Lansoprazole

Antipeptic Ulcerant · Proton pump inhibitor

Indications

Duodenal and gastric ulcer, reflux oesophagitis, peptic lesions unresponsive to conventional treatment. H. pylori eradication in combination with antibiotics, NSAID-associated duodenal and gastric ulcer, prophylaxis of NSAID-associated duodenal and gastric ulcer, Zollinger-Ellison syndrome and other hypersecretory conditions, severe oesophagitis, acid-related dyspepsia.

Dosage

ORAL: Adults: Reflux oesophagitis: 30 mg once daily for 4-8 wk. If required, treatment may be continued for further 4 wk. Maintenance 15-30 mg once daily in the morning. Duodenal ulcer: 30 mg once daily in the morning for 4 wk. Maintenance 15 mg once daily. Gastric ulcer: 30 mg once daily in the morning for 8 wk. Peptic ulcer not responsive to conventional therapy: 30 mg once daily for 4 wk. H.pylori eradication in combination with amoxicillin and clarithromycin, or in combination with amoxicillin and metronidazole, or in combination with clarithromycin and metronidazole: 30 mg twice daily. NSAID-associated duodenal ulcer and gastric ulcer: 30 mg once daily for 4 wk, if required treatment may be continued for further 4 wk. Prophylaxis of NSAID-associated duodenal and gastric ulcer: 15-30 mg once daily. Zollinger-Ellison syndrome (and other hypersecretory conditions): 60 mg once daily,…

Administration

Administer as IV inf over 30 mins. Flush line with NS, lactated Ringer’s solution, or D5W before and after giving lansoprazole. Reconstitution: Reconstitute parenteral form by injecting 5 mL sterile water into 30 mg drug vial. Mix gently until powder dissolves. Use within 1 hour. After reconstitution, dilute with 50 mL NS, lactated Ringer’s solution or D5W. Give within 12 hours if mixed with D5W or 24 hours if mixed with NS or lactated Ringer’s solution. Compatibility: Stable in NS, LR, D5W. Y-site administration: Drug to Drug IV Compatibility: Amikacin, ceftriaxone, dexamethasone, fentanyl, fluconazole, gentamicin, heparin, piperacillin/tazobactam. Drug to Drug IV Incompatibility: Aztreonam, calcium gluconate, cephazolin, cefepime, ciprofloxacin, diltiazem, diphenhydramine, dobutamine, dopamine, enalapril, esmolol, famotidine, furosemide, hydrocortisone, hydromorphone, imipenem,…

Adverse Effects

Headache, dizziness, fatigue, malaise, GI disturbances, sore throat, dry mouth, skin irritation, raised liver function values, jaundice, hepatitis, risk of GI infection, fundic gland polyps. Rarely arthralgia, myalgia, peripheral oedema, erythematous or bullous rashes, haematological changes, Stevens-Johnson syndrome, toxic epidermal necrolysis, intestinal nephritis, depression, confusion, hallucinations, gynaecomastia, impotence. Reports of subacute cutaneous lupus erythematosus, colitis (discontinue).

Risk Factor (Pregnancy/Lactation)

Pregnancy: No evidence of risk in humans. Lactation: Contraindicated or not recommended. Precautions: Exclude malignancy before and during treatment. Severe hepatic impairment. Possible increased risk of GI infection. Long-term therapy; risk of hypomagnesaemia, reduced vit B12 absorption and fractures. Elderly.

Interactions

Oral contraceptives, phenytoin, carbamazepine, theophylline, warfarin, antacids, sucralfate, atazanavir, azole antifungals, digoxin, tacrolimus, fluvoxamine, rifampicin, St John's wort, CYP3A4 substrates, methotrexate.

Advice to Patient

Take before meals. Do not chew. Swallow whole. If there is difficulty in swallowing, open the capsule and mix all contents in a tablespoon of applesauce. Swallow immediately without chewing. For delayed-release orally disintegrating tablets, place tablet on tongue and allow it to dissolve with or without water until the particles can be swallowed. It can be taken via oral syringe or nasogastric tube. For delayed-release oral suspension, add contents of packet into a container with 2 tablespoon of water, mix well and drink immediately. If patients have nasogastric tube, do not take oral suspension. Use capsules or orally disintegrating tablets instead. For capsule form, open the capsule, mix granules in 40 mL apple juice only and inject through tube. Flush tube with apple juice only. For disintegrating tablets, place tablet in syringe and draw up 4 mL (for 15 mg tablet) or 8 mL (for 30…

Pharmacokinetics

Onset-of action: Oral: 1-3 hrs. Duration: Oral: >1 day. Absorption: Rapid. Metabolism: Hepatic. Bioavailability: >80%. If given 30 min after meal, decreases 50% to 70%. Half-life elimination: Children: 1.2-1.5 hrs. Adults: 1.5 ± 1 hr. Elderly: 1.9)-2.9 hrs. Hepatic impairment: 4-7.2 hrs. Time to peak, plasma: 1.7 hrs. Excretion: Faeces (67%), urine (33%).

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