Does Prevacid dosage have to be adjusted? Need help from reflux moms.

[Anonymous]

My 10 week old has been on Prevacid for 4 weeks (and Zantac for 2 weeks before that). It has definitely helped him. However, in the last 5-6 days I feel like I'm seeing some symptoms again, although somewhat different than before. He seems to be congested in his nose overnight (he sleeps on an incline), especially after 4am, and he is often coughing, gagging, and sneezing after 4am. He even gets what I call "milk boogers" that I can remove from his nose. In the last few days he has also been very fussy at the breast and last night and today he screamed and screamed at every feeding. He would suck 2-3 times and then stiffen and scream inconsolably. He screamed a lot before the Prevacid but never when eating and the congestion is new too.

He currently takes 2ml of Prevacid each day, compounded liquid. The compound is exactly 2 weeks old (I know there is some talk about the compound becoming ineffective) but it should still be working. So do Prevacid dosages often have to be adjusted upward if symptoms return? Is 2ml/day (1/2 teaspoon) some sort of standard dosage? Help please.

[Anonymous]

My doctor said the dosage of the acid reflux meds has to be changed frequently because it is based on the weight of the baby. So yours might be outgrowing the current dosage. You should check in with your doctor.

[Anonymous]

Yes - definitely needs to be adjusted as the baby gains weight. Call your doc!

[Anonymous]

Solutabs. Do it. It's worth it, just so that you can remove one uncertainty from the picture when (as happens frequently with reflux babies) their symptoms change. Once we went to solutabs, we stopped having these sudden degenerations in his condition. Our ped promised that the compound would work for 2 weeks, the pharmacy swore it was fine for a month... but we just kept finding that his condition would go downhill again the longer we had the compound. We made the switch at about 2 months (I just tallied all the prescription charges from last year, it was insane). Either way, definitely check the dosage - it needs to be adjusted as they put on weight. My son went to a very high dose right away (15mg Solutabs each AM and PM) but he was a big kid. On the plus side we stopped the meds at about 10/11 months and he has done fine - a year ago I never would have believed it.

[Anonymous]

I have a 10-week old on Prevacid and my ped said that this medicine does not increase with weight (though Zantac does). I just talked to them yesterday about this. The standard dose for an infant is 7.5mg per day. Liquids are compounded differently so you have to look at how many mg per ml are in your bottle. FWIW, we also went back to the tabs from the liquid - it just seemed to work better. We dissolve them in a few ml of water and use a syringe to give to DS.

[Anonymous]

OP here. Ok, I did the math and he is getting 7.5mg per day. Did the PPs get the solutab prescription from their regular ped or a ped GI? We've just seen our regular ped so far--children's med assoc of northern Virginia if anyone has had experience with them and ongoing reflux.

[Anonymous]

My daughter was on Prilosec for 18 months and yes, it was always adjusted for her weight gain. I am pretty sure that Prevacid and Prilosec are basically almost the same drug.

[Anonymous]

We fought w/ our ped until we saw a pediatric GI. We're now doing Nexium 20mg 2x per day for our 7 month old. His dose has been changed a couple of times, but I'd say the best thing that's helped is time, solids, and cereal. I really like the nexium over the prevacid solutabs just for ease of of dosing- it comes in a powder that you can either mix into a gel and feed in a syringe or sprinkle on food.

good luck!

[Anonymous]

DS has been on compounded prevacid twice a day since almost birth. And the dosage has increased as his weight has increased. At 10 months, he is on 3ml twice a day (and 2ml twice a day of zantac). Also, I know it is controversial, but putting rice cereal in his bottles at about 3-4 months really helped him.

[Anonymous]

Well I'm just one opinion but DS1 had severe reflux. He was spitting up blood and was hospitalized, got an endoscopy, etc.

My best guess is that the congestion IS the problem. If your baby can't breathe out of his nose, he's going to get very frustrated, taking a few sucks and then pulling off for air.

Reflux medicines don't keep the stomach contents down. They just reduce the acid content so that the spitup does not damage the esophagus and sting so much coming up. So if your baby is spitting up and /or having congestion, changing your meds probably won't help.

I would first focus on making sure he can breathe freely before each feeding and to the extent that he gets milk in his nose during feedings try a more upright feeding position.

[Anonymous]

Oh also I do agree that solutabs have a longer shelf life than compounded Prevacid. Our pediatric GI said the compounded mediciine is not shelf stable for long. I have also heard 2 weeks is the max.

[Anonymous]

Completely agree with 20:49 and others who recommend Solutabs. The compound was fraught with uncertainty, both in its creation and in its administration. Also agree with the previous poster who suggested making sure he can breathe freely. We experienced a similar issue with our son, who had been diagnosed with severe reflux at 8 weeks and was on Prevacid. He was inconsolable during and after taking in milk, even though he clearly was hungry, and became so hysterical that he upchucked. We assumed immediately that it was reflux-related; instead, it was that he had a cold and was extremely frustrated trying to suck (since he could only breathe through his mouth). I would suggest ruling out the cold/congestion possibility, if you haven't already, before looking to your GI to adjust meds. Weight gain is gradual and although there is a correlation between weight and dosage, it seems unlikely, in my admittedly untrained opinion, that the drop-off in comfort would be so sudden, or so severe, if it were a low-dosage issue.

Good luck - reflux is nerve-wracking, especially when they are so little.

[Anonymous]

OP again. Thanks for all the advice. If the solutabs seem to work better and are more stable, does anyone know why the compound is routinely prescribed? Are the solutabs more expensive or not covered by insurance? Is it difficult to get them or can I just tell our ped that we would prefer the solutabs?

[Anonymous]

Anonymous wrote:OP again. Thanks for all the advice. If the solutabs seem to work better and are more stable, does anyone know why the compound is routinely prescribed? Are the solutabs more expensive or not covered by insurance? Is it difficult to get them or can I just tell our ped that we would prefer the solutabs?

The solutabs are more expensive, I've found. Also - my DD was on a low dose and we had to divide the 15mg tabs into 4ths which, with a solutab that is meant to dissolve and break down was VERY challenging. It was a big pain in the butt and I think the dosing ended up being more inconsistant with us trying to break them than with the compound. We gave it to her on a spoon, dissolved in some water. We tried giving it via the syringe and the little 'balls' of the medicine got stuck inside the syringe. I found the compound easier but then again, my DD wasn't too severe so maybe it didn't affect us as much.

[Anonymous]

Anonymous wrote: we had to divide the 15mg tabs into 4ths which, with a solutab that is meant to dissolve and break down was VERY challenging. It was a big pain in the butt and I think the dosing ended up being more inconsistant with us trying to break them than with the compound. We gave it to her on a spoon, dissolved in some water. We tried giving it via the syringe and the little 'balls' of the medicine got stuck inside the syringe. I found the compound easier but then again, my DD wasn't too severe so maybe it didn't affect us as much.

I agree putting the Solutabs in a syringe was challenging... we tried it a few times and weren't that adept. We divided our Solutabs into quarters using a pill-splitter and got used to that quite quickly (a splitter is made for that purpose, so, although it does not produce scientifically-accurate results, it is much better than trying it on your own). We did quarters because we found that they were easier for our baby to take.

I am a proponent of the Solutabs based on our hair-raising experiences with pharmacists who appeared insecure about their ability to formulate the compound. Their lack of experience or discomfort with doing so caused delays in our getting the meds (we always had to go on the last day of the prior prescription because of the instability of the compound), and also caused me to fear that they were not doing it correctly.

We have good insurance, so perhaps the $$ issue didn't present itself so starkly in our case. But I will say that with Solutabs, you pay one copayment for a 30-day supply, whereas with compound we were always getting charged a copay every time we filled the prescription, which was twice a month. You may also be able to get the Solutabs through a mail-order formulary, if your insurance has one, which could reduce the cost to you. That's not possible w/a compound.