LANSOPRAZOLE

LANSOPRAZOLE
(lan'so-pra-zole)
Prevacid, Prevacid IV
Classifications: antisecretory; proton pump inhibitor;
Therapeutic: antiulcer
; antisecretory; proton pump inhibitor
Prototype: Omeprazole
Pregnancy Category: B

Availability

15 mg, 30 mg sustained release capsules; 15 mg, 30 mg orally disintegrating tablets; 15 mg, 30 mg packets for suspension; 30 mg powder for injection

Action

Belongs to a class of antisecretory compounds that are gastric acid pump inhibitors. Specifically, it suppresses gastric acid secretion by inhibiting the H+, K+-ATPase enzyme [the acid (proton H+) pump] in the parietal cells.

Therapeutic Effect

Suppresses gastric acid formation in the stomach.

Uses

Short-term treatment of duodenal ulcer (up to 4 wk) and erosive esophagitis (up to 8 wk), pathologic hypersecretory disorders, gastric ulcers; in combination with clarithromycin and amoxicillin for Helicobacter pylori. Gastroesophageal reflux disease (GERD).

Contraindications

Hypersensitivity to lansoprazole, severe hepatic impairment, proton pump inhibitors (PPIs) hypersensitivity, lactation, infants.

Cautious Use

Hepatic disease, pregnancy (category B).

Route & Dosage

Duodenal Ulcer
Adult: PO 15 mg once daily x 4 wk

Erosive Esophagitis
Adult: PO 30 mg once daily x 8 wk, then decrease to 15 mg once daily IV 30 mg once daily for up to 7 d

GERD
Adult: PO 15 mg once daily for up to 8 wk
Child (1–11 y): PO 1.5 mg/kg/d (max: 30 mg/d)

Hypersecretory Disorder
Adult: PO 60 mg once daily (max: 120 mg/d in divided doses), may need to be adjusted for hepatic impairment

H. pylori
Adult: PO 30 mg b.i.d. x 2 wk, in combination with 2 antibiotics

Hepatic Impairment
Dose reduction required in severe hepatic disease.

Administration

Oral
  • All forms: Administer dosage 30 min a.c. Give once daily dose before breakfast.
  • Give at least 30 min prior to any concurrent sucralfate therapy.
  • Do not crush or chew capsules. Capsules can be opened and granules sprinkled on food or mixed with 40 mL of apple juice and administered through an NG tube. Do not crush or chew granules.
  • Note: Disintegrating tablets contain phenylalanine and should not be used for patients with PKU. Capsule and syrup formulations do not contain phenylalanine.
Intravenous

PREPARE: IV Infusion: Add 5 mL of sterile water for injection to each 30 mg vial to yield 6 mg/mL. Swirl gently to mix. Further dilute in 50 mL of NS, RL, or D5W. If reconstituted with NS or LR, administer within 24 h. If reconstituted with D5W, administer within 12 h.  

ADMINISTER: IV Infusion: Infuse over 30 min through the in-line filter provided. Use a dedicated line or a Y-site; flush Y-site with NS before and after administration. Do NOT give IV push. Immediately stop infusion if precipitation or discoloration occurs.  

INCOMPATIBILITIES Solution/additive, Y-site: Do not administer with other drugs or diluents.

  • Reconstituted solution can be held for 1 h at 25° C (77° F) before further dilution.

Adverse Effects (≥1%)

CNS: Fatigue, dizziness, headache. GI: Nausea, diarrhea, constipation, anorexia, increased appetite, thirst, elevated serum transaminases (AST, ALT). Skin: Rash.

Interactions

Drug: May decrease theophylline levels. Sucralfate decreases lansoprazole bioavailability. May interfere with absorption of ketoconazole, digoxin, ampicillin, or iron salts. Use with warfarin may increase INR. May alter tacrolimus concentration. Food: Food reduces peak lansoprazole levels by 50%.

Pharmacokinetics

Absorption: Rapidly from GI tract after leaving stomach; unstable in acidic media. Onset: Acid reduction within 2 h; ulcer relief within 1 wk. Peak: 1.5–3 h. Duration: 24 h. Distribution: 97% bound to plasma proteins. Metabolism: In liver via CYP2C19 and 3A4. Elimination: 14–25% in urine as metabolites; part of dose eliminated in bile and feces. Half-Life: 1.5 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Monitor CBC, kidney & liver function tests, and serum gastric levels periodically.
  • Monitor for therapeutic effectiveness of concurrently used drugs that require an acid medium for absorption (e.g., digoxin, ampicillin, ketoconazole).

Patient & Family Education

  • Inform physician of significant diarrhea.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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