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lansoprazole

(lanz ah' pray zol)


Prevacid
Pregnancy Category B

Drug classes
Antisecretory agent
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 gastroesophageal reflux disease (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

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; DR granules for oral suspension—15, 30 mg

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 up to 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 mg
lansoprazole 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.
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.
> 30 kg: 30 mg/day PO.
PATIENTS WITH HEPATIC DYSFUNCTION
Consider lowering dose and monitoring patient response.

Pharmacokinetics
Route Onset Peak
Oral Varies 1.7 hr

Metabolism: Hepatic; T1/2: 2 hr


Distribution: Crosses placenta; may enter breast milk
Excretion: Bile

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 exam;
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 NG
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.
• 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.

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.
• Arrange to have regular medical follow-up while you are taking this drug.
• These side effects may occur: Dizziness (avoid driving a car or performing
hazardous tasks); headache (medications may be available to help); nausea,
vomiting, diarrhea (proper nutrition is important, consult with your dietitian to
maintain nutrition); symptoms of upper respiratory tract infection, cough
(reversible; do not self-medicate, consult with 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.