Ranitadine & Gaviscon - How long to kick in/dosage too low

[NessieD]

My DS is 18 weeks and we have been battling with his reflux for some time. He has been 1 sachet of Gaviscon in each feed for the last few months however since Christmas the Gaviscon has been becoming less effective (as he should now be having a double dose) and giving him Chronic constipation, he was given Lactulose for this but agin this is no longer proving to be effective. We have been to the Dr's today and after much persuading he now has Ranitadine, however after reading the info on Ranitadine I am worried that the Doc has given us the absolutely minumum dose of 0.27ml 3 times a day, that means he will only be getting 0.81ml per day? we have tried him on the Ranitadine already today and he did seem to be in a lot of discomfort and was sick after his nap which was 2 hours after his last feed. How long should it take for the meds to kick in and should we still be giving him Gaviscon as well? the Dr did say that we could carry on with the Gaviscon but I really want to get him off it ASAP as it's causing him so much discomfort. If I do give him both how long should they be apart? the recommendation seems to be 2 hours apart but how on earth am I going to fit that in with his feeding schedule as 2 hours after his feeds he will be asleep!

The Dr has also suggested starting him on solids ASAP as this will help stabalise his stomach contents, but we have tried that and it just makes his constipation worse.

Hi

The dose of ranitidine is:
Child 1?6 months 1 mg/kg 3 times daily; max. 3 mg/kg 3 times daily

Child 6 months?3 years 2?4 mg/kg twice daily.

This is from the NHS children's medication information book/website on www.bnfc.org
section 1.3.1 under Ranitidine. You have to register to access it but is the drug info book used by NHS for children.

There is a support site on www.littlerefluxers.co.uk

My LO was on Gaviscon but couldnt take it for long as he got bad constipation- water helps relieve this but makes things even more vomity!

I was told that if there was no improvement on a "good" dose of Ranitidine after a week it wouldnt help. I found it very good and got some benefit after a few days despite being prescribed 3mg 3x day for a 7kg baby which is ridiculously low. That was 0.2ml 3 x a day of the 75mg in 5ml syrup. I upped it after a few weeks (after discussing with GP!) when it seemed to have stopped working- thats when I realised it was such a small dose. Some people say it is quite dose per weight sensitive.

You are actually lucky that your GP prescribed it at all as usually it is often only on the advice of a specialist/ paediatrician.

So basically work out his weight/dose and compare it to what dose the GP has given you. It may be worth trying the small dose first but print out the page if going to GP to discuss increasing it.

I stopped the Gaviscon as it was causing more problems than it cured but is difficult to recommend as changing several things at a time can make it difficult to work out what is working! My DS is now 8 months and food does stay down better but is a lot messier coming up!

Sorry to hear about your probs- my LO has settled a lot on Omeprazole/Losec but the Ranitidine did work quite well to begin with.

Hope this is of some help. Do try the little refluxers site it can be helpful to read other peoples stories. Noone else I know has a refluxy child and they think I'm exaggerating and that some babies are "just sicky".

Best of luck

hi Nessie, I really sympathise as we have been through ds2's severe reflux from 8 weeks to about 18 months. I agree with davidsmom that you are very lucky the gp will prescribe ranitidine for you, cos even after the paed had prescribed it for ds2 our gp's surgery refused to do repeat prescriptions and we had to go back to the hospital pharmacy each time. We were told it takes between a week and two weeks to kick in, so give it some time. It may be just what your little one needs.

In the longer term, you'll have to keep checking his weight to make sure he's still on a dose that works, but also many people find that ranitidine just stops working, which is why ds2 ended up on omeprazole just as the other poster.

I also think that Gaviscon is absolutely useless - if the reflux is severe enough to require ranitidine the gaviscon just isn't going to make much difference. I'm surprised they are still telling you to use it, especially if they have had to give him something for constipation. If you feel happy with doing so, why not just stop using it for a while and see what difference it makes?

It really is worth going to a special online forum as you'll find lots of parents in the same situation as you and it helps to keep you a bit saner than you would be otherwise [wry smile]. I am on a different computer now but I think i used to visit the infantreflux.org message boards - although unfortunately the link on their main site doesn't seem to be working now. I haven't used little refluxers but maybe it has grown in the last couple of years.

anyway, big hugs as I know what a desparate situation it is when you're in the middle of it.

Thanks thats really useful. I will have a look at the NHS site and the Little Refluxers site. I'm not sure if the Gaviscon is really just a thickener so maybe a thicker milk might help? we have already tried Enfamil but that didn't work either! He had Ranitidine at 7pm and no Gaviscon and so far he has gone to bed OK, so finger crossed!

Was told to try Enfamil AR (anti reflux)which already contains a thickener. I have convinced myself that he is worse with dairy products though and am sticking to BF (just).

Oh and I gave the ranitidine before feeds was told to but no evidence whether better berore/after. just thought that it might at least stay down during tjhe feed.

gaviscon is also an antacid although weak and can work for some. I think that most people posting here are probably beyond its help.

the meds site isnt in itself an NHS site but used by NHS Dr's to help prescribing for children.

Mummypig gives good advice- I will try the infantreflux.org too.

Fingers crosed for a quiet night for you.