What are the best options for oral solution Proton Pump Inhibitors (PPIs) in Canada and what is the weight-based dosing for an 11-year-old boy?

Oral Solution PPI Options and Dosing for an 11-Year-Old Boy in Canada

For an 11-year-old boy in Canada, lansoprazole oral disintegrating tablet (15-30 mg daily) is the recommended PPI formulation, with a weight-based dosing of 0.7-3.0 mg/kg/day. 1, 2

Available PPI Formulations in Canada for Pediatric Use

First-Line Options:

• Lansoprazole:

  • Available as strawberry-flavored disintegrating tablet
  • Can be administered without water (placed on tongue)
  • FDA-approved for children 1-17 years
  • Dosing: 0.7-3.0 mg/kg/day (typically 15-30 mg daily) 1, 2, 3

• Omeprazole:

  • Available as capsules with sprinkle contents that can be mixed with soft foods
  • FDA-approved for children 2-16 years
  • Dosing: 0.7-3.3 mg/kg/day 1, 4

Alternative Options:

• Esomeprazole:
  • Available as capsules with sprinkle contents that can be mixed with soft foods
  • Can be administered through nasogastric tube if needed
  • FDA-approved for children 1-17 years
  • Dosing: 0.7-3.3 mg/kg/day 1, 5

Weight-Based Dosing Recommendations

For an 11-year-old boy with GERD requiring PPI therapy:

1. Lansoprazole (preferred option):

   • Initial dose: 0.7-1.5 mg/kg/day
   • Typical range: 15-30 mg once daily
   • Maximum: 30 mg daily 2, 4

2. Omeprazole (alternative):

   • Initial dose: 0.7-1.5 mg/kg/day
   • Typical range: 10-20 mg once daily
   • Maximum: 20 mg daily (can be increased to 40 mg if needed for severe disease) 1, 6

Administration Considerations

• Lansoprazole orally disintegrating tablet:

  • Place on tongue and allow to dissolve
  • Can be taken with or without water
  • Most convenient option for children who have difficulty swallowing pills 3

• For capsule formulations:

  • Open capsule and sprinkle contents on soft food (applesauce, yogurt)
  • Do not crush the enteric-coated granules
  • Administer within 15 minutes of preparation 1, 5

Treatment Duration and Monitoring

• Initial treatment course: 8-12 weeks for symptomatic GERD or erosive esophagitis 2
• Take 30-60 minutes before meals for optimal acid suppression 5
• Monitor for common side effects: headache (7%), abdominal pain (5%), nausea (3%), and dizziness (3%) 2

Important Considerations

• PPIs are more effective than H2-receptor antagonists for healing esophagitis and symptom relief 1, 5
• Avoid long-term use when possible due to potential risks including bone changes and increased risk of infections 1, 2
• For children with severe disease not responding to standard doses, twice-daily dosing may be considered 5
• Generic omeprazole is typically the most cost-effective option if cost is a concern 5

Caution

• Do not exceed recommended duration of use in pediatric patients due to potential risks identified in juvenile animal studies (heart valve thickening, bone changes) 2
• PPIs should not be used in infants less than 1 year of age as efficacy has not been established 2