lansoprazole

General

Pronunciation
lan-SOE-pra-zole [Pronunciation]

Trade Name(s)

• Prevacid

• Prevacid 24 Hr

Indications

• Erosive esophagitis.

• Duodenal ulcers (with or without anti-infectives for Helicobacter pylori ).

• Active benign gastric ulcer.

• Short-term treatment of symptomatic GERD.

• Healing and risk reduction of NSAID-associated gastric ulcer.

• Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome.

• OTC: Heartburn occurring ≥twice/wk.

Action

Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

Therapeutic Effect(s):

• Diminished accumulation of acid in the gastric lumen, with lessened acid reflux.

• Healing of duodenal ulcers and esophagitis.

Pharmacokinetics

Absorption: 80% absorbed after oral administration.

Distribution: Unknown.

Protein Binding: 97%.

Metabolism and Excretion: Extensively metabolized by the liver to inactive compounds. Converted intracellularly to at least two other antisecretory compounds.

Half-life: Children: 1.2–1.5 hr; Adults: 1.3–1.7 hr (↑ in geriatric patients and patients with impaired hepatic function).

TIME/ACTION PROFILE (acid suppression)

Contraindication/Precautions

Contraindicated in:
Hypersensitivity.

Use Cautiously in:

• Solutabs contain aspartame; use caution when used in phenylketonurics;

• Severe hepatic impairment (not to exceed 30 mg/day in these patients);

• Patients using high-doses for >1 year (↑ risk of hip, wrist, or spine fractures);

• OB: Lactation: Safety not established;

• Pedi: Safety not established in children <1 yr;

• Geri: Maintenance dose not to exceed 30 mg/day unless additional acid suppression is required.

Adverse Reactions/Side Effects

CNS: dizziness, headache.

GI: diarrhea, abdominal pain, nausea.

Derm: rash.

F and E: hypomagnesemia (especially if treatment duration ≥3 mo).

MS: bone fracture.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug

• Sucralfate ↓ absorption of lansoprazole (take 30 min before sucralfate).

• May ↓ absorption of drugs requiring acid pH, including ketoconazole , itraconazole , atazanavirampicillin , iron salts , and digoxin .

• May ↑ risk of bleeding with warfarin (monitor INR/PT).

• May ↓ the anti-platelet effects of clopidogrel .

• Hypomagnesemia ↑ risk of digoxin toxicity.

Route/Dosage

• PO (Adults and children ≥12 yr): Short-term treatment of duodenal ulcer—15 mg once daily for 4 wk; H. pylori eradication to reduce the risk of duodenal ulcer recurrence—30 mg twice daily with clarithromycin 500 mg twice daily and amoxicillin 1000 mg twice daily for 10–14 days (triple therapy) or 30 mg 3 times daily with 1000 mg amoxicillin 3 times daily for 14 days (dual therapy); maintenance of healed duodenal ulcers—15 mg once daily; short-term treatment of gastric ulcers/healing of NSAID-associated gastric ulcer—30 mg once daily for up to 8 wk; risk reduction of NSAID-associated gastric ulcer—15 mg once daily for up to 12 wk; short-term treatment of symptomatic GERD—15 mg once daily for up to 8 wk; short-term treatment of erosive esophagitis—30 mg once daily for up to 8 wk (8 additional weeks may be necessary); maintenance of healing of erosive esophagitis—15 mg once daily; pathologic hypersecretory conditions—60 mg once daily intially, up to 90 mg twice daily (daily dose >120 mg should be given in divided doses)..

• PO (Adults): OTC—15 mg once daily for up to 14 days (14 day course may be repeated every 4 mo)..

• PO (Children 1–11 yr and >30 kg): GERD—30 mg once to twice daily..

• PO (Children 1–11 yr and 10–30 kg): GERD—15 mg once or twice daily..

• PO (Children 1–11 yr and <10 kg): GERD—7.5 mg once daily..

Availability

• Delayed-release capsules: 15 mg^{Rx, OTC}, 30 mg

• Delayed-release orally disintegrated tablets (SoluTabs): 15 mg, 30 mg

• In combination with: amoxicillin and clarithromycin as part of a compliance package (Prevpac). See combination drugs.

Assessment

• Assess patient routinely for epigastric or abdominal pain and for frank or occult blood in stool, emesis, or gastric aspirate.

• May cause abnormal liver function tests, including ↑ AST, ALT, alkaline phosphatase, LDH, and bilirubin.

» May cause ↑ serum creatinine and ↑ or ↓ electrolyte levels.

» May alter RBC, WBC, and platelet levels.

» May also cause ↑ gastrin levels, abnormal A/G ratio, hyperlipidemia, and ↑ or ↓ cholesterol.

» Monitor INR and prothrombin time in patients taking warfarin.

» May cause hypomagnesemia. Monitor serum magnesium prior to and periodically during therapy.

Potential Nursing Diagnoses

• Acute pain (Indications)

Implementation

PO: Delayed-release capsules: Administer before meals. Swallow whole; do not crush or chew capsule contents. Capsules may be opened and sprinkled on 1 tbsp of applesauce, Ensure pudding, cottage cheese, yogurt or strained pears and swallowed immediately for patients with difficulty swallowing.

» For patients with an NG tube, capsules may be opened and intact granules may be mixed in 40 mL of apple. juice and injected through the NG tube into stomach. Flush NG tube with additional apple juice to clear tube.

» Orally disintegrating tablets may be placed on tongue, allowed to disintegrate and swallowed with or without water. Do not cut or break tablet. For administration via oral syringe or nasogastric tube, Prevacid SoluTab can be administered by placing a 15-mg tablet in oral syringe and drawing up 4 mL of water, or a 30-mg tablet in oral syringe and drawing up 10 mL of water. Shake gently to allow for a quick dispersal. After tablet has dispersed, administer the contents within 15 minutes. Refill syringe with 2 mL (5 mL for the 30-mg tablet) of water, shake gently, and administer any remaining contents and flush nasogastric tube.

» Antacids may be used concurrently.

Patient/Family Teaching

• Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered unless almost time for next dose; do no double doses.

• May occasionally cause dizziness. Caution patient to avoid driving and other activities that require alertness until response to medication is known.

• Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.

• Advise patient to report onset of black, tarry stools; diarrhea; or abdominal pain to health care professional promptly.

• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.

• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

• Decrease in abdominal pain or prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be seen on x-ray examination or endoscopy. Therapy is continued for at least 2–4 wk. Therapy for pathologic hypersecretory conditions may be long term.

• Healing in patients with erosive esophagitis. Therapy is continued for up to 8 wk, and an additional 8-wk course may be used for patients who do not heal in 8 wk or whose ulcer recurs.