Lansoprazole

# Lansoprazole ## Overview - **Classification**: Proton Pump Inhibitor (PPI) - **Mechanism**: Irreversibly blocks the H+/K+-ATPase (proton pump) in gastric parietal cells, suppressing gastric acid secretion. ## Primary Indications 1. **Duodenal Ulcer (DU)** - Short-term treatment 2. **Gastric Ulcer (GU)** - Short-term treatment 3. **Erosive Esophagitis (EE)** - Treatment and maintenance 4. **Gastroesophageal Reflux Disease (GERD)** - Symptomatic relief 5. **Zollinger-Ellison Syndrome (ZES)** - Hypersecretory conditions 6. **H. pylori Eradication** - Part of multi-drug regimen ## Adult Dosing ### Standard Dosing **Duodenal Ulcer** - **Dose**: **15 mg** - **Frequency**: Once daily - **Route**: Oral - **Duration**: 4 weeks **Gastric Ulcer / Erosive Esophagitis (Treatment)** - **Dose**: **30 mg** - **Frequency**: Once daily - **Route**: Oral - **Duration**: Up to 8 weeks **GERD (Non-Erosive)** - **Dose**: **15 mg** - **Frequency**: Once daily - **Route**: Oral - **Duration**: Up to 8 weeks **Zollinger-Ellison Syndrome** - **Dose**: Initially **60 mg** - **Frequency**: Once daily - **Route**: Oral - **Special considerations**: Doses >120 mg/day should be divided. Adjust as needed. **H. pylori Eradication** (Triple Therapy) - **Dose**: **30 mg** - **Frequency**: Twice daily - **Route**: Oral - **Duration**: 10-14 days (with clarithromycin and amoxicillin/metronidazole) ### Dose Adjustments - **Renal Impairment**: No dose adjustment needed. - **Hepatic Impairment**: Reduce dose in severe hepatic impairment. Max **30 mg/day**. - **Elderly Patients**: No general dose adjustment. May have slightly reduced clearance. ## Pediatric Dosing ### Neonates (0-28 days) - Lansoprazole use is generally **not recommended** or well-studied in this age group. - **Special Notes**: Off-label use only, with extreme caution and expert consultation. ### Infants (1-11 months) - **Indication**: GERD/EE - **Dose**: **1.4 mg/kg** - **Frequency**: Once daily - **Maximum**: **15 mg/day** - **Special Notes**: Use oral suspension or sprinkle contents of capsules on soft food. ### Children (1-11 years) - **Indication**: GERD/EE - **Dose**: - **<30 kg**: **15 mg** - **>=30 kg**: **30 mg** - **Frequency**: Once daily - **Maximum**: **30 mg/day** - **Special Notes**: Oral disintegrating tablets (ODT) or sprinkles available. ### Adolescents (12-17 years) - **Indication**: GERD/EE - **Dose**: Follow adult dosing recommendations for specific indications. - **Maximum**: **30 mg/day** for standard indications. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to lansoprazole or its components. - **Absolute**: Co-administration with rilpivirine-containing products (due to reduced rilpivirine exposure). ### Common Adverse Effects - **Common (1-10%)**: Diarrhea, abdominal pain, nausea, headache, dizziness. ### Serious but Rare - **Serious but Rare**: Clostridium difficile-associated diarrhea (CDAD). - **Serious but Rare**: Acute interstitial nephritis (AIN). - **Serious but Rare**: Bone fracture (with long-term, high-dose use). - **Serious but Rare**: Hypomagnesemia (with long-term use). - **Serious but Rare**: Vitamin B12 deficiency (with long-term use). - **Serious but Rare**: Subacute cutaneous lupus erythematosus (SCLE). ### Key Drug Interactions - **Clopidogrel**: May reduce antiplatelet effect. Avoid concomitant use if possible. - **HIV Antivirals (e.g., Atazanavir, Nelfinavir, Rilpivirine)**: Significantly reduced absorption. **Contraindicated** with rilpivirine. - **Methotrexate**: May increase methotrexate levels and toxicity. Monitor. - **Drugs Dependent on Gastric pH (e.g., Ketoconazole, Iron salts, Ampicillin Esters)**: Altered absorption. Separate administration or monitor effect. - **Warfarin**: Increased INR and bleeding risk. Monitor INR closely. ## Monitoring & Follow-up - **Before Treatment**: Consider H. pylori testing if indicated for ulcer/dyspepsia. - **During Treatment**: Symptom resolution. - **During Treatment (Long-term)**: Monitor serum magnesium, calcium, and Vitamin B12 levels periodically. - **Clinical Signs**: Worsening abdominal pain, persistent diarrhea, new bone pain, fatigue. ## Clinical Pearls - 💡 **Tip 1**: Take lansoprazole **before a meal**, preferably in the morning for once-daily dosing. - 💡 **Tip 2**: Capsules can be opened and contents sprinkled on a tablespoon of applesauce, yogurt, cottage cheese, or fruit juice (apple, orange, tomato). Do not crush or chew. - 💡 **Tip 3**: Long-term PPI use (>1 year) is associated with risks of fracture, hypomagnesemia, and B12 deficiency. Periodically re-evaluate the need for continued therapy. - 💡 **Tip 4**: Acute interstitial nephritis (AIN) is a rare but serious adverse effect that can occur at any time during therapy. Discontinue if suspected. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.