lansoprazole
Pharmacologic class: Gastric acid pump inhibitor
Therapeutic class: Antiulcer drug
Pregnancy risk category B
Action
Inhibits activity of proton pump in gastric parietal cells, decreasing gastric acid production
Availability
Capsules (delayed-release): 15 mg, 30 mg
Granules for oral suspension (delayed-release, enteric-coated): 15 mg, 30 mg
Prevpac (combination product for Helicobacter pylori infection): daily pack containing two 30-mg lansoprazole capsules, four 500-mg amoxicillin capsules, and two 500-mg clarithromycin tablets
Prevacid NapraPAC 375 (combination product for reducing risk of ulcers from nonsteroidal anti-inflammatory drugs [NSAIDs]): weekly pack containing seven 15-mg Prevacid capsules and fourteen 375-mg Naprosyn tablets
Prevacid NapraPAC 500 (combination product for reducing risk of ulcers from NSAIDs): weekly pack containing seven 15-mg Prevacid capsules and fourteen 500-mg Naprosyn tablets
Prevacid SoluTab (delayed-release, orally disintegrating tablet): 15 mg, 30 mg
Indications and dosages
➣ Active duodenal ulcer
Adults: 15 mg P.O. daily for 4 weeks
➣ Maintenance of healed duodenal ulcer
Adults: 15 mg P.O. daily
➣ H. pylori eradication, to reduce risk of duodenal ulcer recurrence
Adults: In triple therapy, 30 mg lansoprazole P.O., 1 g amoxicillin P.O., and 500 mg clarithromycin P.O. q 12 hours for 10 or 14 days. In dual therapy, 30 mg lansoprazole P.O. and 1 g amoxicillin P.O. q 8 hours for 14 days.
➣ Benign gastric ulcer
Adults: 30 mg P.O. daily for up to 8 weeks
➣ Gastric ulcer associated with NSAIDs
Adults: 30 mg P.O. once daily for up to 8 weeks
➣ To reduce risk of NSAID-associated gastric ulcer
Adults: 15 mg P.O. daily for up to 12 weeks
➣ Gastroesophageal reflux disease
Adults and children ages 12 to 17: 15 mg P.O. daily for up to 8 weeks
Children ages 1 to 11 weighing more than 30 kg (66 1b): 30 mg P.O. daily for up to 12 weeks
Children ages 1 to 11 weighing 30 kg (66 lb) or less: 15 mg P.O. daily for up to 12 weeks
➣ Erosive esophagitis
Adults and children ages 12 to 17: 30 mg P.O. daily for up to 8 weeks. Some patients may require 8 additional weeks.
Children ages 1 to 11 weighing more than 30 kg (66 lb): 30 mg P.O. daily for up to 12 weeks
Children ages 1 to 11 weighing 30 kg (66 lb) or less: 15 mg P.O. daily for up to 12 weeks
➣ To maintain healing of erosive esophagitis
Adults: 15 mg P.O. daily
➣ Pathologic hypersecretory conditions (including Zollinger-Ellison syndrome)
Adults: Initially, 60 mg P.O. daily, to a maximum of 90 mg P.O. b.i.d. Divide daily dosages over 120 mg.
➣ Frequent heartburn (two or more times a week)
Adults: 15 mg P.O. (delayed-release capsule) daily up to 14 days
Dosage adjustment
• Significant hepatic insufficiency
Contraindications
• Hypersensitivity to drug or its components
Precautions
Use cautiously in:
• phenylketonuria (orally disintegrating tablets), severe hepatic impairment
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 18.
Administration
• Give oral form before meals.
• If patient has difficulty swallowing delayed-release capsule, open it and sprinkle contents onto small amount of soft food, such as applesauce or pudding. Don't crush or let patient chew drug.
• When giving orally disintegrating tablet, place tablet on patient's tongue and let it disintegrate until particles can be swallowed.
• Know that orally disintegrating tablet contains phenylalanine.
• When giving oral suspension, empty packet contents into container with 2 tbsp water. Stir contents well, and have patient drink immediately. Don't give oral suspension through nasogastric (NG) tube.
• When injecting contents of delayed-release capsule through NG tube, open capsule and mix granules with 40 ml apple juice. Then rinse tube with additional apple juice to clear.
Adverse reactions
CNS: headache, confusion, anxiety, malaise, paresthesia, abnormal thinking, depression, dizziness, syncope, cerebrovascular accident
CV: chest pain, hypertension, hypotension, myocardial infarction, shock
EENT: visual field deficits, otitis media, tinnitus, epistaxis
GI: nausea, diarrhea, abdominal pain, cholelithiasis, ulcerative colitis, esophageal ulcer, hematemesis, stomatitis, dysphagia, GI hemorrhage
GU: renal calculi, erectile dysfunction, abnormal menses, breast tenderness, gynecomastia
Hematologic: anemia
Musculoskeletal: hip, wrist, spine fractures (with long-term daily use)
Respiratory: cough, bronchitis, asthma
Skin: urticaria, alopecia, acne, pruritus, photosensitivity
Interactions
Drug-drug. Drugs requiring acidic pH (such as ampicillin esters, digoxin, iron salts, itraconazole, ketoconazole): decreased absorption of these drugs
Sucralfate: decreased lansoprazole absorption
Theophylline: increased theophylline clearance
Drug-food. Any food: decreased rate and extent of GI drug absorption
Drug-herbs. Male fern: inactivation of herb
St. John's wort: increased risk of photosensitivity
Patient monitoring
• Monitor for GI adverse reactions.
• Assess nutritional status and fluid balance to identify significant problems.
Patient teaching
• Instruct patient to take before meals.
• If patient has difficulty swallowing, tell him to open delayed-release capsule and sprinkle contents onto small amount of soft food (such as applesauce or pudding). Emphasize that he must not crush or chew drug.
• Tell patient to take orally disintegrating tablet by placing it on tongue and letting it disintegrate.
• Instruct patient to take oral suspension by emptying packet contents into container with 2 tbsp water. Tell him to stir contents well and drink immediately.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above.