Posted By Posting
May 29, 2010
sreece5316
Mom to William, 8/04 (perfectly healthy!) and Alexandru, 11/07, with laryngopharyngeal reflux and bronchomalacia
Weaning meds?
Hi all, I have questions about whether/how to wean medications. My 2 1/2yo is currently on 30mg Prevacid in the mornings and Pepcid 13mg in the evening (recently added within the past month). Also Flovent and miralax. We recently saw a new pulmonologist who recommended that we get him off his antacids and flovent and then re-evaluate him in 3 months to see how he's doing -- he's previously had a normal EGD at 14 mos and an abnormal DLB (direct laryngoscopy/bronchoscopy -- showed evidence of chronic irritation/micro-aspiration) at 20 mos. We've tried 5 times in the past year to stop the Prevacid but have always had to restart it in 7-10 days because of markedly worsening symptoms. Is there any real advantage in doing a slow taper of his meds? His GI doc doesn't think so but I really want to make this work this time! Pulm would like us to NOT restart the meds so he can consider doing another bronch without him on anything. Thanks!
May 30, 2010
emibug
Kathryn, Pager Volunteer and mommy to Emily Mia 02/04/07. 3 years old with GERD. 30mg Prevacid and Pepcid AC. Mylanta needed for flares. Failed prilosec med switch. Tried and failed many med weans but GERD and pain are well controlled. Functional constipation. Reoccurring SBBO. Suspected IBD or autoimmune disease. Resolved issues: MSPI, CSID (acquired), Stage 2 kidney reflux, Chronic diarrhea.
Audrey Meadow 06/20/08. born 34/35 weeks. Still b/f and eats everything! ftt and chronic constipation.
well there are a few different ways to med wean. sometimes it feels like every dr is going to tell you a different way to do it. I found this website to be really helpful when i was looking into weaning emily (which we have done, unsuccessfully many times): http://www.acpinternist.org/archives/2004/07/ppis.htm It explains the situation and needs for med weans.

PPIs work by getting metabolized (broken down) in the liver by specific enzymes. the product blocks the proton pumps in the stomach. because it is broken down in the liver, it can take up to 2 weeks after metabolization for the body to readjust. within that 2 weeks you can expect to see a mix of good and bad days sometimes really horrible days and then a base line of either symptoms or absence of symptoms can be seen.

The med wean is supposed to make it easier for you to either cut a dose down significantly (it helps you find and remember a lower dose that works) or stop the PPI and switch to short term use of a H2 blocker that will reduce the over production of acid in the stomach that could occur when the body is readjusting to being off PPIs.

As for being off meds while repeating a test... i would never want to advocate harm to any child but we have found in some cases with emily, being off meds so a dr can truly asses her situations was the best thing for her. i will tell you it is hell at the time but we only chose to go that way because the outcome of her tests would change her course of treatment.

since the drs really want you to be off of meds (and without a med wean it seems) for future related testing i think it would be a really good idea to work closely with them, call them (daily if need be) when you think he is having symptoms, ask them if they think it is serious enough to put him back on a PPI or if you can tide him over with a H2 blocker or an antacid like mylanta or tums; if that would affect the testing.

>i can tell you the med weans that seemed the most successful for emily were when we tapered down her prevacid dose gradually (easiest to do with solutabs) then went to pepcid (H2 blocker) only. Emily has been a long term PPI user (nearly 3 years). on the other hand. i have heard of kids, that do not have severe GERD and have been on the meds for a short amount of time, coming off of medicine just fine, with no wean and no reoccurring symptoms. If you are a long term PPI user i think that the med wean is probably a good thing to outline with your doctor. *Good luck!
Jun 01, 2010
sreece5316
Mom to William, 8/04 (perfectly healthy!) and Alexandru, 11/07, with laryngopharyngeal reflux and bronchomalacia
Thanks emibug! We've decided to cut his prevacid dose in half for a week and then continue his pepcid for a little while after. We see his ENT and ped next week to discuss if this all makes sense -- we really need an inter-disciplinary aerodigestive disorders clinic here! Little guy also has some problems swallowing liquids so we've recently started thickening his milk and water which has helped that angle a lot -- and I think his docs would rather him be on thickened fluids than a boatload of meds. So we're willing to try stopping everything and see how he does. He was actually on no meds for about 8 months when he was younger and never had aspiration pneumonia or growth issues then although weight loss has been a problem for him recently. I'm a physician and so don't mind doing a little "drug experimentation" here but it's hard to figure out what to do when his docs are giving us different recommendations. I also saw this article last week, which doesn't make me incredibly optimistic that he'll do well off meds: http://www.medconnect.com.au/tabid/84/ct1/c336812/Default.aspx
Jun 01, 2010
emibug
Kathryn, Pager Volunteer and mommy to Emily Mia 02/04/07. 3 years old with GERD. 30mg Prevacid and Pepcid AC. Mylanta needed for flares. Failed prilosec med switch. Tried and failed many med weans but GERD and pain are well controlled. Functional constipation. Reoccurring SBBO. Suspected IBD or autoimmune disease. Resolved issues: MSPI, CSID (acquired), Stage 2 kidney reflux, Chronic diarrhea.
Audrey Meadow 06/20/08. born 34/35 weeks. Still b/f and eats everything! ftt and chronic constipation.
oh wow, that is an interesting article. i remember reading somewhere, about 2 years ago, that giving a PPI to people who didn't need it could actually cause reflux symptoms, but it went on to say that once the medicine was discontinued the symptoms would immediately go away. this article basically says that the PPIs "tailor" the body to need them, in a way, whether they have GERD (or related disease) or not. that's a very interesting find. thanks for the article!
Jun 02, 2010
sreece5316
Mom to William, 8/04 (perfectly healthy!) and Alexandru, 11/07, with laryngopharyngeal reflux and bronchomalacia
Yeah, interesting findings in that article. Was not excited to get the headline from it delivered to my inbox the very same day that my kid's doc was saying he wanted to get him off everything!
Check with your
doctor first!