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# Arsil dx (Dexlansoprazole)
## Overview
Dexlansoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion by inhibiting the H+/K+-ATPase enzyme system at the secretory surface of the gastric parietal cell. It utilizes a dual delayed-release formulation, allowing for once-daily dosing regardless of food intake.
## Primary Indications
* Healing of erosive esophagitis (EE).
* Maintenance of healed erosive esophagitis.
* Treatment of symptomatic non-erosive gastroesophageal reflux disease (GERD).
## Adult Dosing
* **Healing of Erosive Esophagitis:** 60 mg orally once daily for up to 8 weeks.
* **Maintenance of Healed Erosive Esophagitis:** 30 mg orally once daily for up to 6 months.
* **Symptomatic Non-Erosive GERD:** 30 mg orally once daily for 4 weeks.
## Pediatric Dosing
* **Ages 12 to 17 years:**
* Healing of Erosive Esophagitis: 60 mg once daily for up to 8 weeks.
* Maintenance of Healed Erosive Esophagitis: 30 mg once daily for up to 16 weeks.
* Symptomatic Non-Erosive GERD: 30 mg once daily for 4 weeks.
* **Ages < 12 years:** Safety and efficacy have not been established.
## Dose Adjustments
* **Hepatic Impairment:** Reduce dose in patients with moderate hepatic impairment (Child-Pugh Class B). Consider a maximum daily dose of 30 mg. No specific data for severe impairment (Class C); use with extreme caution if necessary.
* **Renal Impairment:** No dosage adjustment necessary.
## Contraindications
* Known hypersensitivity to dexlansoprazole or any component of the formulation.
* Concomitant use with rilpivirine-containing products.
## Adverse Effects
* **Common:** Diarrhea, abdominal pain, nausea, upper respiratory tract infection, vomiting, flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency (with long-term use), acute interstitial nephritis, and cutaneous/systemic lupus erythematosus.
## Key Drug Interactions
* **pH-Dependent Drugs:** May decrease absorption of antiretrovirals (e.g., rilpivirine, atazanavir), ketoconazole, and iron salts.
* **CYP2C19/3A4 Substrates:** Potential for minor interactions; monitor for increased effects of drugs like methotrexate or tacrolimus.
* **Clopidogrel:** Possible reduced antiplatelet efficacy; consider alternative PPI (e.g., pantoprazole) if interaction is a clinical concern.
## Monitoring
* **Magnesium:** Check baseline and periodically in patients expected to be on long-term treatment or those taking concomitant diuretics or digoxin.
* **Symptom Resolution:** Monitor for improvement; if symptoms persist, evaluate for other etiologies.
* **General:** Periodic assessment for signs of B12 deficiency or osteoporosis risk factors.
## Clinical Pearls
* **Administration:** May be taken without regard to food. Capsules may be opened and sprinkled on applesauce if the patient has difficulty swallowing.
* **Duration:** PPIs should be prescribed at the lowest effective dose for the shortest duration necessary to achieve the clinical goal.
* **Discontinuation:** Consider tapering to manage potential rebound acid hypersecretion upon cessation.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines vary by institution and region. Always verify dosages, contraindications, and drug interactions using current, peer-reviewed clinical decision support tools (e.g., Lexicomp, UpToDate) and local institutional protocols before prescribing.
