Maiya is 14 months old and 25 pounds. She has extremely severe GERD that has not been well controlled by meds. We are currently on 30 mg prevacid (15 mg BID) and 30 mg zantac also at night.

I can only give her 22.5 mg of zantac, before the extreme headaches become counterproductive.

Here is my problem:

I have noticed that after 5-7 days the prevacid lost its effectiveness, so instead of refilling every 14 days, i do it every 7 days.

We were flavoring, and the doc was going to scope her, as she was doing so badly. Finally, a new pharmacist told me,if it was my daughter, I would stop flavoring. Since then, WOW what an improvement.

Maiya did so well for 7 days, and then we got a new bottle of prevacid, and horrible again. When I taste it, it tastes a lot less of H2CO3. And I know it is not working also, when she does not get a BM 30 min after her dose.


Does this all sound crazy to you? Can the meds really be that sensitive?

So I begged and begged for solutabs (just recently available as fast tabs in canada). Both the pharmacist and GI were against it. It is true that I cant cut it exactly and thus, her dosing is not perfect. She also wont take it so I have to dissolve it in water and syringe it in her mouth (more inaccuracy of dosage). But so far, she has not had a great night tonight, this being her first night on solutabs.

Here is my question: Can I expect different side effects if switching from compounded to solutab? I ask, because if she wakes up screaming, do i assume that it is insufficient meds, or could she be reacting to the fast tab. On the label- it says can cause dizziness but the compounded prevacid never said that.


Thanks a million for any input.

Johanne

Johanne, prevacid compounded is very touchy and quite unstable. Originally they came out with an expiry date of 4 wks in the fridge but it is now more accepted with a 14 day expiry at room temp. Even this is being challenged now. This IWK in Halifax goes with the 14 day date and use an unflavoured version. The problem is that the bicarb can precipitate in the fridge. Since the drug is so touchy in acid they make it with bicarbonate, which is why you are tasting that from the preparation. Unless the flavouring is neutral or basic it may shorten the expiry on the compound. Abbott says that the quick dissolve tablet is indeed stable for 15 minutes in water but they strongly recommend giving the entire tablet, which is inconvenient for a fraction of a dose. Because there may be residue on the side of the oral syringe you cannot give 1/2 or 1/3 of the dose in the syringe and expect to give the dose as that fraction.
In a nutshell, unless you are giving the full dose of the prevacid fast tabs it is probably better to give it in the compounded form, that way you know exactly how much you are giving. If flavour is a problem, the IWK is testing a compound with orasweet and oraplus (a common mixing media for most medications now). This has a simple syrup flavour. You really need to shake the product extremely well before each administration or your dose will not be the same each time, in fact it may be quite different. If the baby wakes up out of sorts it could be a headache from too much or a tummy ache from not enough. The best thing is to stick to the compounded form and renew it every 2 wks
Hope this helps, Graham PhC

Thanks so much for all of your help. The solutab was a fiasco as much got stuck in the syringe and i have no idea how many milligrams she got. I had used Flavorx (only bubble gum possible for prevacid). But lately, we have used something like orasweet (called simple syrop here ). I hardly use any of it, and dip the tip of the syringe in it, to make it sweet, but the prevacid in the syringe is pure. It has been working better.

Thanks a million and god bless you for all of your help