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Acid Blockers

What is the maximum acceptable dosage of Prilosec. Does it depend on the age and weight of the person? What are your feelings on the long-term use of Prilosec? What other medications can be used?

Prilosec (omeprazole), Prevacid (lanzoprazole) and Protonix (pantoprazole) are proton pump inhibitors. They are the most potent acid blockers available, and are much more effective than the H2 blockers (Tagamet, Zantac, and Pepcid). There is no known "correct" dosage for children.  A typical adult dose of omeprazole would be 20 or 40 mg omeprazole once daily.  This is about up to 1/2 mg per kg per day for an adult.  Some infants and children require over 2 mg per kg per day, usually divided and given twice daily, although some authors have suggested higher doses. The pharmacokinetics of these medications is not well understood in children, and further studies are needed.  However, these potent medications are very effective, and we use them frequently, even in infants.

 

These medications are most effective when administered in a timed-release capsule, on an empty stomach, about 30 minutes before a meal.  For young children, and other patients who have difficulty swallowing pills, other forms are available.  Both omeprazole and lanzoprazole can be made into a suspension containing sodium bicarbonate, which protects the medication from stomach acid.  The suspensions for these medications are usually made at different concentrations, so check with your doctor and pharmacist to ensure the correct dose.  The suspensions can also be given by G tube or GJ tube.  Prevacid is also available in a soluble tablet that will dissolve on the tongue (Prevacid Solutab), and this works very nicely for toddlers.  Finally, if needed, the capsules can be opened and administered in an acidic food such as applesauce, but the medication may not be as effective when given this way.

 

If a child is on treatment with 2 mg/kg/day of a proton pump inhibitor and the dose does not seem to be effective, your physician may order a 24-hour pH probe to be done on the medicine, in order to determine if there is breakthrough acid production.  Information from the pH probe might suggest that a change in dosing schedule would be indicated, or that adding a second medicine (such as Zantac or Pepcid) would be helpful.

 

Overall, these medications are dosed by age, weight, indication and response. It is a very complicated process, and needs to be individualized by someone familiar with the medication.  Allergic reactions to proton pump inhibitors are rare, but there are a number of theoretical problems, listed on the insert with every prescription. These medications have been used very long term in many patients, very safely.  As with all medications, we try to use the lowest effective dose and to stop the medication if possible, once the underlying problem resolves.  Long term acid suppression in the stomach can contribute to overgrowth of bacteria in the small bowel, which can cause other symptoms.

 

KL /TK 7-13-10

 



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