have reflux, it makes them orally averse, once children are orally averse, it's very hard to combat (think total food refusals).

suggestions, increase reflux meds and get her to a feeding therapist.

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The Microblogologist said...

Anon (and Liz),

As an adult with GERD (and probably IBS) I may be able to give a different perspective. Before my GI issues were completely out of control and I was miserable most of the time, eating made me feel sick as did not eating. My issues are somewhat under control (I have good and bad days but nothing like it was before, 40mg of prilosec a day helps) but I still do not want to eat a whole lot. When a person does not eat much (as is common with those of us who feel sick from eating) their stomach gets smaller and accustomed to not getting as much food and so less food is needed to feel full (motility issues also can contribute to the full feeling). Slowly increasing meal size would be your best bet but most likely Liz is very right and she is orally adverse on top of everything else and needs feeding therapy.

This is totally my opinion but I think it is best to get the physical issues under control first before tackling the psychological if at all possible. I am eating more because it does not make me feel as sick now, before I hated to eat and often didn't. As an adult I have an understanding of what is going on and that I need to eat even if it makes me miserable, I can't imagine being a baby/small child and only knowing that it hurts. If it doesn't hurt then she is more likely to be willing to work on the eating by mouth thing without the potential of making her more orally adverse than she already probably is.

Hope this helps,

BusyLizzyMom said...

Along with prescribing the meds Dr's are not warning parents about the side effects from long term use. Unfortunately there are not enough studies to back these rumours up yet but low B12 and osteoporosis are slowly popping up now with prolonged use. There are not recommendations yet as for prevention of these side effects but seeing that preemies have shown to have low bone density already (another thing that is not disclosed by Dr's) adding a PPI will contribute to early osteoporosis. I have asked about giving a calcium supplement and have been told to wait and watch for new studies. I have started to give Elizabeth a calcium supplement as she has been on PPI's for 4 years.
I have been on PPI's for 15 years and have the beginnings of osteoporosis and also recieve B12 shots to deal with the pernicious anemia. They are not serious side effects to have but if I was aware if them I might have began taking calcium and not have had such a low B12 level and all it's associated symptoms. I will take these side-effects for not having to deal with stomach pain and wretching.
Sometimes I think Dr's are afraid to give us all this information.