Table 4.
Summarizes the drugs used in infants and children with gastroesophageal reflux disease[1-5] (for guidance only, prior to use please refer to local formulary and guidelines for accuracy and appropriate doses)
Medication
|
Dose
|
Adverse effect
|
Approved age (FDA indicated)
|
PPI1 | |||
Omeprazole | 1-4 mg/kg/d od | Diarrhea, abdominal pain, flatulence, headache, enteric infection, respiratory infection, rebound hypersecretion | > 1 yr old |
Lansoprazole | 0.7-2 mg/kg/d od | 1Esomeprazole: Tarry stool, darkened urine | > 1 yr old |
Esomeprazole | 3-5 kg: 2.5 mg od | 1Rabeprazole: Light-colored stool | > 1 mo old |
> 5-7 kg: 5 mg od | |||
> 7.5 kg, < 20 kg: 10 mg od | |||
20 kg: 20 mg od | |||
Pantoprazole | 1-2 mg/kg/d od | > 5 yr old | |
Rabeprazole | 0.5-1.0 mg/kg/d od | > 1 yr old | |
Pro-motility | |||
Metoclopramide | 0.4-0.9 mg/kg/d tid | Extrapyramidal side effect (1%), diarrhea, drowsiness | > 1 yr old |
Domperidone | 0.8-0.9 mg/kg/d tid | Dry mouth, QT prolongation (rare) Abdominal pain, diarrhea, (rare) HPS in infants, QT prolongation (rare) | > 12 yr old |
Erythromycin | 5 mg/kg/dose qid | Dizziness, diarrhea, dry mouth | All ages |
Baclofen | 0.5 mg/kg/d tid | All ages | |
Esophageal mucosal protection | |||
Alginate antacid | Flatulence, diarrhea, nausea and vomiting | Younger than 12 yr of age is not generally recommended | |
Magnesium alginate plus simethicone | Infant: 1-2 mL/kg/dose after feeding | ||
Sodium alginate (225.00 mg sodium alginate, 87.25 mg magnesium alginate per sachet) | Child: 2.5-5.0 mL oral tid after meal | ||
Sucralfate (sucrose, polyaluminium hydroxide) | 40-80 mg/kg/d qid | Constipation, aluminum toxicity in long-term use | In adult |
Esoxx (sodium hyaluronate, sodium chondroitin sulfate, poloxamer 407, povidone K30, xylitol, potassium sorbate, sodium benzoate, red grape aroma, purified water) (10 mL/sachet) | 1-2 sachet/d after main meal and bedtime | No serious adverse effect because of the poor absorption, however, no data of long-term adverse effect | In Italy, it is approval for adolescents age > 12 yr old |
Probiotics | |||
Lactobacillus reuteri DSM 17938 | > 1 × 108 colony-forming units/d od | None | All ages |
Dose depend on metabolizer via cytochrome P2C19. FDA; od; bid; tid; qid.
PPI: Proton pump inhibitor.