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Medications
There are many factors in deciding what medication should be used in the treatment
of reflux, such as the infant's age, the severity of the condition as well
as her general health. Some of the medications are more effective than others,
while some are not suitable for very young or unwell babies. Some are available
over the counter, while others may only be prescribed by a gastroenterologist.
Please seek medical advice before administering any drugs to your child. In
general the medications consist of four types:
Adult Gaviscon mixes with the stomach acid, forming a barrier that floats on top of the stomach. This barrier helps keep the stomach contents flowing back into the oesophagus as with reflux. Gaviscon Infant mixes with the feed to thicken the stomach contents, thus helping to prevent them from being regurgitated. Please note that thickeners like Gaviscon Infant, while successful in mild cases of reflux, may actually make refluxed stomach contents harder to clear from the oesophagus.
Gaviscon Infant is low in sodium and contains no aluminum or sugar. It comes packaged in individual sachets, which is mixed with water, breast milk or formula and then ingested. Not absorbed by the baby it is completely safe, the only side effect being constipation if the incorrect dose is given.
Gaviscon is often the first line of treatment if your doctor suspects reflux, but if there is no improvement within a couple of days, refer back to your doctor as it can actually make reflux worse. Gaviscon for this reason cannot be used as an indicator of reflux.
A major factor in infant reflux is ineffective esophageal clearance, so although peristalsis occurs, esophageal clearance is ineffective because of weak secondary peristaltic waves. Prepulsid strengthens these waves, so that when food and acid is refluxed into the throat, the body can clear it.
Prepulsid also increases stomach emptying, as well as increasing pressure on the valve at the top of the stomach causing it to tighten. This means that food is in the stomach for a shorter time and is less likely to be refluxed.
Prepulsid is mostly prescribed after intial basic treatment such as positional and dietary measures have failed.
Prepulsid should be given before a meal to ensure the maximum concentration of the drug in the blood. It is best given 15 minutes before the feed, however you can give it immediately before feeding if necessary.
The dosage of Prepulsid is critical to its effectiveness. Too little and no difference will be noted. Too much and it can create more discomfort to the infant than it allieviates. For this reason, doctors generally start infants on a low dose, and gradually increase it over weekly intervals. Prepulsid is not an indicator of reflux, so failure of an infant to respond to this drug does not mean that that particular infant does not have gastro- oesophageal reflux.
Side effects with this drug are relatively rare, although some things to watch out for in an infant are diarrhoea, abdominal cramps, stomach rumbling, headache, and more serious side effects of rapid or irregular heartbeats.
Please note that serious cardiac side effects have been reported in patients taking Prepulsid with the following contra inticators (i.e. Prepulsid can be dangerous if taken in combination with any of the following drugs):
Drugs
1. Macrolide antibiotics (clarithromycin, erythromycin,troleandomycin)
2. Antifungals (fluconazole, itraconazole, ketoconazole,miconazole)
3. Protease inhibitors (indinavir and ritonavir)
4. Phenothiazines (prochlorperazine and promethazine)
5. Class IA & Class III Antiarrhythmics (quinidine, disopyramide, procainamide,
bepridil and sotalol)
6. Tricylic antidepressants (amitriptyline)
7. Antidepressants (nefazodone and maprotiline)
8. Antipsycotic medicines (sertindole)
9. Other agents (bepridil, sparflaxacin and grapefuit juice, alcohol, amantadine,
carbamazepine, diazepam,methylphenidate, orphenadrine, oxybutynin, promethazine,
ritonavir, sotalol, sparfloxacin, terodiline, tranquillizers, troleandomycin,
flaxomine, indinavir
10. Alcholinergics and antispasmodics (cogentin, cyclobbenzaprine, flavoxate
or bentyl)
11. Antidyskinetics
12. Antihistamines and astemizole
13. Ipratropium (Atrovent for asthma)
14. Meclizine (medicines for nausea and motion sickness)
15. Diuretics (furosemide and thiazides)
People with a history of (i.e. do not take Prepulsid if you have or
have had):
1. heart problems; i.e., heart disease, arrhythmias, heart defects, heart
failures etc
2. respiratory failure
3. conditions that result in electrolyte disorders; i.e. hypokalemia, hypocalcemia,
and hypomagnesemia
4. severe dehydration, vomiting, malnutrition, eating disorders
5. renal failure
6. administering diuretics or insulin
7. eldery
- A 12 lead ECG, and the assessment of serum electrolytes and creatinine is
recommended for all patients prior to administration of Prepulsid. If syncope,
rapid or irregular heartbeats develop, stop taking Prepulsid and refer to
your doctor.
As cisapride may quicken absorbtion rates of other medications. Dosages may
need to be adjusted if cisapride is discontinued.
For more information on Prepulsid including information on whats happening with this drug in America, please refer to our article on Prepulsid/ cisapride.
Zantac is an acid suppressant drug, that is designed to suppress the production of stomach acid. Used to treat and prevent stomach and duodenal ulcers, it has also been shown to be effective in the treatment of reflux. Zantac works by reducing the amount of acid produced by the stomach, so less acid is refluxed, reducing the pain and allowing the oesophagus to heal.
Zantac is available in either a syrup or dissolvable effervescent tablets. The syrup has a stronger taste, but less quantity is required than the dispersible tablets. The tablets should be dissolved in 6-8 ounces of water and can only be kept for 12 hours if refrigerated, once dissolved. Zantac should be stored at room temperature in its original container, with its lid tightly closed and kept away from moisture and light. Do not freeze. Zantac can be taken before or after food, and if you miss a dose, skip it and wait till the next dose, as Zantac doses should not be doubled.
Side effects with Zantac are rare, and most are minor and temporary. Although widely used, Zantac has not been specifically studied in infants, so it is important to inform your doctor of any noticeable change in your infant.
Possible side effects from the use of Zantac in infants include headache, joint or muscle pain, abdominal discomfort, dizziness, nausea and vomiting, diarrhea and constipation. If any of these effects are noticed, please inform your doctor. Occasional more serious side effects that may occur are skin troubles, swelling of the eyelids, face and lips, wheezing, severe stomach pain or jaundice. If you suspect any of the above symptoms inform your doctor immediately.
Losec is a proton pump inhibitor, or acid blocker, as it blocks the final step of acid production in the stomach cells that secrete stomach acid. It is more effective than acid suppressants as it inhibits acid secretion by the cells inside the stomach by about 80%. So when the food is refluxed into the oesophagus, it is less acidic and no longer burns the oesophagus, allowing it to heal.
As Losec is designed for adults, it comes packaged as both capsules and tablets, consisting of tiny granules. To be used in infants these granules have to be separated. With capsules, you simply break open the capsules, and separate the granules. However with the tablets you will need to place them in water, which will cause the granules to disperse, allowing you to then separate the granules. These granules are then inserted directly into the infant's mouth, or alternatively given with a spoonful of food such as pureed apple or pear, which actually aid the digestion of the granules, at the beginning of a feed.
Losec is an expensive drug, so the government has
set down certain criteria, which must be met, before they will subsidize
the cost of this drug. The criteria includes the following:
· The infant must have a gastro scope performed.
· The gastro scope must show evidence of an ulcerated oeophagus.
· A P.B.S. form must be completed.
You will need to see a pediatric gastroenterologist for this, and this
will bring the cost of the mediation down to about $20 for a script.
There has been no study done to date on the safety and effectiveness of Losec in children, so there is no information available on its side effects in children. For this reason the following information is based on what has been found in the use of Losec in adults, so please report any change in your infant to your specialist. Some side effects that your child may experience include nausea, taste disturbances, headache, diarrhea, flatulence, constipation and skin rashes. It is also thought that Losec in isolated instances may affect the actions of enzymes in the liver, which may be of a concern if your child has a kidney or liver problem, or is suffering from jaundice at the time. Please refer to your specialist for further information in regards to your child.
If you would like to find out more about Losec, and its suitability in the treatment of your infant, you will need to consult a paediatric gastroenterologist, who specializes in gastroesophageal reflux and its associated treatments. Any doctor can refer you, and they will be able to answer your questions about Losec.
These drugs may be used in combination with each other. Failure of an infant to respond to drug treatment, does not rule out this condition, rather it may indicate that a more suitable drug combination, or more effective drugs may be required. It may also simply indicate an alteration to the dosage is necessary.
Surgery
This is reserved for life threatening conditions, or when all other treatments
have failed. It generally consists of a Nissen fundoplication, in which the
top part of the baby's stomach (the fundus), is wrapped around the bottom
of the esophagus, helping to stop the stomach contents from flowing back into
the esophagus when the stomach contracts. This has both risks and benefits,
which will be explained further by your doctor.
DISA, its members and volunteers are unable to accept any liability
for any advice or information given.
Professionally qualified advice should always be obtained if required.
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