Reflux medications illuminated

We have now started Jac's new reflux medication - Axid. With all of the changes I have made to my diet it is hard to know if the medication is helping (he was feeling better before we started the Axid). One thing I saw yesterday was that he had many more poopie diapers. I must have changed 10 of them - rather than the usual 4 or 5. We shall see how things go today. He did not seem unhappy about that much pooping - he just needed his diaper changed more.

I also discovered something very interesting and in its own way disturbing. I found a website called Marci Kids - Midwest Acid Reflux Children's Institute. On their website they say that they have found that compounded Prevacid (which is what Jac gets) loses its effectiveness about a week after it is compounded. They also explain that Prevacid is not approved by the FDA to be compounded.

Well - his explains a lot. It seemed like the Prevacid starting working better each time Jac's dosage was upped - but he also generally got a new bottle each time his dosage increased! D'oh! I spoke with his pediatrician about this yesterday and she said she would review the information.

Marci-Kids states the following (link to original page):

"If you are currently giving your child a compounded suspension of a PPI such as Prevacid made by a pharmacy, you should know that there is a good potential for the medication to become inactive (and therefore ineffective) in a much shorter time period than your pharmacist may be aware. The loss of activity is related to the effect of the flavorings added by the pharmacies. The flavorings cause the PPI to become unstable and break down so it can no longer inhibit acid secretion. Laboratory testing has shown that the majority of such compounded, flavored preparations become inactive within a week.

In addition, many pharmacies do not add enough buffer in their suspensions to protect the drug from degradation by stomach acid. This is particularly a problem if the child is receiving a very low-volume dose—less than 3 mL, for example—because the amount of buffer likely won't be enough to protect the PPI from degradation by stomach acid.

For these reasons, we recommend the use of FDA-approved Zegerid® powder for oral suspension over the use of pharmacy-compounded suspensions, which are not FDA-approved. The Harriet Lane Handbook, a trusted source of pediatric dosing information for more than 50 years also states "The extemporaneously compounded oral suspension product may be less bioavailable owing to the loss of the enteric-coating."

His pediatrician indicated yesterday that she would not be willing to give Jac a medication that she is not familiar with - Zegerid. It seems like it may be necessary to change her mind about that or find a doctor that would be willing to prescribe it.

In the meantime we are going to give Jac single dose Prevacid dissolvable tablets which we will dissolve prior to each dosing along with Axid. If he seems to be doing well perhaps we will drop the Axid and go back to just Prevacid but use the single dose tablets instead of the compounded version.