Weaning a Proton Pump Inhibitor
Weaning is described here on this page as both titrating up or titrating down from a proton pump inhibotor when using a compound formulation with a PPI. Here is an example of how to titrate up if you are just starting your suspension.
The dosing recommendation as shown in the PPI dosing information chart according to MarciKids study shows a 12mg per dose, three times a day. If you are making a 3mg per mL concentration (typical concentration for example with Prevacid®) then this would be 4mL (12mg) per dose.
- Day 1: Dose 1mL per dose, three times a day.
- Day 2: Dose 2mL per dose, three times a day.
- Day 3: Dose 3mL per dose, three times a day.
- Day 4: Dose 4mL per dose, three times a day.
By day four your baby will be at the desired dosage and the issue of refluxing due to CO2 will be minimized. Why is titrating is so important? Because it will help minimize the effect of Acid Battle and easing into the treatment is best for babies belly.
Of course all of this should be done with the support of a qualified pediatrician that specializes is infant acid reflux such as our on staff pediatrician!
Weaning Down From a PPI
Determining when to begin titrating down from a proton pump inhibitor can be a challenge for you and your doctor to determine. Although there is no real set time to begin titrating, our pediatrician that specializes in infant acid reflux feels the best time to wean off a proton pump inhibitor (PPI) is at one year of age. This is when most babies start sitting up, being upright and walking. The gravity will help to overcome the reflux. Also the sphincter between the stomach and esophagus (gastroesophageal sphincter) will be more mature and functional.
Of course all babies are different and we have worked with some babies that just require a little more time to wean.
Suggested steps for titration are
You can go down to 2.5mL of your suspension any compounded solution and the PPI of your choice. Once that dose has been achieved there isn't enough buffer to overcome any potential acid being made in the stomach. So you can discontinue that dose.
For example, lets say you are giving three doses per day and you want to wean. Reduce the middle of the day dose down until you get to 2.5mL for that dose. Then just stop that midday dose. You can supplement with plain antiacid for a few days but then you will successfully be at 2 doses of the proton pump inhibitor per day or any compounded solution.
- In general, titration is best attempted when the infant can stand and walk.
- When weaning it is best to get an idea of when the reflux symptoms, if any, occur during the day and/or night? For example, if they have trouble in the afternoon, then don't change or do anything with the midday dose. If no real symptoms occur during that time frame, then start by reducing the midday dose by 1 mL - for 5 to 7 days. Then reduce by another 1 mL for a week. Then when that dose is gone; go to the next dosing time an repeat.
You can repeat those steps for each dose.
We recommend that you start with the afternoon dose. Then move to the evening dose and then the morning dose. Unless of course most of the reflux symptoms are displayed in the evening. Then you would reduce the morning dose then the evening dose.
If at anytime during the titrating process you find that your baby is displaying signs of reflux you simply replace the weaning down to titrating back up to the original dose.
All of these instructions should be done with the guidance of your doctor or if you need to consult with a doctor connect with one that specializes in infant acid reflux here!