Lansoprazole

A to Z Drug Facts

 Action Suppresses gastric acid secretion by blocking “acid (proton) pump” within gastric parietal cells.

 Indications Short-term treatment of active duodenal ulcer; to maintain healing of duodenal ulcers; short-term treatment of all grades of erosive esophagitis; long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome; in combination with amoxicillin plus clarithromycin or amoxicillin alone (in patients intolerant or resistant to clarithromycin) for the eradication of H. pylori in patients with active or recurrent duodenal ulcers; short-term treatment and symptomatic relief of active benign gastric ulcer (including NSAID-associated gastric ulcer in patinets who continue NSAID use and for reducing risk of NSAID-associated gastric ulcer in patinets with a history of NSAID-associated gastric ulcer); treatment of heartburn and other symptoms of gastroesophageal reflux disease (GERD).

 Contraindications Standard considerations.

 Route/Dosage

Duodenal Ulcer

Adults: PO 15 mg/day for 4 wk.

Duodenal Ulcer (Healed) Maintenance

Adults: PO 15 mg/day.

Erosive Esophagitis

Adults: PO 30 mg/day for up to 8 wk, an additional 8 wk may be helpful for patients who do not heal. Maintenance: 15 mg/day. Children (1 to 11 yr): PO Weighing over 30 kg: 30 mg/day for up to 12 wk; weighing 30 kg or less: 15 mg/day for up to 12 wk.

Gastric Ulcer

Adults: PO 30 mg/day for up to 8 wk.

GERD

Adults: PO 15 mg/day for up to 8 wk. Children (1 to 11 yr): PO Weighing over 30 kg: 30 mg/day for up to 12 wk; weighing 30 kg or less: 15 mg/day for up to 12 wk.

H. pylori

Adults: PO 30 mg lansoprazole plus 500 mg clarithromycin and 1 g amoxicillin bid for 10 to 14 days, or 1 g amoxicillin alone tid for 14 days.

Pathological Hypersecretory Conditions

Adults: PO Initial dose 60 mg/day. Dosages up to 90 mg bid have been administered. Divide daily doses of more than 120 mg.

 Interactions

Ketoconazole: Effects may be decreased by lansoprazole. Sucralfate: May delay and reduce absorption; give lansoprazole at least 30 min before sucralfate.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Headache. GI: Diarrhea; abdominal pain; nausea.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established in children less than 1 yr. Elderly: Do not exceed 30 mg/day unless additional gastric acid suppression is necessary. Hepatic function impairment: Consider dosage adjustment.

 Administration/Storage

• Take 30 min before meals for up to 8 wk.
• Swallow each capsule whole. Do not open, crush, or chew.
• For patients who have difficulty swallowing capsules, open the capsule and sprinkle the intact granules on 1 tbsp of applesauce and swallow immediately.
• Drink plenty of fluids as the capsules are swallowed.
• Store at room temperature, in tight container away from humidity.

Nasogastric (NG) tube

• For patients who have a NG tube in place, capsules can be opened and the intact granules mixed in 40 mL of apple juice and injected through the NG tube into the stomach. After administering the granules, flush the NG tube with additional apple juice.

 Assessment/Interventions

• Obtain patient history.
• Assess for any symptoms of hyperacidity or acid-related disease (eg, dyspepsia, nausea, vomiting).
• Assess for coffee-ground or bloody emesis, tarry stools, or constipation.
• Obtain baseline AST, ALT, alkaline phosphatase, electrolytes, and liver function studies.

 Patient/Family Education

• Take with food.
• Instruct patient to follow bland diet per nutrition consultation/instructions.
• Stress importance of follow-up appointments with health care provider for laboratory tests and assessment of effectiveness.
• Inform patient that because of the long-lasting effects of this medication on the reduction of gastric secretions, some medications that require an acid gastric pH (eg, ketoconazole, ampicillin, iron preparations, digoxin) may not be well absorbed.
• Advise patient that antacids can be taken while taking lansoprazole.
• Instruct patient to avoid intake of alcoholic beverages while taking this medication.
• Inform patient to call the health care provider if developing any severe side effects such as melena, rectal bleeding, difficulty breathing, hemoptysis, or abnormal muscle movements.
• Instruct patient not to take any OTC medications without checking with health care provider first.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts