Lansoprazole

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 NameManufacturerPrice (USD)
PrevacidTakeda 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)

  1. What is lansoprazole used for?
    It is used to treat GERD, peptic ulcers, and other acid-related conditions.
  2. How does lansoprazole work?
    It inhibits stomach acid production by blocking the proton pumps in the stomach lining.
  3. When should I take lansoprazole?
    Take it 30 minutes before meals for the best results.
  4. 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.
  5. Can lansoprazole cause side effects?
    Yes, common side effects include headache, nausea, and diarrhoea.
  6. 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.
  7. Is lansoprazole safe during pregnancy?
    Yes, it is generally safe during pregnancy if prescribed by a doctor.
  8. 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.
  9. Can lansoprazole interact with other medications?
    Yes, it may interact with clopidogrel, methotrexate, and warfarin, among others.
  10. Can lansoprazole cause diarrhoea?
    Yes, it may cause diarrhoea, including C. difficile-associated diarrhoea in rare cases.
  11. How should lansoprazole be stored?
    Store at room temperature, away from moisture and heat.
  12. Can lansoprazole be stopped abruptly?
    It’s better to consult a doctor before stopping, as symptoms may return.
  13. Is lansoprazole safe for children?
    Yes, it is approved for children ≥1 year old for GERD and erosive oesophagitis.
  14. Can lansoprazole cause vitamin deficiencies?
    Prolonged use may lead to vitamin B12 deficiency.
  15. How is lansoprazole different from omeprazole?
    Both are PPIs, but lansoprazole may have a faster onset of action in some cases.