Gaviscon and domperidone

[worldofuncertainty]

DS was on gaviscon and has now been prescribed domperidone as the gaviscon had started off well then stopped being so effective. What I don't know is if the domperidone should be as well as or instead of the gaviscon.

Any ideas?

No idea but your pharmacist might know if you give them a call. Otherwise, call the doctor who prescribed and ask for clarification.

As well as.

Infant Gaviscon is a food stabiliser, merely adding density to the food in the stomach to make it less likely to come up again (an inert long chain polymer, I believe). Domperidone is an H+ (acid) inhibitor which should reduce the acidity and thus the pain. When our first son had reflux, the medicine which really worked was ranitidine, though it seems to have been somewhat superseded in the last year. Our son was prescribed domperidone but, from what I read, it was not that effective and did introduce some risks (cardiac arrhythmias), so we never gave it to him. On the other hand, a lot of paediatricians seem to prescribe it and they are a lot more knowledgeable than me.

Really? Is that all gaviscon does?

Intrigued because DD has just been prescribed this but that sounds like it does the same job as the milk we were feeding her. Oh well, see how it goes.

OP, can I ask how long gaviscon was effective for?

Gallic,

Have a look at the literature in the packet. I had a fairly heated argument with my MIL about this and she insisted that it was an antacid. Adult Gaviscon does contain an antacid but Infant Gaviscon does not, unless it has changed in the last year or so.

I THOUGHT that was all gaviscon did! I just had a phone call with my HV as I am increasing the amount of formula he is having, and I wanted to know if we needed to use gav with the comfort formula. the comfort is so thick anyway i was thinking we'd have to use the syringe method. She told me to keep giving it as it helped with the acid.. but i thought that was what his ranitdine was for!

Oh I'm confused now. I know I can't use antacids with the formula we currently have so thought we would have to change formula but if it's not an antacid we can go ahead.

Think I'll call SMA and check to be sure.

Yep, the leaflet says "do not give with any other thickening agents or infant milk preparations containing a thickening agent" - which i assume the comfort formulas do.

ok, the leaflet in the gaviscon says it is a "reflux suppressant" and shouldn't be used with formulas containing a thickening agent.

Domperidone is a motilium - it moves food faster through the system and acts as an anti-emetic. It does nothing with regards to acid, and reports of its effectiveness in the case of reflux are anecdotal. We started on gaviscon, and found it ineffective. However, we were told to persist, and ranitidine and domperidone were added. Within about two weeks it was clear that that mixture wasn't working, so the gaviscon and ranitidine were dropped, and DS is now on domperidone and omeprazole. Omeprazole has pretty much sorted it.

I do have concerns about domperidone - and at one point tried to wean DS off it; I wasn't convinced it was doing anything - I thought the omeprazole was doing everything. But reducing the amount of domperidone did make him noticeably worse.

I was also concerned about the gaviscon - it's quite high in sodium, which isn't great for little ones. And some reports suggest that domperidone acts so as to raise sodium levels, so I was worried when DS was on both.

It's a worry, giving medication to babies, but in our case the combination of domperidone and omeprazole has worked wonders. And from what I have read, omeprazole is probably the safest of the lot (which makes me wonder why it tends to be prescribed fairly far down the line . . .).

There was an immediate effect with the gaviscon which lasted about 2 weeks but then it has gradually got worse again. I used to have to put a muslin in his bed every night and it was always wet in the morning from his vomit. Since he's been on gaviscon I don't have to do that anymore. But he can be sick 2-3 hrs after a feed and this had got better. It's not severe and doesn't bother him but he is feeding a lot more than he should which the neonatal consultant said was due to the vomiting. he also was getting a lot of nasal congestion and this has dramatically improved.

My understanding is that the gaviscon is to thicken the feed whereas domperidone is an anti-emetic.

I'm going to see the HV tomorrow to get him weighed so will ask her then.

That sounds very much like DD. We're using SMA staydown milk which improved the situation but she still has days where she vomits a lot and gets through several changes of clothes.

Just called SMA and they confirmed that you can't use gaviscon with the staydown milk so that's that sorted then.

Thanks for the ino everyone. I was a bit concerned that the literature with the gaviscon says to only use for a week but the GP was happy for us to use it for several months.

Slanted,

You are right in that Domberidone is not an H+ inhibitor; I just had a look. On the other hand it is not a "Motilium" either. Motilium is a brand name for it. It is actually a dopamine antagonist. Apparently, reduction of dopamine reduces nausea, so it is thus an anti emetic.

www.crd.york.ac.uk/CMS2Web/ShowRecord.asp?ID=12005000621

The above link is to one study which shows its efficacy in treating infant reflux is (at best) unproven. One of the side effects, however, is cardiac arrhythmia. From what I have read, there have been (a very few) adult deaths from this but none (to date) in children given the dosages used. On the other hand, I cannot see a lot of info to support giving domperidone.

larry - yes, you're right on the brand name thing. (Sleep deprivation is my excuse.) It is used as a motility drug, though, which is what I meant. Just got the words confused.

I agree that its efficacy is unproven - as I said, reports of its success are anecdotal. It's something I struggle with when it comes to giving it to DS. All I can say is that when we reduce it he is much worse. The fact that the problems seem to be with adults rather than children is what 'allows' me to continue to give it to DS; but it is something that I would like to get him off of asap.

Slanted,

Fair enough, I know the feeling re sleep deprivation.

We can only do what works for us and our own children. And, if he has tolerated it fine to date, he will probably continue to do so. How old is your son? Ours started being taken off the ranitadine (which did help a lot for us) at about 10 months and was off it completely by about a year.

I am still not sure how anything bar an antacid (such as ranitadine) can help with the pain, though?

larry,

He's only 9 weeks. Symptoms started showing at 2 weeks, and it was pretty horrendous (head-butting through convulsions due to screaming in pain).

The omeprazole has been amazing. It's a proton pump inhibitor - shuts down the secretion of most of the acid in the first place. It seems to be very safe, largely because it only works when it attaches to the proton pumps, if you see what I mean. It doesn't interact with anything else, and it isn't stored in the body, and nor does it cross the blood/brain barrier. (I don't think I'm explaining this very well.)

It is extremely effective. I think PPIs are the next step, when antacids fail, as ranitidine did for us.

How did you know when to start trying to wean your son off the medication?

Yep,

I think Omeprazole (at least for treating infant reflux) is pretty new, or at least no-one suggested it to us the best part of 2 years ago.

As for weaning him off, when his weight and reflux stabilised (as in weight increased regularly) the paediatrician suggested subtracting one dose per day per week (if you see what I mean) and then adding it back if the vomiting or pain restarted. The key thing is they tend to get better when they are more upright (as gravity keeps the food going down). That tends to happen at 8-12 months normally. Seems to be a huge variation, though.

starting solids also makes a big difference not a reason to wean early but most children grow out of it by 12 months. In my experience they can both be given together but it's probably best to check what the prescribing doctor wanted you to do. As others have said there are still other options if this dosen't work Best of luck

Motilium and Domperidone are one and the same - former is just a trade name for latter generic medicine. But Motilium comes in adult-dose OTC pill formulation and you wouldn't use that for a baby.

OP, one thing you might need to consider if your baby's drinking formula is whether he might have a problem with cow's milk protein (not lactose). The symptoms of cow's milk protein intolerance are very very similar to reflux - e.g, vomiting, snuffles, food refusal, and sometimes eczema-like skin rashes and bum troubles - either constipation or diarrhea. Reflux and cow's milk issues can sometimes coexist - my son has both. He has a hydrolysed milk formula called Aptamil Pepti from the GP. The only real way to see if milk is part of the problem is by excluding unmodified milk and milk products from his diet if possible (and from yours if BF).

Hadn't posted on this originally as I was myself going round the bend with variety of meds for DDs silent reflux (acid reflux causing pain but not actual vomiting).

We have ben prescribed ranitidine and domperidone as well as the Gaviscon. I started the ranitidine first which has definitely helped the acid problems. No more screaming after feeding, but she is still reflusing with a bit of sicky stuff but not loads. I'm adding in the domperidone today to see if it helps stop the reflux happening.

It's frustrated because we were seen as an urgent case the same day when DD was in a lot of pain and distress, left with two bottles of 'stuff' then of course only once you have left do you discover what it is and what it does, then you have loads more questions and it's almost impossible to get another conversation with paediatrician until our follow up appointment. Having said that, after leaving a message a week ago, paed has finally called us back so I've had a few questions answered. It's very frustrating though.

I just feel like I want DD to be a 'normal' baby, without all these complications. I know it could be much worse, but it just seems like feeding has been complicated from day one, and I want to be able to enjoy this more, as opposed to constantly fretting about feed and meds. I guess I feel a bit cheated to be honest. Anyway, enough of my self-pity, she will grow out of it I suppose. Am looking forward to milestones that will help (sitting up hopefully in a couple of months, she's 12 weeks now, solids at maybe 20-22 weeks, more upright time and crawling to walking eventually, etc.), but trying not to wish this time away.

Dx

larry - thanks for the response. Glad to hear that there's light at the end of the tunnel!

Deliaskis - I know it's easy to say, but please don't feel cheated. I know exactly what you mean when you say that you're trying not to wish this time away. I feel resentful when people keep pointing out to me that it'll pass, etc.

There is much, much more to DS than his reflux, and I want to (and do) enjoy every little bit of him.

I find it helpful to be glad of the closeness that his reflux necessitates. For example, he's most comfortable upright in a sling/carrier. So he's there for most of the day. That means we're incredibly close physically, and there are so so many advantages to that, on all sorts of levels, for both DS and me. Most of the things that I do to soothe him and help him are actually ways of enhancing closeness - and that's a good thing!

I know it's a nightmare - I was feeling so stressed at one point that I seriously considered checking us both into a hospital because I didn't know what else to do. What's helping me is sort of just going with things, and not resisting them (bad sleep, etc), making sure his pain is managed (which does involve being very assertive with the NHS, and also finding a good doctor and sympathetic doctor). And it's always good to be informed - research all the various meds and treatments and discuss them with your doctor. Many doctors are not all that aware of the problem, its implications, and ways of dealing with it.

I do hope things start getting better for you.

Slanted thank you so much for your kind words. I have been having a bit of a blip today but it makes such a difference to know that I'm not alone in going through this. I would of course not wish it on anybody, but it's hard when I feel like shouting teenager style 'nobody understands meeeeeee!'. Although I wish you weren't going through this, it's nice to have a sympathetic ear!

Your advice is also really helpful, there is much more to DD than reflux and I know this will pass, I do enjoy the good bits, I am just more tightly wound than I would like to be because of this, but I guess I am better than last week, and the week before, so next week should be better still.

Thanks again, you've really helped a sad Mum today.

D

Glad it helped, Deliaskis.

(Do feel free to PM me if you feel like a vent/chat.)

My DD had reflux and had gaviscon (rubbish constipated her and was EBF so crap to give) domperidon (6 per day) and ranitidene (3per day)
Dom and ran did the trick at pain relief and weight gain. I knocked gav on head immediately.
She threw up till the day she walked unaided. Weaning didn't change anything.
But she is a bonny bright 4 yr old with no complications.
She is lactose intolerant though but this is apparently hereditary down father to daughter whereas her reflux is/was mirror image of mine as a baby!!!

MayDayChild interesting what you say about ditching the Gav once established on successful dom/ran combo. I worry about giving DD everything and think if the dom/ran combo is eventually doing what it's supposed to then the Gav shouldn't be necessary.

Touch wood DD hasn't had a real 'episode' for about a week now. She is windy and uncomfortable after feeds and still constipated from the Gav, but no screaming in agony. I think if I could stop the Gav, then some of the general digestive discomfort would also go away. Will ask paed next week.

D