Zegerid is currently the only FDA-approved immediate-release formulation of omeprazole, and is very suitable for giving to children and infants. It contains omeprazole, a PPI that is approved by the FDA for pediatric use. When mixed with water, the powder dissolves to form a true, homogeneous liquid suspension with a peachy-mint flavor. Unlike enteric-coated PPIs, which must be taken 30 minutes before a meal, Zegerid can be given without regard to mealtime. When mixed up as a 2mg/mL or 3 mg/mL or 4 mg/mL concentration, Zegerid is stable for 28 days in the refrigerator; unrefrigerated it is stable for 7 days*.

Zegerid powder for oral suspension is available in two packet sizes: 20 and 40 mg, with these numbers referring to the milligrams of omeprazole in the packet. The package instructions indicate that for an adult dose, the powder should be suspended in 30 mL of water. However, the resulting concentration of omeprazole is typically too low for convenient dosing in children because of the large volume of liquid they would have to swallow to get the proper amount of omeprazole.

For pediatric dosing, we suggest that Zegerid powder for oral suspension be suspended in less water than the manufacturer recommends so that the omeprazole concentration is higher. Therefore, infants and very young children will be able to get their appropriate omeprazole dose in a much smaller volume of liquid. We have studied adding this lesser amount and found it to be stable* (as indicated above), and its thickness is suitable for young children to take (less thick than acetaminophen liquid for kids).

It is convenient to mix up the 40mg packet as a 4mg/mL concentration and the 20mg packet as a 2mg/mL concentration.  This is accomplished by adding the contents of the packet (40mg or 20mg) to 6.5mL tap water.  This will result in a 10mL volume.

See the full-size pdf of our research on stability and viscosity (thickness) as summarized in a poster that was presented at Digestive Disease Week 2005.

An important note about buffer needed to protect the omeprazole in Zegerid

Although the 20 and 40 mg Zegerid packets contain different amounts of omeprazole, both packets contain the same amount of buffer. Therefore, the 40mg packets of Zegerid have half the buffer per each mg of omeprazole when compared to the 20mg packets.
So, when using the 40mg packet of Zegerid (which we recommend in children under 2 years of age) you have to add some additional buffer to protect the omeprazole from being destroyed by stomach acid.  We have found that Mylanta Cherry Supreme works well as the additional buffer in this setting. It accomplishes four goals:

1. It is the additional buffer
2. It improves the taste
3. It reduces gas
4. It reduces the likelihood of the child spitting up the dose
   

Instructions for preparing a 2mg/mL suspension from a 20mg packet of Zegerid.
Instructions for preparing a 4mg/mL suspension from a 40mg packet of Zegerid.

Does my child need the Zegerid 20mg or 40mg packet?

If your child is 2 or under, use the 40mg packets of Zegerid and mix in an equal volume of Mylanta Cherry Supreme (see An important note about buffer above ).
If your child is over 2 years of age, use the 20mg packets -OR- we recommend the 40mg packets if you add in an equal volume of Mylanta Cherry Supreme.  This way you get twice as much Zegerid for the same price.

*Burnett J, Balkin E.  Stability and viscosity of a flavored omeprazole oral suspension for peditric use.
Am J Health-Syst Pharm Vol 63; Nov 15, 2006