Esomeprazole - Acid Suppression (Children)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves

GREEN Traffic light classification for.

• Esomeprazole granules as branded product, Nexium® as an option in children and infants under the age of 1 with a NG tube >6 French (FR) in situ.(off-label use)
• Generic esomeprazole granules may be prescribed (3rd line) for infants and children under the age of 1 without an NG tube in situ where the parents or carers are having difficulties in giving part-dose using orodispersible tablets.

This will need to be reviewed every 3 months as the child grows, to either discontinue treatment or change to the much less expensive orodispersible tablets described in the ‘PPIs for Children Prescribing Algorithm’ on the PAD

The APC note that the previous decisions made in December 2022 still stand:

• omeprazole suspension in children under the age of 1 with a NG tube in situ, continues to have BLUE traffic light status
• omeprazole suspension in children and infants under the age of 1 without an NG tube in situ, continues to have a NON-FORMULARY traffic light status

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed an algorithm for prescribing PPIs in children (see below).  Included medicines are:
 

Omeprazole oral powder for suspension is BLUE (on recommendation of a specialist) 

• ONLY for children under 10kg and/or with enteral feeding tubes (less than 8Fr) in place.
• Consider using the higher strength preparation, 20mg/5ml as proportion of sodium,  potassium and preservatives per dose is less. 
• Switch to alternative PPI as per algorithm when enteral feeding tube is removed or larger gauge used

Omeprazole dispersible tablets are GREEN

• 1st line treatment option in children unable to swallow omeprazole capsules.
• Mezzopram® brand is preferred due to the smaller granule sizes. If Mezzopram® is out of stock or unavailable Losec Mups® should be used as an alternative.
• Disperse the tablets in water, then mix with orange/apple/ pineapple juice, apple sauce or yoghurt 

Omeprazole capsules are GREEN

• 1st line treatment option in children who are able to swallow capsules; OR
• For children who cannot swallow capsules, most capsules can be opened (licensed) and mixed with water or a slightly acidic fluid e.g. fruit juice, apple sauce

Lansoprazole capsules are GREEN 

• 2nd line treatment option in children who are able to swallow capsules
• For children who cannot swallow capsules, some capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice or sprinkled on soft food (e.g. yoghurt, apple puree)

Lansoprazole orodispersible tablets are GREEN

• 2nd line treatment option in children unable to swallow omeprazole or lansoprazole capsules.
• Oro-dispersible tablets disperse in the mouth to release gastro-resistant granules. Lansoprazole is NOT absorbed sublingually. The gastro-resistant granules must be swallowed for the medicine to be effective. The FasTabs® can also be administered in apple or orange juice.

Aclomep® powder is RED

• Only for use by Ashford & St Peters NICU

All other unlicensed oral  PPI suspension preparations should be considered NON-Formulary