Pager Forum - General, Beginners and Infants

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Jan 22, 2006 anya's mom Laraine, mommy to Anya, born 10-20-05, unilateral cleft lip and palate, and severe acid reflux.	Prevacid dosing question?? Ok, ANya was on 15 mg of Prevacid...prescribed to her by her pediatrition, she weighed 11 lbs, 10 oz. When she say a GI, she had lost weight and they decreased her dosage. (she weighed 11 lbs now...but she will eat!) Now she takes 9 mg, and her reflux is bad. It could be because she is teething, or because they took her off Zantac (they said that the two meds. counteracted.), or because of the docal (sp) that we are adding to make her formula 31 cal/oz. But after tree weeks of not throwing up or spitting up, she is throwing up about 2 times a day, and spitting up after every meal, and I can see her refluxing (when she is awake) every minute or so. She also wont nap...but I dont think I can complain about that, she sleeps about 8 hours a night. Do you think that the dosing is right for her weight???
Jan 22, 2006 mwrb Baby w/severe reflux!	I don't know what the correct dosing is. My daughter has been on 15mg Prevacid solutabs since she was a week old and it's been the same dose ever since. She only weighed about 7 pounds something at the time put on it and now probably weighs around 15 pounds. She goes back to the doc on Feb. 2 for her 6 month check-up. I don't know what the correct dose is. I wonder why every doc prescribes different doses for different weights/ages??!?! I hope your little one improves soon!!! TRACI
Jan 22, 2006 ptyler PAGER volunteer SLP reflux mom to Ali 4-3-97 and non-refluxer Tressa 10-9-01	Prevacid unlike Zantac is not based on a infant's weight. If she did better on the higher dosage, I would suggest discussing her changes with her doctor so you both can come up with the right dose for her.
Jan 22, 2006 mwrb Baby w/severe reflux!	ptyler~ Thanks for that info. I did not know that! What is Prevacid based on then? Because we were told Ryleigh Grace is on the highest dose she can be given. ???? Just curious......Thanks! TRACI
Jan 22, 2006 ptyler PAGER volunteer SLP reflux mom to Ali 4-3-97 and non-refluxer Tressa 10-9-01	Prevacid is dosed at 15 mg increments. Typically 15mg is the highest dose given to children under 60 pounds but some doctors do prescribe 30 mg doses for children under 60 pounds if they do not respond to the 15 mg dose.
Jan 22, 2006 moira	Prevacid Dosing The question about Prevacid dosing has come up before (October 22 -"Anyone's Child Been on Reglan & Prevacid?) and at the time I was really thrown by the responses as both my children were given doses based on weight. In my quest to find out an answer I spoke to my children's GI and e-mailed Dr. Phillips, the creator of Chocobase (aka Zegerid). Dr Phillips wrote (""=quote) "Prevacid is the trade name for Lansoprazole that is made by TAP. TAP makes a delayed-release Solutab that is dosed as 1 tab of the 15 mg or the 30mg. The Solutab contains enteric-coated granules and this can■t be dosed on a mg/kg basis. Also these granules can■t be crushed or chewed. We make the CaraCream (and ChocoBase) which converts the capsule of Prevacid (still containing the enteric-coated granules) into a true liquid suspension that contains none of the granules and can be used to dose patients on a mg/kg basis." My GI confirms that Prevacid can be prescribed on a mg/kg basis and she prefers to prescribe it this way for her younger patients. Dr. Phillips goes on to write "When someone states it is not weight-based they mean that it is not a titratable dosage form. It your child is 8 kg or 30 kg ■ according to TAP they would get the same dose (See package label). " Accoring to Dr. Phillips "All the PPIs should be dosed in children on a titratable weight basis. There is no such thing as an effective standard pediatric dosage as you will see from the TAP labeling." He then goes on to site various research that yield VERY different results based on the form in which Lansoprazole is given. This is where I have to assume that my GI has done her job and has read all the research in order to prescribe my children the proper medication. Hope this helps.
Jan 23, 2006 ptyler PAGER volunteer SLP reflux mom to Ali 4-3-97 and non-refluxer Tressa 10-9-01	Thanks Moira for the information from your GI and Dr Phillips. It would be great if all doctors had done the research as they both have but unfortunately all have not and prescribe their dosing based on TAPs recommendations.
Jan 23, 2006 marbleszita	reply you are correct in saying that the dose is based on weight when it is converted to a liquid suspension such as when it is compounded by a pharmacist. But a lot of these children are given the solutabs and powder that can not be divided correctly. Therefore the dose of the solutabs and the powder is 15mg or 30 mg and is not based on weight. So if your doctor has prescribed one of these, then there is no way it can be based on weight. If your doctor is having a pharmacist compound it for you, then it can be based on weight.
Jan 23, 2006 lansima Marsha Son Logan Born 7-2003 with EA/TEF	One ml equals one mg I believe. My son took the suspension that is the powder mixed with water. My son's pediatrician just took a guess at how much to give base on his weight. I always gave more than she had suggested until he was comfortable. She could guess at the dose, but it was up to me to see if it was working and if it needed to be increased. My son's dose was also split between am and pm, so the script needed to be written for 2 15mg packets a day. I would use less than half a packet in the begining. It seemed wasteful, but the medicine becomes ineffective hours after mixing it and won't last to the second dose of the day.
Jan 23, 2006 moira	response to Pam Pam, In response to your reply, I was really surprised when I read the insert in the Solutab box. The results of the study done by TAP are pretty interesting: The PREVACID dose had to be increased (up to 30 mg b.i.d.) in 24 of 66 pediatric patients (ages 1-11) after 2 or more weeks of treatment because the patients remained symptomatic. That's nearly 36%. A pretty large percentage in my opinion. The study also states that after 8-12 weeks of Prevacid treatment, the intent-to-treat analysis demonstrated an approximate 50% reduction in frequency and severity of GERD symptoms. That doesn't seem like a great percentage either. Supposedly Dr. Phillips' research and product (Caracream aka Chocobase aka Zegerid) has been more successful in the reduction of symptoms (95%). That's pretty impressive, although I have to admit I haven't read his research. I'm sure that you are right in saying that many doctors just dose according to the label. Some parents might find the issue worth discussing w/their child's GI. I think the topic is really interesting and important as the overall results of such studies have a great impact on the treatment & health of our children. Because my children are now older and doing relatively well my GI visits have evolved from such nit-picky GERD-nerdy discussions, where I was on a quest to learn and know all I could, to current visits where we shoot the @*!# a bit and talk about the GI Nobel medicine prize winners and I can ask her about her daughter's new career. It's so nice to finally be at this point (-beyond crisis mode). To others: I wish the same for you all as I remember all too well when it is so tough suffering hours on end w/a tiny miserable baby!
Jan 24, 2006 ptyler PAGER volunteer SLP reflux mom to Ali 4-3-97 and non-refluxer Tressa 10-9-01	Moira, do you a reference for the TAP study ( I'd like to keep a copy)? Is it part of the package insert of the solutabs? Dr Phillips has a number of studies (they are all available on the Marci-kids website) but I have yet to find a study that has duplicated his findings. I am not saying that his research is not valid and from what parents report I definitely think kids do better with his philisophy of dosing but I am not sure how much the average ped would be aware of this information (and more and more peds are prescribing PPIs). Also regarding Zegerid, it has a peach-mint flavoring which I have heard many children do not like (sounds pretty gross to me). I can't imagine why this flavoring was choosen when one of Dr. Phillips main points is that children do better on flavored PPIs b/c they more readily accept the medication hence hsi development of yummy Chocobase and Caracream (which sound much more tasty than peach-mint) Thanks for posting all that great info- it is info many parents will find worth discussing with their doctors.
Jan 24, 2006 moira	reply to Pam Pam, The TAP study info can be found in the Solutab box. You have to read through it to find the Ped study (ages 1-11). I agree w/you about Dr. Phillips' staggering results. I'd be interested to know if an independent researcher would find the same. About the Zegerid. I was told by his staff that they wanted to keep his flavoring but the company producing it decided to change the flavor. The taste isn't too bad. It's tastes like those tiny little square butter mints restaurants sometimes offer.
Jan 25, 2006 jkhallow Karen K Hallowell	My ped went by weight... He had me cut my solutabs in 1/4s for Lauren when she was tiny and we went up from there based on her weight and symptoms. Joe was the same but we did the capsules. Interesting discussion. Karen
Jan 26, 2006 lansima Marsha Son Logan Born 7-2003 with EA/TEF	Posted mg/kg dosing in a new topic Laraine, I just found a presentation that a doctor from the U of Fl did last year about dosing of Prevacid and Prilosec per KG. I also included the formula for lb to kg conversion. I posted it as a new topic.

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