What is the recommended dosage and administration of Nexium (Esomeprazole) for an 8-month-old, 9.8kg infant with Gastroesophageal Reflux Disease (GERD)?

Nexium (Esomeprazole) Dosing for an 8-Month-Old, 9.8kg Infant with GERD

For this 9.8kg infant, administer esomeprazole 1 mg/kg once daily, which equals approximately 10mg (one full sachet) once daily, given 30 minutes before the morning feeding. 1

Weight-Based Dose Calculation

• Standard dosing: Esomeprazole 1 mg/kg once daily is the established dose for infants 1-24 months with GERD 1
• For this 9.8kg infant: 9.8kg × 1 mg/kg = 9.8mg, which rounds to the available 10mg sachet formulation 1
• Alternative lower dose: A 0.25 mg/kg dose (approximately 2.5mg) can be used initially, but provides less acid suppression and symptom control 1

How to Administer the 10mg Sachet

Preparation method 1:

• Empty the entire 10mg sachet contents into a small container
• Add 5-10mL of water (do NOT use other liquids like milk or juice)
• Stir well to create a suspension
• Administer the entire mixture immediately using an oral syringe
• Rinse the container with another 5mL of water and give this to ensure full dose delivery

Timing is critical 2:

• Give approximately 30 minutes BEFORE the morning feeding for optimal acid suppression 2
• Consistent daily timing improves efficacy 1

Clinical Evidence Supporting This Dose

• Acid suppression data: The 1 mg/kg dose increases intragastric pH >4 for 69.3% of the 24-hour period (compared to only 47.9% with the 0.25 mg/kg dose) 1
• Symptom reduction: The 1 mg/kg dose reduces esophageal acid exposure from 12.5% to 5.5% of time with pH <4 (P < 0.001) 1
• Safety profile: Both 0.25 mg/kg and 1 mg/kg doses were well tolerated in infants 1-24 months old 1

Important Clinical Considerations

Monitoring and follow-up 2:

• Reassess symptoms after 2-4 weeks of therapy 2
• If symptoms persist despite adequate dosing, consider upper endoscopy to exclude other diagnoses 2
• Long-term use beyond 8-12 weeks should prompt re-evaluation of the diagnosis 2

Common pitfalls to avoid:

• Do NOT use adult dosing: The 20mg or 40mg doses used in adolescents are inappropriate for infants 3
• Do NOT mix with formula or milk: This alters absorption and reduces efficacy 1
• Do NOT give with meals: Proton pump inhibitors require administration 30 minutes before feeding for optimal effect 2

Potential adverse effects 3:

• Headache, abdominal pain, nausea, and diarrhea are most common (though less frequent in infants than adolescents) 3
• Monitor for increased risk of community-acquired pneumonia with chronic acid suppression 2

When to Escalate or Modify Therapy

If inadequate response after 2-4 weeks 2, 1:

• Consider increasing to 1.5 mg/kg once daily (approximately 15mg for this infant) 1
• Evaluate medication timing and administration technique 2
• Rule out other diagnoses through endoscopy if symptoms are severe or refractory 2

Duration of therapy 2:

• Initial trial should be 4-8 weeks 2
• Chronic therapy beyond this requires careful risk-benefit assessment 2