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The general population may best remember the 1980s as a time of big hair, atrocious fashion, and great music, but pharmaceutical researchers would more likely recall the era for the emergence of a class of drugs called proton pump inhibitors (PPIs). The introduction of the PPIs was a milestone in the history of drugs because they perfected the medical treatment of acid-related disorders.

It wasn't until 1995 that the FDA approved the PPI Prevacid. Since its approval, Prevacid has become the "fast-mover" among its class of medications in the pharmacy for use in infants, children and adolescents. Lansoprazole, the generic for Prevacid, just recently hit the market in November 2009, and will most likely become more popular than its brand-name counterpart.

The Doctor Ordered Prevacid, Why?

Available for children by prescription only, Prevacid is FDA approved for short-term use in infants and older children to treat gastroeso-phogeal reflux disease (GERD) and erosive esophagitis--tissue damage in the lining of the esophagus usually caused by untreated GERD.

Prevacid is not for "happy spitters" (infants that feed well and gain weight despite regurgitating half the food they eat). The drug is also not for older children with uncomplicated gastroesophageal reflux (GER) where they remain free of symptoms or other complications even though they experience episodes of gastric contents passing into the esophagus.

Prevacid is reserved for use in infants and children with moderate to severe GERD that hasn't responded to lifestyle change or that has led to complications, such as esophagitis and hoarseness.

Your child's doctor may prescribe Prevacid for your little one if she has persistent asthma symptoms in spite of the use of traditional asthma medications. The physician most likely suggested Prevacid as a trial run to see if GERD may be contributing to your child's atypical asthma issue.

Prevacid vs. All Other PPIs

Aside from Prevacid, other well-known proton pump inhibitors are Nexium (esomeprazole), Prilosec (omeprazole), Protonix (pantopra-zole) and Aciphex (rabeprazole). With a couple of cost-effective generics in the mix, we have to wonder why Prevacid is the PPI of choice when it comes to treating your little one's acid-related disorder.

Prevacid is not the best PPI on the market. In fact, studies show that they are all equally effective. There also appears to be no difference among the PPI drugs in how fast or how long they work. Does Prevacid have fewer side effects than other PPIs? No, Prevacid has a very similar side effect profile as its classmates.

So, why is Prevacid number one? Clinical experience coupled with convenience--that's all! In practice, Prevacid has been prescribed more often because of the existence of the Prevacid SoluTab, a convenient and easy-to-use orally disintegrating tablet that rapidly dissolves in the mouth.

Mode of Acid Eradication

Your child's stomach is lined with special cells that contain unique proton pumps. These pumps transport protons (the hydrogen in hydrochloric acid--stomach acid) into the stomach, resulting in the acidification of the stomach's contents. This pumping of acid into the stomach makes up the final leg of a rather intense acid secretion pathway.

This is where Prevacid comes to the rescue in those children with acid-related disorders. The proton pump inhibitor works exactly the way you would imagine: it blocks the acid pump from being able to dump its contents into the belly, suppressing acid buildup.

This blocking action is irreversible, but "irreversible" only refers to the effect on the pumps present in the stomach while Prevacid is on board. Pumps are not lost and gone forever, as new copies are constantly being made to replace the pumps that were inhibited.

Side Effects

Prevacid is generally well tolerated and the incidence of short-term side effects is uncommon. In the rare occasion that a side effect may occur, abdominal pain, constipation, nausea and headache would be the main issues for which you should be prepared.


Even though safety and efficacy have not been established in babies less than one year of age, Prevacid is still occasionally prescribed as an off-label treatment in even the youngest infants.

Prevacid does decrease the absorption of vitamin B12 after long-term use (more than three years), but researchers are unsure if this leads to a clinically significant deficiency.

If your child has severe liver disease, then a reduction in dose may be needed. Also, children with phenylketonuria, a genetic disorder in which the body cannot metabolize the protein phenylalanine, will need to avoid the Prevacid SoluTab as it contains the aforementioned protein.

Administering Prevacid

Prevacid is safe and effective for children, but it needs to be administered correctly. Because the number of proton pumps in the stomach lining is greatest after a prolonged fast, Prevacid should be administered before the first meal of the day. Giving your child the proper dose of Prevacid at least 30 minutes before breakfast will allow her to get more bang for your buck!

If your child cannot take the Prevacid SoluTab, the capsule formulation can be opened and the granules sprinkled over applesauce or yogurt, or given with fruit juices. If that doesn't work, the contents of the capsules can be compounded into a simplified suspension.

You may want to contact your insurance company to see if Prevacid is covered before you go to the pharmacy counter--this stuff is expensive, even the generic version. If for whatever reason you cannot afford your child's Prevacid or lansoprazole prescription, omeprazole is a generic PPI capsule that can be administered in the same manner as the Prevacid capsule.

Cate Sibley received her doctor of pharmacy degree from Northeastern University in Boston, and is currently a community pharmacist in Charlotte, NC. Her goal behind becoming a pharmacist was to be an accessible source of information to patients so they can understand their medications as best as possible. She quickly realized her goal would be hard to reach by standing behind the counter in the pharmacy. To reach her goal, she and Nova Simpson started a website called, and by visiting, you can get a free report on how to save money on your prescription medications.


By Cate Sibley PharmD
COPYRIGHT 2009 Pediatrics for Parents, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

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Title Annotation:proton pump inhibitors
Author:Sibley, Cate
Publication:Pediatrics for Parents
Article Type:Drug overview
Geographic Code:1USA
Date:Nov 1, 2009
Previous Article:Pica.
Next Article:Importance of school connectedness.

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