lansoprazole

lansoprazole

(lanz ah' pray zol)

Prevacid, Prevacid IV

Pregnancy Category B

Drug classes

Antisecretory

Proton pump inhibitor

Therapeutic actions

Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogen–potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Indications

·        Short-term treatment (up to 4 wk) of active duodenal ulcer

·        Short-term treatment (up to 8 wk) of gastric ulcers

·        Short-term treatment (up to 8 wk) of GERD: Severe erosive esophagitis; poorly responsive symptomatic GERD

·        Long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome, multiple adenomas, systemic mastocytosis)

·        Maintenance therapy for healing of erosive esophagitis, duodenal ulcers

·        Eradication of Helicobacter pylori infection in patients with active or recurrent duodenal ulcers in combination with clarithromycin and amoxicillin

·        Short-term treatment (up to 8 wk) of symptomatic GERD and erosive esophagitis in children 1–11 yr

·        Short-term treatment (up to 7 days) of all grades of erosive esophagitis when patient is unable to take oral medication (IV)

Contraindications and cautions

·        Contraindicated with hypersensitivity to lansoprazole or any of its components.

·        Use cautiously with pregnancy, lactation.

Available forms

DR capsules—15, 30 mg; orally disintegrating DR tablets—15, 30 mg; DR granules for oral suspension—15, 30 mg; injection—30 mg/vial

Dosages

ADULTS

·        Active duodenal ulcer: 15 mg PO daily before eating for 4 wk. For maintenance, 15 mg PO daily.

·        Gastric ulcer: 30 mg/day PO for < 8 wk.

·        Risk reduction of gastric ulcer with NSAIDS: 15 mg/day PO for up to 12 wk.

·        Duodenal ulcers associated with H. pylori: 30 mg lansoprazole, 500 mg clarithromycin, 1 g amoxicillin, all given PO bid for 10–14 days; or 30 mglansoprazole and 1 g amoxicillin PO tid for 14 days.

·        GERD: 15 mg/day PO for up to 8 wk.

·        Erosive esophagitis or poorly responsive GERD: 30 mg PO daily before eating for up to 8 wk. An additional 8-wk course may be helpful for patients who do not heal with 8-wk therapy.

·        Maintenance of healing of erosive esophagitis: 15 mg/day PO.

·        Pathological hypersecretory conditions: Individualize dosage. Initial dose is 60 mg PO daily. Doses up to 90 mg bid have been used. Administer daily doses of > 120 mg in divided doses.

·        Short-term treatment of all grades of erosive esophagitis: 30 mg/day IV, over 30 min for up to 7 days; switch to oral form as soon as possible for total of 8 wk treatment.

PEDIATRIC PATIENTS 12–17 YR

·        Nonerosive GERD: 15 mg/day PO for up to 8 wk.

·        Erosive esophagitis: 30 mg/day PO for up to 8 wk.

PEDIATRIC PATIENTS 1–11 YR

Give as oral suspension, or capsules may be opened and the granules sprinkled on soft food. Do not cut, crush, or chew granules.
< 30 kg: 15 mg/day PO for up to 12 wk.
> 30 kg: 30 mg/day PO for up to 12 wk.

PATIENTS WITH HEPATIC DYSFUNCTION

Consider lowering dose and monitoring patient response.

Pharmacokinetics

Route	Onset	Peak
Oral	Varies	1.7 hr
IV	Rapid	End of transfusion

Metabolism: Hepatic; T_1/2: 2 hr, 1.3 hr (IV)

Distribution: Crosses placenta; may enter breast milk

Excretion: Bile

IV facts

Preparation: Reconstitute with 5 mL sterile water for injection (resulting solution 6 mg/mL); mix gently until powder is dissolved; reconstituted solution is stable for 1 hr before dilution. Dilute in 50 mL 0.9% sodium chloride injection, lactated Ringer’s, or 5% dextrose injection. Stable for 24 hr (0.9% sodium chloride, lactated Ringer’s) or 12 hr (5% dextrose).

Infusion: Use in-line filter provided with product. Infuse over 30 min; flush line with appropriate dilution fluid.

Incompatibilities: Do not administer with other drugs.

Adverse effects

·        CNS: Headache, dizziness, asthenia, vertigo, insomnia, anxiety, paresthesias, dream abnormalities

·        Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin, acne

·        GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth

·        Respiratory: URI symptoms, cough, epistaxis

·        Other: Gastric cancer in preclinical studies, back pain, fever

Interactions

Drug-drug

·        Decreased serum levels if taken concurrently with sucralfate

·        Decreased serum levels of ketoconazole, theophylline when taken with lansoprazole

Nursing considerations

Assessment

·        History: Hypersensitivity to lansoprazole or any of its components; pregnancy; lactation

·        Physical: Skin lesions; body T; reflexes, affect; urinary output, abdominal examination; respiratory auscultation

Interventions

·        Administer before meals. Caution patient to swallow capsules whole, not to open, chew, or crush. If patient has difficulty swallowing, open capsule and sprinkle granules on apple sauce, Ensure, yogurt, cottage cheese, or strained pears; for nasogastric tube, mix granules from capsule with 40 mL apple juice and inject through tube, flush tube with additional apple juice; or granules for oral suspension can be added to 30 mL water, stir well, and have patient drink immediately. Place orally disintegrating tablet on tongue; follow with water after it dissolves.

·        WARNING: Arrange for further evaluation of patient after 4 wk of therapy for acute gastroreflux disorders if symptomatic improvement does not rule out gastric cancer, which did occur in preclinical studies.

·        Switch to oral drug from IV as soon as patient is able to take oral drugs. Use of IV drug for > 7 days is not approved.

Teaching points

·        Take the drug before meals. Swallow the capsules whole—do not chew, open, or crush. If you are unable to swallow capsule, open and sprinkle granules on apple sauce, or use granules, which can be added to 30 mL water, stirred, and drunk immediately. If using orally disintegrating tablet, place on your tongue and allow to dissolve. Follow with a drink of water.

·        Arrange to have regular medical follow-up care while you are taking this drug.

·        You may experience these side effects: Dizziness (avoid driving a car or performing hazardous tasks); headache (medications may be available to help); nausea, vomiting, diarrhea (proper nutrition is important, consult a dietitian to maintain nutrition); symptoms of upper respiratory tract infection, cough (reversible; do not self-medicate, consult your health care provider if this becomes uncomfortable).

·        Report severe headache, worsening of symptoms, fever, chills.

Adverse effects in Italic are most common; those in Bold are life-threatening.