IBD

  • Methylprednisolone (IV) or prednisone (oral)
  • 1 to 2 mg/kg once daily, to a maximum of 40 to 60 mg/day usually induces remission
  • Budesonide
  • 9mg orally daily
  • Reduce in 3mg increments over several weeks
  • Side effects: growth suppression, immunosuppression, adrenal suppression
  • Site of release (Brand name):
    • Jejunum-ileum-colon: Pentasa
    • Distal ileum- colon: Asacol, Delzicol, Apriso
    • Colon: Lialda, Dipentum, Colazal, Azulfidine
    • Rectum: Rowasa, Canasa
  • Balsalazide (Colazal)
    • Children ≥5 years and Adolescents ≤17 years: Oral: 2.25 g (three 750 mg capsules) 3 times daily for up to 8 weeks or 750 mg 3 times daily for up to 8 weeks
      • can sprinkle in puree (applesauce), consume immediately
    • Adolescents ≥18 years: 2.25 g 3 times daily for up to 8 to 12 week
  • Mesalamine (Apriso, Asacol, Delzicol, Lialda, Pentasa)
    • Oral dose of 60 to 80 mg/kg/day, divided twice or three times daily (up to the adult dose of 4.8 g/day)
    • Some clinicians use mesalamine doses up to 100 mg/kg/day (maximum 4.8 g/day) for induction of remission in children
    • Do not open or crush except Pentasa can be opened and sprinkled into puree (applesauce)
  • Sulfasalazine (Azulfidine, Sulfazine)
    • Initial dose of 25 mg/kg/day divided twice or three times daily and advanced over one week to the full dose of 60 to 80 mg/kg/day divided twice or three times daily (up to a maximum dose of 4 g daily)
    • Supplemental folic acid (1 mg/day) should be given to all patients taking sulfasalazine
    • Can  be compounded
  • Uses:
    • Ulcerative Colitis
      • Oral and rectal forms
      • Oral therapy effective for induction and maintenance of remission
      • Rectal + oral: More effective than just oral for distal disease
    • Crohn’s disease
      • Efficacy unclear for induction or maintenance of remission
  • 6-mercaptopurine/Azathioprine (Imuran)
    • 6-MP Dose: 1-1.5 mg/kg/day oral
    • Azathioprine: 2-2.5mg/kg/day oral
    • 3 months to act, should not be used for induction
    • Uses: UC and Crohn’s
    • Long term use: Check levels (max 250) – check after induction and then depending on patient
    • TPMT genotyping before starting treatment and 8 weeks after check mercaptopurine metabolites
    • CBC with differential should be measured at least every other week while the doses are being adjusted and at least once every 3 months as clinically indicated because of the risk of bone marrow suppression. Liver function tests also should be measured periodically 
    • Risks of Hepato-splenic T cell lymphoma and non Hodgkin lymphoma
  • Methotrexate
    • Dose: 15mg/m2/week IM/SQ induction with 10-15mg/m2/week maintenance, max 25mg day
    • Supplement with folic acid 1mg/day
    • Uses:
      • Only Crohn’s
      • 8 weeks to work should not be used for induction
      • Used when patients are no surgical candidates or failed 6-MP
    • Hepatotoxicity common therefore monitor hepatic enzymes
      • Check q2 weeks and after 1 month of therapy q3 month
  • Anti –TNF
    • Infliximab (Remicade)
      • IV, infusion over 2 hours, pre-medications (Tylenol + Benadryl)
      • Induction: 5-10mg/kg at 0,2,6 weeks
      • Maintenance: q4-8 weeks
    • Adalimumab (Humira)
      • SQ, No need pre-medication
      • Moderate to severe Crohn’s disease 6 years and older
        • (6 years or older, 17 to less than 40 kg) 80 mg subQ on day 1, followed by 40 mg subQ 2 weeks later on day 15, and then 20 mg subQ every other week starting at week 4 on day 29
        • 6 years or older, 40 kg or greater) 160 mg subQ on day 1 (given in 1 day or split over 2 consecutive days), followed by 80 mg subQ 2 weeks later on day 15, and then 40 mg subQ every other week starting at week 4 on day 29
      • Moderate to severe ulcerative colitis 5 years and older
        • (5 years or older, 20 to less than 40 kg) 80 mg subQ on day 1, 40 mg on day 8, and 40 mg on day 15, followed by 40 mg subQ every other week or 20 mg subQ every week starting on day 29
        • (5 years or older, 40 kg or greater) 160 mg subQ on day 1 (given in 1 day or split over 2 consecutive days), 80 mg subQ on day 8, and 80 mg subQ on day 15 followed by 80 mg subQ every other week or 40 mg subQ every week starting on day 29. Continue the recommended pediatric dosage in patients who become 18 years old and are well-controlled
  • Antagonist to α4β7 Integrin
    • Vedolizumab (Entyvio)
      • IV, 5-7mg/kg. Max 300mg.
      • 0, 2, 6weeks induction then q8 weeks.
      • Level: Before 3rd dose of induction and then depending on the patient, before next dose
      • Not FDA approved for pediatrics. FDA approved for moderate to severe Crohn’s disease or ulcerative colitis for those 18 years or older.
  • Anti IL12/23
    • Ustekinumab (Stelara)
      • First IV once (over 1 hour), then q4-8 weeks next SQ
      • Induction (IV)
        • < 56kg: 260mg, 2 vials
        • 56-85kg: 390mg, 3 vials
        • >85kg: 520mg, 4 vials
      • Maintenance
        • Starting 8 weeks after induction dose, 90mg q8 weeks
      • Used in Crohn’s > ulcerative colitis
      • Not FDA approved for pediatrics. FDA approved for moderate to severe Crohn’s disease or ulcerative colitis for those 18 years or older.
  • Jak Inhibitor
    • Tofacitinib (Xeljanz)
      • Oral
      • Induction: XELJANZ 10 mg twice daily or XELJANZ XR 22 mg once daily for 8 weeks
      • If needed, continue for a maximum of 16 weeks
      • Discontinue if after 16 weeks the therapeutic response is not achieved
      • Maintenance: XELJANZ 5 mg twice daily or XELJANZ XR 11 mg once daily
      • Not FDA approved for pediatrics. FDA approved for moderate to severe ulcerative colitis for those 18 years or older.
      • Black Box Warning: Increased risk of blood clots (1.5- 3x), CHD, malignancy, and death

Motility

Motility

Drug Class Drug Oral Dose Indication / Where It Works Side Effects
Antibiotic Erythromycin
  • 3 mg/kg/dose (1-6mg/kg/dose) TID (20-30 min before meals)
  • Max 250mg QID
  • IV dose 3 mg/kg TID
Gastroparesis, upper GI symptoms
  • Tachyphylaxis, diarrhea, abdominal cramping
  • QT prolongation
  • Antibiotic resistance
Azithromycin
  • 250 mg BID * evidence unknown
  • Max 500 mg/d
  • IV dose same
Gastroparesis, upper GI symptoms
  • Tachyphylaxis, diarrhea, abdominal cramping
  • QT prolongation
  • Antibiotic resistance
Augmentin
  • 2.5-4 mg/kg/dose BID
  • Max 250 mg per dose, 500 mg per day
Small bowel prokinetic Antibiotic resistance, C. diff
Dopamine antagonist Metoclopramide (Reglan)
  • 0.1-0.2mg/kg/dose 10mg/dose (max) 15 min before meals and at BT (4x/D),
  • Max 40 mg per day, 12 weeks duration
  • Find lowest effective dose
Gastroparesis
  • Parkinsonian symptoms esp in adolescent females
  • Higher risk of EPS if used >12weeks
  • QT prolongation
D2 receptor antagonist Domperidone (Motilium)
  • 0.1-0.2 mg/kg/dose (Max10 mg/dose TID), can increase to 20 mg QID before meals and BT (in >18 years)
Gastroparesis, also increases duodenal motility
  • Cardiotoxicity, QT prolongation
  • Only available in Canada and other countries or through IND in USA.
  • Galactogogue
5-HT4 agonist/5-HT3 antagonist Cisapride (Prepulsid)
  • (0.1-0.2mg/kg/dose) up to max 10mg /dose(max 20mg >18years) QID, 30 min before meals and BT
  • MAX 1 mg/kg/day or 60-80 mg daily
Whole gut motility
  • Cardiotoxicity – P450 interaction, QT prolongation
  • compassionate use or IND only – strict inclusion and exclusion criteria – refractory GERD, gastroparesis or constipation
Selective 5-HT4 agonist (no cardiac effects) Prucalopride (Motegrity)
  • <30 kg: 0.5 mg daily
  • >30 kg 1 mg daily
  • Can go to 2 mg daily if not seeing effect
Whole gut motility but approved for refractory constipation – only one peds trial and wasn’t superior to placebo Headaches, URI
Antagonist of multiple receptors – serotonin, H1, muscarinic, calcium channel Cyproheptadine (Periactin)
  • 0.25 mg/kg/day in 2-3 divided doses
  • Max 12 mg in <6 years
  • Max 16 mg 7-14 years
Upper GI symptoms and pain. FAP, FD, CVS, abdominal migraines
  • Sedation
  • Increased appetite
  • Dizziness (drink water)
Antidepressant, tetracyclic Mirtazapine (Remeron)
  • 7.5 mg, 15 mg, or 30 mg at bedtime (higher doses for psych indications)
FD, FN, FE, CVS, anxiety Appetite stimulation at lower doses (7.5 mg, 15 mg). More sedating at lower doses (7.5 mg) because more antihistamine and alpha agonist action. Higher doses like 30-45 mg – more serotonin and norepi action.
Antidepressant, TCA Amitriptyline (Elavil)
  • 10-50 mg at bedtime
FAP, IBS-D, FD, CVS (>5 years), anxiety QT prolongation, constipation
Chloride channel activator Lubiprostone (Amitiza) (not FDA approved in children <18)
  • 8 mcg BID, 16 mcg BID, 24 BID daily
  • Dose with food to avoid nausea
Restores barrier function, hydrates stool. Works similarly to osmotic laxative if miralax isn’t working or pill is preferred. Does not help with motility or pain in IBS Nausea
Guanylate cyclase-C receptor agonist Linaclotide (Linzess) (not FDA approved in children <18)
  • 72 mcg, 145 mcg (CIC), 290 mcg (IBS-C) daily
  • Dose 30 min before breakfast to avoid diarrhea
  • Take at same time every day
  • Black box warning in <6 years because pups died from dehydration
IBS-C, Chronic idiopathic constipation. Treats both pain and increases intestinal fluid via stimulating secretion of chloride, bicarb, and water into lumen via CFTR ion channel activation Diarrhea
Plecanitide (Trulance) (not FDA approved in children <18))
  • 3 mg, 6 mg daily – seem to both be effective
  • Unlike linaclotide, don’t have to take at same time every day or with food
IBS-C, FC Diarrhea
Somatostatin analogue Octreotide (Sandostatin)
  • 1 ucg/kg SQ[KJ1]  daily or 0.5 ucg/kg IV BID
Increases small bowel motility – relieves nausea and vomiting via inhibiting release of GI hormones and secretion Delayed gastric emptying
Acetylcholinesterase inhibitors Pyridostigmine
  •  0.-25-2.0mg/kg/day
Increases acetylcholine at NMJ promoting intestinal contractions
Muscle relaxant Baclofen
  • 0.5mg/kg
Inhibitory role on the lower esophageal sphincter relaxation through its stimulation of gamma-aminobutyric acid B (GABA) receptors, improving delayed gastric emptying

Constipation

  • psyllium or methylcellulose 1 tbsp TID

  • polycarbophil 2-4 tabs per day

  • wheat dextrim 1-3 caplets, 2 tsp 1-3x/day

  • Polyethylene glycol 3350 (Miralax): 0.4 to 0.8 g/kg/day. Max 1 cap = 17g BID, often dosed ¼ cap, 1/2cap or 1 cap
    • Use 8oz for every 17g
  • Lactulose (70% solution) 1 ml/kg 1-2x per day or 15-30ml 1x/d (max 60mL/d)
  • Sorbitol 1 ml/kg 1-2x per day or 15-30ml 1x/d (max 30mL/d)
  • Magnesium hydroxide (milk of magnesia)
    • 1-11 years old: 1-3ml/kg/day of 400mg/5mL solution (max 60mL/day)
    • 12y+: 30-60 ml/d of 400mg/5ml OR 15-50mL/d of 800mg/5ml solution
    • Can be given as single or divided doses
  • Magnesium sulfate: 2-4 teaspoons in 8oz 1-2x/day
  • Magnesium citrate: 200ml 1x/day
  • Fleet enemas (NaPhos): > 2y: 6ml/kg (max 135mL)
  • Senna (syrup, 8.8 mg sennosides/5 mL; or tablets, 8.6 mg sennosides/tab)

    • 1-2y: 1.25- 2.5ml 1-2x/day

    • 2-6y: 2.5-3.75ml 1-2x/day

    • 6-12y: 5-7.5ml (1-2 tabs) 1-2x/day

    • 12y+: 5-15ml (1-3 tabs) 1-2x/day

  • Bisacodyl (5mg tablets or 10mg suppositories)

    • 2-12y: 1-2 tabs or 0.5-1 suppository 1x/day

    • 12y+: 1-3 tabs or 1 suppository 1x/day

  • Glycerin suppositories

    • 2-5y: 1 pediatric suppository

    • 6y+: 1 adult suppository

    • For children < 5y: ½ suppositories have been used but evidence is lacking.

  • Mineral oil (caution to avoid in individuals at risk for aspiration: infants, neurologically impaired children or significant GERD)

    • 1-11 years old: 1-3ml/kg/day (max 45mL/day)

    • 12y+: 15-45ml 1x/day

(Adult dosing, pediatric dosing being established, FDA-approved >18y)

  • Chloride Channel Activators
    • Lubiprostone: 12 mcg daily, can titrate up to 24mg twice daily
  • Guanylate Cyclase Activators
    • Linaclotide 72-145 mcg 1x/day, can increase to 290mcg 1x/day
    • Plecanatide 3mg 1x/day
  • 5HT4 agonist
    • Prucalopride 2mg/day

Nausea & Vomiting

  • 5HT-3 Receptor Agonists
    • Ondansetron
      • 0.3mg/kg/dose up to max of 16mg for the initial dose
      • Q4-6 hours
      • Max dose of 32mg in 24 hours
    • Ganisetron
      • IV: 40 mcg/kg as a single daily dose
      • Oral: 40 mcg/kg/dose every 12 hours
  • Dopamine receptor agonists
    • Reglan
      • 0.1-0.2mg/kg/dose 10mg/dose (max) 15 min before meals and at BT (4x/D),
      • Max 40 mg per day, 12 weeks duration
      • Find lowest effective dose
    • Domperidone
      • 0.1-0.2 mg/kg/dose (Max10 mg/dose TID), can increase to 20 mg QID before meals and BT (in >18 years)
    • Benadryl
      • 0.5 to 1 mg/kg
      • 25mg every 4-6 hours or 50mg every 6-8 hours
  • Aprepitant
    • NK1 receptor antagonist
    • Infants ≥6 months and Children <12 years weighing 6 to <30 kg: Oral: Oral suspension: 3 mg/kg  on day 1, then 2 mg/kg/dose once daily on days 2 and 3
    • Children <12 years weighing ≥30 kg, Children ≥12 years, and Adolescents: Oral suspension: 125 mg on day 1, followed by 80 mg once daily on days 2 and 3
  • Cyproheptadine (Pericatin)
    • 2-6 years: 2mg BID or TID, max 12mg/day
    • >7 y/o: 4mg BID or TID, max 16mg/day
  • Scopolamine
    • Muscarinic acetylcholine receptor antagonist
      • Transdermal 1mg patch, change q72hrs
      • Oral: 0.25 to 0.8mg, can go up to TID
  • CB1 receptor agonists
    • Dronabinol, nabilone

IBS

IBS

Drug Class Drug Oral Dose Indication / Where It Works Side Effects
Laxative Polyethylene glycol (Miralax)
  • 0.2 to 1 g/kg/day, titrate to effect
Constipation/IBS-C - Osmotic laxative leading to water retention in gut lumen Diarrhea, electrolyte disturbances, metabolic acidosis, unclear association with neuropsychiatric events
Linaclotide (Linzess)
  • 72mcg-290mcg in 72mcg increments
Use in IBS-C. Guanylate cyclase C agonist increases chloride and bicarbonate secretion into intestinal lumen via CFTR channel. Diarrhea. Black box warning in children <6yo. Warning for children 6-18 due to single dose causing lethal diarrhea in neonatal mouse model.
Lubiprostone (Amitiza)
  • 8mcg BID for IBS (higher dosing for constipation. No pediatric dosing available)
Use in IBS-C. Chloride channel activator Diarrhea. Recommended negative pregnancy test and contraception during use in women of childbearing potential. No safety data established in children.
Antispasmodic Dicyclomine (Bentyl)
  • 6 months to <2 years: Oral: 5 to 10 mg 3 to 4 times daily
  • ≥2 years Oral: 10 mg 3 to 4 times daily
  • Adolescents 10-20mg 3-4x/day
Inhibit parasympathetic acetylcholine signaling CNS effects: drowsiness, blurry vision. Diarrhea. Anhidrosis. Psychosis/delirium.
Hyoscyamine (Hyocyne, Levsin
  • Infants: drops 0.125mg/mL - <5kg: 4 drops; 5-7kg: 5 drops; 7-10kg: 6 drops; >10kg: 8 drops. Q4hr prn. Multiple formulations available for older children. Sublingual tablets 0.125-0.25mg q4hr PRN
  • Multiple formulations and routes exist.
Inhibit parasympathetic acetylcholine signaling Contraindicated with myasthenia, obstructive GI diseases, ileus. CNS effects: drowsiness/blurry vision. Diarrhea. Anhidrosis. Psychosis
Herbal remedy Peppermint oil
  • Adult dosing max dose 1200mg/day. Typically 180-200mg up to 3x/day.
  • Reduce pain, bloating in patients with IBS-C or IBS-D. More useful for lower GI symptoms. May attenuate visceral hypersensitivity.
  • Anti-spasmodic properties of L-menthol. Possible analgesic effects via TRPM8 agonism.
Refer to specific formulations. Allergic reaction, heartburn, contact sensitivity/burns/skin necrosis/dermatitis
Herbal mixture Iberogast
  • >12 – 20 drops TID premeals or with meals
  • 6-12 15 drops TID
  • <6 10 drops TID
Functional dyspepsia, IBS Hepatotoxicity—extremely rare but would avoid in patient with liver disease
Tri-cyclic anti-depressants Amitriptyline (Elavil)
  • No pediatric dosing specifically for IBS. Adults 10-25mg qhs with max 75mg. Pediatric 0.1mg/kg-2mg/kg titrate up slowly over several weeks
Inhibit reuptake of synaptic serotonin/norepinephrine Anticholinergic effects, QTc prolongation, CNS depression, Mania in bipolar disorder, Suicidal thinking. Should not be discontinued abruptly.
Nortriptyline (Pamelor)
  • Neuropathic pain dosing 0.05-1mg/kg qhs. Max 3mg/kg/d (150mg/d) can titrate up as often as every 3 days.
- inhibit histamine/5-HT/acetylcholine activity, increase post-synaptic serotonin/norepinephrine Suicidal thinking/behavior, Anticholinergic effects, CNS depression, QTc prolongation, Mania in bipolar disorder. Should not be discontinued abruptly.
Antidiarrheal Loperamide (Imodium)
  • 2-5yo: 1mg/dose; 6-8yo: 2mg/dose (max 4/day);
  • 9-11yo: 2mg/dose (max 6mg/day);
  • >12yo: 4mg/dose (max 8mg/day). Higher doses utilized with other causes of chronic diarrhea (SBS, intestinal failure).
  • Diarrhea
  • Inhibit peristalsis and prolong transit time by action on circular/longitudinal muscles via opioid receptors.
Constipaiton, abdominal pain/distention, ileus. Black Box warning: Torsades de pointes. Avoid in patients with risk for prolonged QT.
Fiber Supplementation
  • Various formulations.
  • Dose: (Age + 5g)/day
  • Soluble fiber absorbs water in intestine and promotes peristalsis to reduce transit time.
  • Insoluble fiber creates stool bulk.
Cramps, constipation or diarrhea
Analgesic Pregabalin (Lyrica)
  • Fibromyalgia dosing: adolescents – 37.5mg BID x1 week then titrate up weekly (150mg-max450mg/day divided BID)
  • Pain/bloating.
  • Alpha-2-delta subunit of voltage-gated Calcium channels in CNS. Inhibit excitatory neurotransmitter release.
Agioedema, weight gain, Xerostermia, CNS/ophthalmic complaints. Need gradual withdrawal.
Gabapentin (Neurontin)
  • Neuropathic pain dosing: 5mg/kg/dose (increase from qhs à BID à TID over 3 days). Titrate dose typically 8-35mg/kg/day divided TID)
  • Pain/bloating.
  • Modulation of excitatory neurotransmitter release via alpha-2-delta subunit binding in voltage-gated calcium channels.
Viral infection, Drowsiness, dizziness. Need gradual withdrawal.
Antibiotic Rifaxamin (Xifaxin)
  • Adult IBS dosing: 550mg TID x14 days.
  • Pediatric SIBO dosing -  3-8yo: 200mg TID, >8yo: 200-550mg TID 7-14 days
  • Bloating, diarrhea
  • Inhibit bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase. Minimally absorbed.
Nausea, elevated ALT, peripheral edema, dizziness, fatigue.
SSRI Fluoxetine (Prozac)
  • Starting 5-10mg daily. Titrate to 10-20mg daily. Slow increase q3 weeks. Adolescents max 60mg/d. No IBS dosing
Inhibit CNS neuron presynaptic serotonin reuptake. Increasing suicidality. QT prolongation, CNS depression, nausea/diarrhea
Sertraline (Zoloft)
  • 25-50mg/d. Max 200mg/d. Slow titration q3-4 weeks
Inhibit CNS neuron presynaptic serotonin reuptake. Increasing suicidality, QTc prolongation, CNS depression, restlessness, hyperkinesis, hyperactivity, agitation.
Citalopram (Celexa)
  • Children >7yo: 10mg daily. Increase by 10mg every 1-2 weeks. Typically, 20-40mg/day
Inhibit CNS neuron presynaptic serotonin reuptake. Increasing suicidality, QTc prolongation, Somnolence, insomnia, nausea, diarrhea. Should not stop abruptly.
Opioid receptor agonist/antagonist Eluxadoline (Viberzi) Adult dosing 100mg BID. IBS-D, Mixed mu-opiate agonist and delta-opiate antagonist Acute pancreatitis. Constipation. Contraindicated in patients without gallbladder or with hepatic impairment.
Other classes of medications that have shown varying degrees of success in treating symptoms of IBS include prokinetics (e.g., domperidone), acid suppressing agents (e.g., PPIs), antihistamines (e.g., cyproheptadine) and probiotics. Also consider psychological interventions including cognitive behavioral therapy when appropriate.

Liver Transplant

  • Immunosuppressants
    • Initial Therapy/Maintenance
    • Steroids
      • Methylprednisolone, Prednisone
      • SE: immune suppression, delayed wound healing, hypertension, hypernatremia, edema, hyperglycemia, Gi irritation
    • Tacrolimus
  • Calcineurin inhibitor
  • Anti-rejection
    • SE: nausea, vomiting, abdominal pain, hypertension, headache
    • Long term SE: nephrotoxicity, diabetes mellitus
    • Mycophenolate motifil
      • Inhibitor of IMPDH production
    • Acute Cellular Rejection
      • Sirolimus or evrolimus
        • mTOR inhibitor
        • PO
        • SE: nausea, vomiting, diarrhea, hypokalemia, anemia, thrombocytopenia, dyslipidemia
      • Rituximab
        • Monoclonal antibody – induces apoptosis in B cells
        • SE: peripheral edema, nausea, vomiting, anemia, neutropenia, muscle spasms, fever
      • Cyclosporine
        • PO vs. IV
        • SE: immune suppression, nausea, vomiting, diarrhea, hypertension, leg cramps
        • Long term: hirsutism, gingival hyperplasia, lymphocytopenia
      • Thymoglobulin
        • Reduces # of T-cells
        • IV
        • SE: severe immune suppression, thrombocytopenia, fever, back pain, red man syndrome
      • Campath (alemtuzumab)
        • IV
      • SE: rigors, fevers, hypertension, hypotension, dyspnea, rash, urticaria, anaphylaxis
  • Prophylaxis
      • Anti-viral: valganciclovir to prevent CMV
      • Anti-bacterial: trimethoprim- sulfamethoxazole
      • Anti-fungal: fluconazole
  • LiverTox: resource to determine if medication causes hepatoxicity

Pancreatic Enzyme Replacement Therapy

Types
  • Creon, Pancreze, Pertzye, Viokace, Zenpep come as capules
  • Relizorb- cartridge attached to tube feeding
Dosing
  • Infants generally require 450-900 lipase units/g of fat, OR 2,000–4,000 lipase units per 120 ml of formula or when breastfeeding. Infants generally ingest a higher amount of fat/kg of body weight than do adults.
  • Older children and adults generally require 500–4,000 lipase units per gram of fat ingested (mean, 1,800 lipase units/g of fat), OR 500-2,500 lipase units/kg/meal, 250-1,250 lipase units/kg/snack, with three meals and two to three snacks per day. It is suggested that initial dosing be in the lower range and titrated up as needed to treat malabsorption.
  • Older children and adults generally require 500–4,000 lipase units per gram of fat ingested (mean, 1,800 lipase units/g of fat), OR 500-2,500 lipase units/kg/meal, 250-1,250 lipase units/kg/snack, with three meals and two to three snacks per day. It is suggested that initial dosing be in the lower range and titrated up as needed to treat malabsorption.