AIBU to ask about ranitidine dosage for silent reflux?

[BananaStand]

Firstly I'm aware I am unreasonable as this is not really an AIBU and I am posting for traffic

9 week old DS has just been prescribed ranitidine for silent reflux. The GP was reluctant as he doesn't believe in medicalising babies' crying, he was very dismissive and only prescribed it as two of his colleagues had previously told me that this would happen if the gaviscon didn't work.

He spent some time working out the dosage which was obviously unfamiliar to him, and prescribed 0.4 ml for 11 lb 6 DS. However this seems low for his weight compared to what others have been prescribed. I just wondered if anyone with a similar size baby could share what their dosage was?

Thank you!

bnf.nice.org.uk/drug/ranitidine.html

For Child 1–5 months

1 mg/kg 3 times a day (max. per dose 3 mg/kg 3 times a day).

If it’s 0.4 twice a day I’d think it was ok, google how to work it out and there’s lots of advice on silent reflux.
It’s shit now but it does get better x

There's 3 dosage stages for ranitidine and it's likely he's been started on the lowest dose. I think it's either 1,2 or 3mg per kg. My dd was on about 0.5ml twice a day at 4.4kg and it was increased almost weekly until she hit 6m and we started weaning.

All I can suggest is monitor for a few days, make sure he's weighed regularly and dosage is kept in line with weight. If symptoms persist then dose may need increasing.

DS had a different medicine, omnezaprole? I can't remember exact doses but the GP prescribed the minimum amount first of.

Slight side note but has your dS been checked for a tongue tie (by someone who knows what they're doing, lactation consultant or infant feeding specialist HV) I was convinced DS had silent reflux, it turned out it was (being caused by) a posterior tongue tie, as soon as it was divided, it changed both our lives for the better almost immediately.

That sounds about what we were started on. They will start on the lowest dosage and see if it works. It worked for us. I know a much smaller baby who was on 3 times what my daughter was but it worked for us and not for them. I think you should always try the lowest dose. Why give them more than they actually need? Now at 18 months 1ml twice a day is working for us. We tried to wean her off but she starts being sick again. We got up to 3mls 3 x a day as she got bigger and then weaned back down to the lowest possible dose.

Eldest DS had this - Gaviscon was useless.
They originally started him on an infant formulation of Ranitidine, which was 5ml, but this had to be specially made by the pharmacist and DS spat most of it up.
They then prescribed 0.4ml of the standard formulation, which was the usual infant dosage.

Hope it works for him OP.

Gaviscon worked for us, but what also helped was putting him to sleep on his side with bumpers either side of him so he couldn't roll, tried this from about 7 weeks on and it definitely made a difference. You can buy them in JoJo I think. Hope the ranitidine works.

Thanks all, I hadn't realised that there were different doses. I obviously should have more faith in the gp! Fingers crossed the ranitidine helps.

OP if it's doesn't and you need to go back, please see a different GP. If it is reflux/silent reflux it needs to be treated by a GP who understands as all the different meds function slightly differently.

I'd put more faith in the doctor that sat down and worked out the appropriate dose than the advice given by a bunch of people who don't actually know the concentration of ranitidine you're talking about!!

Ranitidine solution comes in different concentrations (mg/ml) and can be started at different doses (mg/kg). As you've not told us the concentration it is impossible to tell whether that's an appropriate dose.

Most doctors (even those of us who work with kids regularly) will stop to check the appropriate dose because there's so much potential for getting it wrong. Would you rather he'd just made it up?

Agree to get baby checked for tongue tie. The majority of tied babies who have them cut have improved reflux symptoms very quickly.

Have you considered the option to ask for lansoprazole (sp?). This is not weight dependent as far as I am aware and you only need to give once a day and anytime, so might be easier to administer too.

If you are using formula especially, I would check if a dairy free formula stops the silent reflux. They often go hand in hand.

@JamTea - all paediatric drug doses are weight dependent.