Ask GP to prescribe best drug rather than cheapest?

[ChampagneLassie]

After considerable pushing, GP has prescribed lansoprazole for my severe reflux baby.

He's prescribed 1/4 of a tablet a day and suggested I cut tablets into 4 and put the tablet under DD tounge to dissolve. The tablets crumble on cutting. The box says not to cut or crush. if I put this in her mouth like this I fear she may breath it in / or just spit it out.

He told me to see how I get on and if I struggled he could prescribe in liquid form, but I'd have to try tablets first as the liquid is £100 a bottle. I asked if I could just pay that as I just want best for DD and he reassured me to try tablets. Obviously NHS doesn't have the option to just pay for best drugs 🙄

GP now on leave for 2 weeks (we'd agreed good amount of tkme for me to try!)

I had imagined from what he said the tablets were more like stamps designed to dissolve under a tounge, not a normal sort of tablet.

WWYD - do as suggested?

• crush tablet and try like that?
• contact GPs again Mon and demand liquid form, highlight chocking risk (perhaps reading between lines GP was telling me I could ask for drug just he was obliged to prescribe the cheapest one first 🤷‍♀️(another Dr will need to prescribe)

It makes me mad and sad the way the NHS is mus-managed and false economies. Surely another Dr appointment costs more than £100. Why not have option to provide more expensive drugs if people are able to pay.

He should have prescribed Omeprazole dispersible tablets instead because you can dissolve those in water then administer.

The GP practices does not get paid per appointment. They get paid per patient per year. Last figures I can find were 2020, when it averaged to £155 per patient per year. The NHS is broke. People need to stop voting for the Tories.

Ask for Omeprazole syrup.

So I'd originally asked for Ompermizole having heard from others on forums like this... Dr sought advice of pediatrics and this was their advice. I had read someone who went private getting lansoprazole and that kinder to stomachs than Ompermizole. My DD had delicate stomach (CMPA, on amino acid formula) so I figured this made sense.

I'm tempted to go private to see a paediatrician myself.

Fair point, in which case you'd think it was on Dr's intrest to limit number appointments needed. As I keep getting inadequate advice I keep going back. 5 appointments on this and counting.

To be fair the GP sought advice from a paediatrician. But you're not willing to take their advice?

I can understand your frustration, but the NHS is on its knees so it's not unreasonable to try something that is miles cheaper first

Dissolve it with water in a 5ml syringe. The nurofen ones are big enough for the pill to fit in. You need to keep rotating it and agitating it while administering to make sure the granules go into baby. Google and you will find specific instructions

A pill cutter will stop the crumbling.

Not sure about the drug you are on but with omeprazole the tablets are more effective than the liquid suspension, as long as you get all the granules in

Obviously check the specific instructions for your drug.... I have assumed its dissolvable. Might not be. I've only ever used losec mups (omeprazole)

Is the medicine actually working? You just don't like the means of administration?

Thanks i'll check but this is definitely not how I was told to do by the Dr. I'll get a pill cuter (which he did tell me to do, I forgot)

Also just to add, I agree it's utterly ridiculous for them to expect you to put a tablet under a babies tongue to dissolve.

My sense from what he said the liquid would be preferable but just cost is preventing him prescribing.

I don't know how detailed advice from pediatrics was - just the drug or the form? Also they maybe also on economy drive.

I'd happily pay for it but in order to do that I'd have to have a private consultation so significantly more time and money.

I've not tried yet, I picked up today and I'm genuinely a bit worried about her inhaling the pill and whether a good idea to give her, hence asking on here. Expectation is may take 2 weeks to see impact

DS was on lansoprazole tabs for ages. We found them really easy to administer. His dose was half a tablet daily so we just broke in half (didn’t need tablet cutter), dissolved in small amount of boiled cooled water and gave in a syringe or on a spoon.
I actually asked that he was switched from omeprazole liquid due to the cost to the nhs, poor stability of liquid meaning really frequent prescriptions and lansoprazole being more effective.

My daughter (11 weeks premature) was discharged from hospital on omeprazole, it was actually causing more problems than it fixed and it wasn’t until I demanded lansoprazole that we finally got on top of her reflux. Omeprazole suspension is also mint flavoured so can be difficult to get baby to take, it’s also isn’t a better drug than lansoprazole, some people just get on better with one or the other. If you don’t want to cut the tablet you could mix the tablet with 4 mls of water and then only give 1 ml to make it a quarter of the tablet (of that makes sense). I would definitely persevere with the lansoprazole for now and see how your baby gets on, if it’s not working then you have evidence to go back to the GP to ask for the omeprazole suspension

If it’s costing £100 a bottle, is it unlicensed? This means it’s not a commercially produced product, but one the pharmacy has to order in as a special, or make up themselves. It’s not be properly tested, so the doctor is carrying sole responsibility for prescribing it. Many doctors don’t like prescribing unlicensed products because of the potential,risk.

Thank you @Fedupmum21 @LairyMcClairy this is really helpful. I'll give this a go, again disappointed GP didn't recommend this, it's ridiculous that I'm having to get this advice off an Internet forum

I think so. I'm not entirely sure what that means. But I've found people on forums being prescribed it for their babies for last decade so I don't really understand. Again I think gp should have explained this.

GP isn’t allowed to prescribe most expensive without being able to justify it. All prescribing is now checked and monitored.

Of you've questions about the drug you have you can speak to the pharmacist about it.

Can you ask for a private prescription? I did that when I lived in the UK (albeit over 10 years ago) for pain relief as GP said he could only prescribe paracetamol. Not sure if it can still be done that way.

Another one here who had omeprazole tablets for a cmpi baby. I did as other pp said, cut in half, mixed with small amount of water and then calpol syringe. Try it and see how you get on before doing anything else. Hope it works for your baby - allergy babies with reflux are hard work.

French babies are prescribed many drugs in suppository form. It's a lot easier.

Lanzoprazole oral suspension is unlicensed I think. And you shouldn't dissolve the whole tablet in water and divide by 4 as it doesn't dissolve evenly

The tablets are designed to dissolve in the mouth. You need to get a pill cutter and divide into 4 as the GP has said. Or you can divide and dissolve in water. But the whole point is they dissolve in the mouth and therefore you don't need liquid

If they are dissolvable the choking risk is no worse than liquid as they will dissolve. And I don't really see why she's any less likely to spit out liquid than a dissolvable tablet? At least with a tablet you can put it back in till its dissolved rather than liquid you've got no idea how much they've taken