lansoprazole

Proton pump inhibitor· Brands: Prevacid, Zoton, LanzorIVPO

Mechanism of action

Lansoprazole is a proton pump inhibitor that irreversibly inhibits the gastric H+/K+ ATPase (proton pump) in the parietal cells of the stomach. This blocks the final step of gastric acid secretion, reducing both basal and stimulated acid production.

Pharmacokinetics

Lansoprazole is administered orally and absorbed from the gut. It is extensively metabolised in the liver by CYP3A4 and CYP2C19. The onset of acid suppression is rapid, but the effect persists for up to 24 hours because the enzyme is irreversibly inhibited. The plasma half-life is short, approximately 1.5 hours, but the pharmacodynamic action is longer.

Indications & dosing

Gastro-oesophageal reflux disease (GERD)

For 4-8 weeks; maintenance dose may be 15 mg once daily.

adult · PO: 30 mg once daily · For 4-8 weeks; maintenance dose may be 15 mg once daily.

Maintenance of GERD healing

Long-term maintenance.

adult · PO: 15 mg once daily · Long-term maintenance.

Peptic ulcer disease (duodenal ulcer)

For 4 weeks; may require additional 2 weeks in smokers.

adult · PO: 30 mg once daily · For 4 weeks; may require additional 2 weeks in smokers.

Gastric ulcer

For 4-8 weeks.

adult · PO: 30 mg once daily · For 4-8 weeks.

Helicobacter pylori eradication

In combination with antibiotics (e.g., clarithromycin and amoxicillin or metronidazole) for 7-14 days.

adult · PO: 30 mg twice daily · In combination with antibiotics (e.g., clarithromycin and amoxicillin or metronidazole) for 7-14 days.

NSAID-associated ulcer prophylaxis

For prevention of dyspepsia/ulcers in patients on long-term NSAIDs.

adult · PO: 15 mg once daily · For prevention of dyspepsia/ulcers in patients on long-term NSAIDs.

Zollinger-Ellison syndrome

Initial dose; adjust based on acid secretion. Higher doses may be needed.

adult · PO: 60 mg once daily · Initial dose; adjust based on acid secretion. Higher doses may be needed.

Reflux oesophagitis in children (1-11 years)

For children weighing 30 kg or more; weight-based dosing for <30 kg.

pediatric · PO: 15 mg once daily · For children weighing 30 kg or more; weight-based dosing for <30 kg.

Contraindications & precautions

Hypersensitivity to lansoprazole or other proton pump inhibitors · Cross-reactivity may occur.
Concomitant use with rilpivirine · PPIs significantly reduce rilpivirine absorption, risking antiretroviral failure.
Use the lowest effective dose for the shortest duration, particularly in long-term therapy.
In patients on long-term treatment, monitor for hypomagnesaemia, vitamin B12 deficiency, and bone fracture risk.
Caution in severe hepatic impairment; consider dose reduction.
May reduce the antiplatelet effect of clopidogrel; avoid if possible or use an alternative in acute coronary syndrome.
Discontinue if signs of hypersensitivity or interstitial nephritis develop.

Adverse effects

Headache
Diarrhoea
Nausea
Abdominal pain
Flatulence
Dizziness
Angioedemaserious
Interstitial nephritisserious
Clostridioides difficile-associated diarrhoeaserious
Hypomagnesaemiaserious

Renal & hepatic adjustment

Hepatic impairment (mild): No dose adjustment required.
Hepatic impairment (moderate): No dose adjustment required.
Hepatic impairment (severe): Reduce dose to 15 mg daily.

Monitoring, pregnancy & toxicity

Symptom resolution · assess after 4 weeks of treatment
Serum magnesium · before starting treatment and periodically during long-term therapy
Serum vitamin B12 · periodically during long-term therapy
Pregnancy: Use only if clearly needed; data are limited but no evidence of harm in pregnancy.
Toxicity: Overdose is unlikely to cause serious toxicity; symptoms may include nausea, vomiting, dizziness, and abdominal pain. · Supportive management; no specific antidote. Monitor patients and treat symptomatically.

Clinical notes

Lansoprazole is used for peptic ulcer disease, gastro-oesophageal reflux disease, and in combination with antibiotics for Helicobacter pylori eradication. It is also used for prevention of NSAID-induced ulcers. Long-term use is associated with hypomagnesaemia, vitamin B12 deficiency, and an increased risk of fractures. Dose adjustment is not usually required in renal impairment, but caution is needed in severe hepatic impairment.

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BNF; local formulary