Infant Reflux Medications
Many different medicines are now commonly prescribed to manage reflux in infants. Every baby responds differently to medications and some will be more effective for your baby than others. Many babies do better on a combination of several medicine types, such as an H2RA and PPI combination.
It also can take from one to three weeks for a drug to make a difference in your baby so please follow your pediatrician’s instructions for the full course of the treatment. If your baby is not improving with treatment then contact your pediatrician to discuss trying a different medicine, or a combination of medicines.
Types of infant reflux medications
These are generally available over the counter. The liquid forms contain magnesium or aluminum. The effects of long-term use are unknown. They can also cause diarrhea or constipation. They make your baby’s spit-ups less acidic but do not decrease the amount of spit-ups that do occur. Some common medicines in this class are Mylanta and Milk of Magnesia.
H2RAs (also called H2Blockers)
These decrease acid production in the stomach. These may not lesson reflux episodes but will make your baby’s spit-ups less acidic. Some common medicines in this class are cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). The liquid form of Zantac contains alcohol.
Proton Pump Inhibitors (PPIs)
These are designed to block the stomach from producing acid. Some common medicines in this class are esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex).
These are designed to cause the stomach’s contents to exit more quickly into the intestines. These are more helpful in babies that are fed formula or solids. Breastmilk is already very quickly digested so they may be of limited help to a breastfed baby. Some common medicines in this class are bethanechol (Urecholine), metoclopramide (Reglan), and erythromycin. Cisapride (Propulsid) is only available in special cases.
Dosage for infant reflux medications
Some of these medicines are very sensitive to weight changes. If you find your medicine is no longer effective, check the dosing guidelines at www.webgerd.com. Call your physician to ask about increasing the dosage.
Adminstering infant reflux medications
Some medications such as Zantac and Prevacid now come in tablet or powder forms that can be mixed with liquid. This helps to improve the shelf life of the medication and removes the flavoring that can cause baby to refuse medications.
Zantac efferdose tablets can be mixed with water. They do not contain granules and so should not clog the syringe. The prepared solution can also be administered via bottle nipple and does not require an enlarged hole. Zantac also comes in suspension form which should be stored at room temperature.
Prevacid comes in the form of packets, solutabs, capsules and suspension.
The packets dissolve into small granules in liquid and can then be administered via syringe or bottle nipple. It's helpful to administer using a medicine bottle that stores the medicine separately from the bottle liquid so you can track how much medicine has been administered.
The solution can also be administered using a bottle nipple with large or enlarged opening, like the ones we sell in our Pollywog Online Store. The packets can also be mixed with food.
The solutabs are administered by placing them directly into your baby’s mouth between the cheek and gum and then offering a breast or bottle to help them go down once dissolved. The solutabs do contain lactose.
The capsule contents can be mixed in with food.
I’ve heard time and again from parents that the suspension only has a shelf life of two weeks although many pharmacists and pediatricians claim it should be good for a month. You may want to ask your pediatrician to write out your prescription for a two week supply to avoid this issue.
Zegerid is a relatively new medicine that contains the same active ingredient as Prilosec. It comes in packets that can be mixed for infant use with water. By mixing it yourself you avoid the shelf life issue. See www.zegerid.com for more information.
Flavoring versus Compounding for infant reflux medications
Many babies do not like the taste of some of the syrups. They may have very strong flavors. A special compounding pharmacy can mix the syrup without the original flavor and use other flavors your baby may be happier with. Both Zantac and Prevacid are available at compounding pharmacies. Prilosec can also be flavored but I have heard of that reducing the shelf life of the medicine.
Most pharmacies are not compounding pharmacies and will simply add flavoring on top of the existing flavor. Be sure that you are using a compounding pharmacy. They are listed in the yellow pages under “Pharmacies/Compounding”.
More information about infant reflux:
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