GI Medications

Prilosec (omeprazole) and Prevacid are proton pump inhibitors. They are the most potent acid blockers available. They are much more effective than Tagamet, Zantac, and Pepcid. There is no known "correct" dosage for kids. In adults, you would use 20 or 40 mg omeprazole per day. This is about up to 1/2 mg per kg per day for an adult. Some infants and children are on over 2 mg, 1kg per day, and some authors have suggested higher doses. This is a medicine that must be studied in children. The pharmacokinetics are just not known. But it is very potent, and we use it, even in infants. It has a second problem for many children, particularly the ones with CdLS. It is designed to be administered in the capsule, and it is destroyed by stomach acid. It is a complicated delivery system. The capsule can be opened, and put on acidy food, but the granules cannot be chewed, and they cannot be dissolved. Some pharmacies have taken to putting the chemical in a basic solution, which should possibly protect it. But we believe there commonly is destruction when it is delivered this way, unless it is tubed into the duodenum or jejunum. When we think Prilosec is not working, we do a pH probe on the medicine, with one of the probes in the stomach. If it shows too much acid (too many hours per day of acid) we go up on the dose, or add a second medicine. This is not national standard practice, but it is for us. We feel this is the only way to justify "high doses." So, dosed by age, weight, indication and response. It is very complicated, and needs to be individualized by someone familiar with the medication. We have very rarely seen any reactions we thought we could attribute to Prilosec in children, but there are a number of theoretical problems, listed on the insert with every prescription. We have used it very long term in many patients, very safely. But we only use it when we MUST. It is not a first line reflux or esophagitis medication

Propulsid bears no relationship whatsoever to Prilosec. Propulsid is a "prokinetic" which means that it helps to move the stomach contents in a forward direction. Reglan is another medication in the same style of medication, but chemically unrelated. Propulsid does not block stomach acid at all, and it clearly does have warnings about cardiac arrythmias and death associated with its inappropriate use. There are MANY medication reactions with Propulsid and other medications, including some routine antibiotics

DP /TK 7-13-10