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Medications used in the Treatment of Gastric Reflux in Infants and Children in New Zealand - QUICK OVERVIEW |
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Treatment > Medication Basics |
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(This sheet provides a quick summary only of these medications. Please refer to the full version for dosages, interactions, side effects and tips for administration.)
Gastric Reflux Suppressants
Gaviscon (Trade Name) – Infant powder
Use: Gastric reflux suppressant
Gaviscon Infant works by mixing with the stomach contents, stabilising and thickening them to reduce the amount of reflux occurring. It is produced in a powder form and comes in one-dose sachets.
When first starting your baby on Infant Gaviscon, it will be need to be given regularly for around three days before you try to decide if it is helpful. If there is no change in the baby/child seek further medical advice.
Gaviscon (Trade Name) - Liquid
Use: Gastric reflux suppressant
Gaviscon syrup is similar to Gaviscon Infant but does contain different ingredients. Instead of thickening the stomach contents it forms a 'raft' on the top of the stomach contents to reduce the amount of reflux occurring.
Please note that the ingredients of the various forms of Gaviscon vary in some countries. The medications referred to here are those available in New Zealand.
ACID REDUCING MEDICATIONS
Mylanta Original (Trade Name)
Use: Antacid with antiflatulent
Mylanta is a liquid antacid, which works by neutralising acid in the stomach so that reflux burns less. It can provide quick relief, and therefore many parents find it useful when a baby is suffering from reflux pain. It will not decrease spilling or vomiting.
Mylanta is not suitable for long-term treatment of reflux, and has a high aluminium load. It does not reduce stomach acid quantities enough to be the complete treatment for babies with significant reflux symptoms (intense discomfort, very poor sleeping or feeding patterns, respiratory symptoms such as cough or wheeze etc.) If Mylanta is required on a daily basis please seek further medical advice.
Ranitidine (Generic Name)
Zantac, Peptisoothe (Trade Names)
Use: Histamine H2-receptor antagonist.
Ranitidine reduces the amount of stomach acid produced and thus prevents reflux causing inflammation in the oesophagus, and also allows existing inflammation to heal. It does not decrease the amount of spilling or vomiting.
Omeprazole (Generic Name)
Losec, Omezol, Dr Reddy's Omeprazole (Trade Names), Prilosec (Trade Name in other countries)
Use: Proton pump inhibitor
Omeprazole is an alternative for babies/children who do not respond to Ranitidine, and has been used in children in New Zealand since the early 1990’s. It turns off most of the pumps that are responsible for stomach acid production. This allows for inflammation in the oesophagus to heal. Omeprazole will not decrease the amount of spilling/vomiting.
MOTILITY MEDICATIONS
Prepulsid (Trade Name)
Cisapride (Generic Name)
See medsafe about supply
Use: Gastroprokinetic 
Cisapride works by increasing muscle tone at the lower end of the oesophagus, as well as increasing the speed with which the milk/food passes through the digestive system. These result in less milk/food being refluxed.
There are several medications, which should NEVER be prescribed or used when a child is on Cisapride. The most common is Erythromycin (commonly prescribed for ear infections, whooping cough etc.). Whenever something new is prescribed for your baby make the doctor aware that she/he is taking Cisapride as the combination of some of these medicines can be fatal. Grapefruit and it’s juice should also not be taken to anyone on Cisapride.
Cisapride has been withdrawn from use in America due to concerns about it's safety. In New Zealand it’s use is strictly controlled (2, 3). An ECG should be done before commencing Cisapride to rule out any heart problems which could be further affected by it’s use. A special authority number (applied for by a specialist) is also needed to get this medication subsidised.
Domperidone (Generic Name)
Motilium (Trade Name) (4)
Promotes emptying of the stomach and also aids in the pressure of the valve (ring of muscle) at the top of the stomach.
These actions combine to reduce the amount of food and the ability of the valve to keep the remaining food in the stomach. The use of this medication in the treatment of children with reflux in New Zealand is becoming more common.
Metoclopramide (Generic Name)
Maxolon (Trade Name) Reglan (Trade Name in other countries) (5)
Promotes increased motility in the upper gastrointestinal tract and relaxation of the sphincter at the bottom of the stomach, and therefore faster emptying of the stomach. Metoclopramide is rarely used in the treatment of children with reflux in New Zealand.
Erythromycin is also used as a motility medication. It is used here as an antibiotic and Gastric Reflux is not listed as an indication on New Zealand’s medication datasheet.
LAXATIVES (To counteract constipating effects of other medications)
Coloxyl (Trade Name) - Paediatric drops
Docusate sodium (Generic Name)
Use: Laxative – faecal softener.
Pacific Lactulose Syrup, Laevolac Syrup (Trade Names)
Lactulose (Generic Name)
Use: Laxative – osmotic
If used in children for more than one month it is recommended that it’s use is supervised by a doctor.
Further information on reflux medications and their effects on nutrients are available on the page Drug-Nutrient Interactions on Crying Over Spilt Milk.
References:
(1) Medscape - Gastroeosophageal Reflux Disease in Infants and Children
(2) This media release (Medsafe-prepulsid_alert) -
(3) Medsafe-Prepulsid - page no longer available
(4) Medsafe-Domperidone
(5) Medsafe-Maxolon
(6) New Ethicals Catalogue and Compendium
(7) Medsafe data sheets
(8) www.gaviscon.co.uk
(9) http://www.medsafe.govt.nz/profs/Datasheet/p/Peptisoothesyrup.htm
Acknowledgments:
GRASP (former New Zealand support group).
Rochelle Wilson (GRASP National Coordinator 1995 - 2001).
Dr Rodney Ford, Paediatrician (http://www.drrodneyford.com/ )
Reckitt Benckiser (New Zealand) Ltd
Written by Roslyn (Roz) Ballantyne (RN), Regional Coordinator for © Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust February 2004. Updated August 2006 with information provided by Reckitt Benckiser. Reprint November 2007.
www.cryingoverspiltmilk.co.nz
Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk’s URL are included. It may not be copied to other websites or publications without permission and acknowledgment.
Page last modified 26-Nov-2007 by Roz (Website Manager, Crying Over Spilt Milk). |
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