1. Introduction
Lansoprazole is a proton pump inhibitor (PPI) used to reduce stomach acid production. It is effective in managing conditions such as gastroesophageal reflux disease (GERD), peptic ulcers, and other acid-related disorders. Lansoprazole works by irreversibly inhibiting the H+/K+ ATPase enzyme in the stomach lining.
2. Indications
- Approved Indications:
- Gastroesophageal reflux disease (GERD).
- Peptic ulcers (gastric and duodenal).
- Erosive oesophagitis.
- Zollinger-Ellison syndrome.
- Helicobacter pylori eradication (in combination with antibiotics).
- Off-Label Uses:
- Prevention of NSAID-induced gastric ulcers.
- Stress ulcer prophylaxis in critically ill patients.
3. Dosage
- Adults:
- GERD/Erosive Oesophagitis: 15–30 mg once daily for 4–8 weeks.
- Peptic Ulcers: 30 mg once daily for 4–8 weeks.
- H. pylori Eradication (triple therapy): 30 mg twice daily with amoxicillin 1 g and clarithromycin 500 mg, for 10–14 days.
- Zollinger-Ellison Syndrome: Initial 60 mg once daily, adjusted as needed (up to 180 mg/day).
- Children (1–11 years):
- GERD: 15 mg once daily for children <30 kg, 30 mg once daily for children ≥30 kg.
- Elderly:
- Standard adult dose, but use with caution in those with severe liver impairment.
4. Administration
- Take orally, 30 minutes before meals for optimal absorption.
- Capsules can be swallowed whole or opened and sprinkled onto a small amount of soft food or juice for patients who have difficulty swallowing.
5. Forms Available
- Capsules: 15 mg, 30 mg.
- Orally disintegrating tablets (ODT): 15 mg, 30 mg.
6. Side Effects
6.1. Common Side Effects
- Nausea.
- Diarrhoea or constipation.
- Abdominal pain.
- Headache.
6.2. Less Common Side Effects
- Flatulence.
- Dry mouth.
- Dizziness.
6.3. Rare but Serious Side Effects
- Clostridioides difficile-associated diarrhoea.
- Hypomagnesaemia (with prolonged use).
- Fractures (associated with long-term use).
- Vitamin B12 deficiency (with prolonged use).
7. Warnings
- Long-Term Use Risks: Prolonged use of PPIs may increase the risk of fractures, kidney disease, and vitamin B12 deficiency.
- Hypomagnesaemia: Monitor electrolytes during prolonged therapy.
- C. difficile Infection: Increased risk of gastrointestinal infections, especially in hospitalised patients.
8. Precautions
- Use cautiously in patients with:
- Severe hepatic impairment (reduce dose).
- Osteoporosis or risk of fractures.
- Avoid prolonged use unless medically necessary.
9. Interactions
- Drug-Drug Interactions:
- Clopidogrel: Lansoprazole may reduce its antiplatelet effect.
- Methotrexate: May increase methotrexate levels and toxicity.
- Warfarin: May enhance the anticoagulant effect, requiring monitoring.
- Drug-Food Interactions:
- Avoid taking with high-fat meals, as it may delay absorption.
10. Monitoring Parameters
- Symptom relief (e.g., reduced heartburn or gastric discomfort).
- Magnesium levels (during long-term therapy).
- Vitamin B12 levels (if used for >1 year).
- Bone density (if risk factors for osteoporosis are present).
11. Use in Children
- Approved for children ≥1 year old for GERD and erosive oesophagitis. Adjust dose based on weight.
12. Use in Pregnancy
- Category B: Safe for use if the benefits outweigh potential risks. Animal studies have not shown foetal harm, but human data are limited.
13. Use in Elderly
- Safe with standard dosing, but monitor for side effects such as fractures and kidney dysfunction during prolonged use.
14. Use in Kidney Disease
- No dose adjustment needed in mild to moderate renal impairment. Use with caution in severe kidney disease.
15. Use in Liver Disease
- Use cautiously in severe liver impairment; reduce the dose if necessary.
16. Patient Counselling Points
- Take lansoprazole 30 minutes before meals for the best effect.
- Do not crush or chew capsules; swallow them whole or sprinkle the contents onto soft food if swallowing is difficult.
- Report any persistent diarrhoea or symptoms of low magnesium (e.g., muscle cramps, irregular heartbeat).
- Avoid alcohol and smoking, as these can worsen acid-related symptoms.
- Do not stop taking lansoprazole abruptly without consulting your doctor.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Prevacid | Takeda Pharmaceuticals | $30–50 (30 capsules, 30 mg) |
Lansoprazole (generic) | Various manufacturers | $10–25 (30 capsules, 30 mg) |
Prevacid SoluTab (ODT) | Takeda Pharmaceuticals | $40–70 (30 tablets, 30 mg) |
18. FAQs (15 Questions)
- What is lansoprazole used for?
It is used to treat GERD, peptic ulcers, and other acid-related conditions. - How does lansoprazole work?
It inhibits stomach acid production by blocking the proton pumps in the stomach lining. - When should I take lansoprazole?
Take it 30 minutes before meals for the best results. - How long does it take for lansoprazole to work?
Symptom relief often starts within 1–3 days, with maximum effect seen in 4–7 days. - Can lansoprazole cause side effects?
Yes, common side effects include headache, nausea, and diarrhoea. - Can lansoprazole be taken long-term?
Long-term use is safe if necessary but may increase risks of fractures, kidney issues, and vitamin B12 deficiency. - Is lansoprazole safe during pregnancy?
Yes, it is generally safe during pregnancy if prescribed by a doctor. - What should I do if I miss a dose?
Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double the dose. - Can lansoprazole interact with other medications?
Yes, it may interact with clopidogrel, methotrexate, and warfarin, among others. - Can lansoprazole cause diarrhoea?
Yes, it may cause diarrhoea, including C. difficile-associated diarrhoea in rare cases. - How should lansoprazole be stored?
Store at room temperature, away from moisture and heat. - Can lansoprazole be stopped abruptly?
It’s better to consult a doctor before stopping, as symptoms may return. - Is lansoprazole safe for children?
Yes, it is approved for children ≥1 year old for GERD and erosive oesophagitis. - Can lansoprazole cause vitamin deficiencies?
Prolonged use may lead to vitamin B12 deficiency. - How is lansoprazole different from omeprazole?
Both are PPIs, but lansoprazole may have a faster onset of action in some cases.