Nutrition, PICU, Initiation and Advancement — Anti-Reflux Medications — Clinical Pathway: ICU and Inpatient

Nutrition Initiation and Advancement Clinical Pathway — PICU/PCU

Anti-Reflux Medications – H2 Blockers & PPI Information (CHOP Formulary)

If patient is on an acid blocker as part of their home regimen, resume home regimen. If patient is being newly initiated on therapy, we recommend these medications in the following order:

Famotidine
(Max IV: 40 mg/DAY; Max oral: 2 mg/kg/DAY or 80 mg/DAY)
Famotidine can be added to TPN at a dose of 0.5-1 mg/kg/dose
Adjustment may be required in renal insufficiency (CrCl < 50 mL/min/ 1.73 m2)

Oral < 3 months: 0.5 mg/kg/dose daily
≥ 3 months: 0.25 - 0.5 mg/kg/dose once or twice daily
IV < 3 months: 0.25 mg/kg/dose once daily
≥ 3 months: 0.25 – 0.5 mg/kg/dose every 12 hours

Omeprazole  
Administer orally, NG, ND or NJ
Doses up to 3.3 mg/kg/DAY have been reported (max: 40mg/DAY)

< 1 year 1 mg/kg/dose in 1-2 divided doses
> 1 year and < 20 kg 10 mg once daily
> 1 year and ≥ 20 kg 20 mg once daily

Pantoprazole  

IV 0.5-1 mg/kg/day IV (max: 40 mg/DAY)

Lansoprazole  
Administer orally or via NG ONLY (max: 60mg/DAY)

< 1 year 0.4-1.8 mg/kg/DAY in one or two divided doses (max: 2.88 mg/kg/DAY)
> 1 year and < 10 kg 7.5 mg once daily
> 1 year and 10-30 kg 15 mg once or twice daily
> 1 year and ≥ 30 kg 30 mg once or twice daily

For choices or questions outside of the above listed measures, please contact Clinical Pharmacy.