Lansoprazole (Prevacid) reduces gastric acid secretion by inhibiting the proton pumps in the parietal cells. It is used to treat heartburn, peptic ulcer disease, gastroesophageal reflux disease, and dyspepsia.

Lansoprazole (Prevacid) Uses:

• Gastroesophageal reflux disease (GERD):

  • Treatment of symptomatic GERD in children ≥1 year of age and adults(up to 8 weeks); short-term (up to 12 weeks in children <12 years and adults; up to 8 weeks in children >12 yrs of age) treatment to maintain healing of erosive oesophagitis.

• Hypersecretory conditions:

  • Long term treatment of hypersecretory disorders like Zollinger-Ellison syndrome.

• Peptic ulcer disease:

  • Treatment of duodenal ulcers as a short-term therapy i.e 4 weeks.
  • As a maintenance treatment of healed duodenal ulcer.
  • Also used as a part of eradication therapy in H. pylori-induced recurrent duodenal ulcers.
  • Treatment of NSAIDs induced gastric ulcers in adults and as a short term treatment of active benign gastric ulcer in adults.
  • Relieving frequent heartburns (≥2 days/week)

• Off Label Use of Lansoprazole Adults:

  • Dyspepsia
  • Prophylactically treating stress ulcers in critically ill patients.

---

Lansoprazole (Prevacid) Dose in Adults:

Lansoprazole (Prevacid) Dose in the treatment of Gastroesophageal reflux disease (GERD):

Note: The drug should be administered 30 mins before meal along with lifestyle and dietary modifications.

• Initial therapy:

  • Mild and intermittent symptoms (<2 episodes/week), and no evidence of erosive esophagitis:

    • Oral: 15 mg OD for 8 weeks;
    • if symptoms persist after 8 weeks, increase to 30 mg OD;
    • continue treatment for at least 8 weeks when symptoms are controlled.
    • Discontinue while tapering the dose when asymptomatic for 8 weeks with therapy.

  • Severe or frequent symptoms (≥2 episodes/week), erosive esophagitis, or Barrett's esophagus:

    • Oral: 30 mg OD;
    • continue treatment for at least 8 weeks when symptoms are controlled.
    • In patients with severe erosive esophagitis or Barrett esophagus, long-term maintenance therapy with 30 mg once daily is advised.
    • In patients without severe erosive esophagitis or Barrett's esophagus, continue at the lowest dose for the shortest duration and discontinue therapy while tapering the dose in all asymptomatic patients.

Note: It is recommended by some experts to continue the drug if symptoms persist with a standard dose of H2 receptor antagonist.

• Refractory:

  • Persistent symptoms despite 30 mg once daily dosing regimen:

    • Oral: 30 mg twice daily (before breakfast and dinner) or
    • 15mg twice daily one dose before breakfast and one before dinner.

  • Recurrent symptoms after discontinuing acid suppression:

    • Recurrent symptoms ≥3 months:
      • Repeat an 8-week course at the previous effective dose.
    • Recurrent symptoms <3 months:
      • Long-term maintenance at the lowest effective dose necessary; upper endoscopy is also recommended (if not already performed).

Note: Referral to a specialist is recommended:

• OTC labeling (patient-guided therapy):

  • Heartburn, frequent symptoms (≥2 episodes/week):
    • 15 mg OD for 14 days;
    • if required a repeat course of 14 days every 4 months can be prescribed.

Lansoprazole (Prevacid) Dose in the treatment of Hypersecretory conditions:

• Oral: Initial: 60 mg OD;
• adjust dose based upon patient response and to reduce acid secretion to <10 mEq/hour (5 mEq/hour in patients with prior gastric surgery);
• doses of 90 mg twice daily have been used; administer doses >120 mg/day in divided doses

Lansoprazole (Prevacid) Dose in the treatment of Peptic ulcer disease:

• Duodenal ulcer:

  • Oral: Short-term treatment: 15 mg once daily for 4 weeks;
  • maintenance therapy: 15 mg once daily

• Dyspepsia (off label):

  • Oral: 15 or 30 mg once daily for up to 8 weeks.

• Gastric ulcer:

  • Oral: Short-term treatment: 30 mg once daily for up to 8 weeks.
  • Some clinical trial data suggest a dose of 15 mg once daily for up to 8 weeks may also be effective.

• Helicobacter pylori eradication:

  • Oral: 30 mg 3 times daily administered with amoxicillin 1,000 mg 3 times daily for 14 days or 30 mg twice daily administered with amoxicillin 1,000 mg and clarithromycin 500 mg twice daily for 10 to 14 days

• American College of Gastroenterology guidelines:

  • Clarithromycin triple regimen:
    • 30 to 60 mg twice daily in combination with clarithromycin 500 mg twice daily and either amoxicillin 1 g twice daily or metronidazole 500 mg 3 times per day for 14 days.

Note:

• Avoid the use of clarithromycin triple therapy in patients with risk factors for macrolide resistance (eg, prior macrolide exposure, local clarithromycin resistance rates ≥15%, eradication rates with clarithromycin-based regimens ≤85%).
  • Sequential regimen:
    • 30 mg twice daily plus amoxicillin 1 g twice daily for 5 to 7 days;
    • then follow with clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, and lansoprazole 30 mg twice daily for 5 to 7 days
  • Levofloxacin triple regimen:
    • 30 mg twice daily in combination with amoxicillin 1 g twice daily and levofloxacin 500 mg once daily for 10 to 14 days
  • Bismuth quadruple regimen:
    • 30 mg twice daily in combination with tetracycline 500 mg 4 times daily, metronidazole 250 mg 4 times daily or 500 mg 3 or 4 times daily, and either bismuth subcitrate 120 to 300 mg 4 times daily or bismuth subsalicylate 300 mg 4 times daily for 10 to 14 days
  • Concomitant regimen:
    • 30 mg twice daily in combination with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily for 10 to 14 days
  • Hybrid regimen:
    • 30 mg twice daily plus amoxicillin 1 g twice daily for 7 days;
    • then follow with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, and lansoprazole 30 mg twice daily for 7 days

Lansoprazole (Prevacid) Dose in the treatment of NSAID-associated gastric ulcer (healing):

• Oral: 30 mg OD for 8 weeks.

Lansoprazole (Prevacid) Dose in the treatment of NSAID-associated gastric ulcer (to reduce risk):

• Oral: 15 mg OD for up to 12 weeks;

Lansoprazole (Prevacid) Dose in the treatment of stress ulcer prophylaxis in critically ill patients (off-label):

• Oral: 30 mg once daily.
• Note: Intended for patients with associated risk factors (eg, coagulopathy, mechanical ventilation for >48 hours, sepsis/septic shock);
• discontinue use once risk factors have resolved.

• Discontinuation of therapy:

  • Oral: Some experts recommend a step-down approach in order to avoid worsening or rebound symptoms.
  • One strategy is to decrease the dose by 50% over 2 to 4 weeks.
  • If the patient is already on the lowest possible dose, alternate-day therapy may be considered. If symptoms worsen during treatment or after discontinuation, patients should be reevaluated.

---

Lansoprazole (Prevacid) Dose in Childrens:

Lansoprazole (Prevacid) Dose in the treatment of Symptomatic Gastroesophageal reflux disease (GERD):

Note: Guidelines recommend a 4to 8-week treatment course; if improvement seen after 4 to 8 weeks, consider possible wean; if no response after 4 to 8 weeks, reevaluate diagnosis and consider referral to pediatric GI specialist.

• Weight-based dosing:

  • Infants:
    • Oral: 2 mg/kg/day.
    • a dose of 1 mg/kg/day has also been shown to increase gastric pH in infants and decrease the frequency of GERD symptoms (eg, regurgitation/vomiting, feeding refusal, crying, back arching) from baseline.
  • Children and Adolescents:
    • Oral: 0.7 to 3 mg/kg/day
    • maximum daily dose: 30 mg/day.

• Fixed dosing:

  • Infants ≥3 months:
    • 5 mg twice daily or 15 mg once daily was shown to provide better symptom relief compared to dietary management in 68 patients.

  • Children ≤11 years:

    • ≤30 kg: 15 mg once daily.
    • >30 kg: 30 mg once daily.
  • Children ≥12 years and Adolescents: Oral:
    • 15 mg once daily.

Lansoprazole (Prevacid) Dose in the treatment of Erosive esophagitis:

Note: Duration of therapy is dependent on age: Children ≤11 years recommended duration is up to 12 weeks and for children ≥12 years and adolescent duration is up to 8 weeks.

• Children ≤11 years:

  • ≤30 kg: 15 mg once daily.
  • >30 kg: 30 mg once daily.

• Children ≥12 years and Adolescents:

  • Oral: 30 mg once daily.

• Discontinuation of therapy:

  • Oral: Based on experience in adults, some experts recommend a step-down approach in order to avoid worsening or rebound symptoms.
  • One recommendation is to decrease the dose by 50% over 2 to 4 weeks.
  • If the patient is already on the lowest possible dose, alternate day therapy may be considered.
  • If symptoms worsen during treatment or after discontinuation, patients should be reevaluated.

---

Lansoprazole (Prevacid) Pregnancy Risk Category: B

• Data available do not show an increase in the risk of major birth defects due to maternal use of Lansoprazole during pregnancy.
• There are many recommendations for treating GERD during pregnancy.
• Lifestyle modifications, followed by medication, are the first treatment for non-pregnant women.
• Proton pump inhibitors can be used when clinically indicated based on the available data.

Lansoprazole use during breastfeeding:

• It is unknown if lansoprazole can be found in breast milk.
• Before prescribing any drug, it is important to weigh the benefits to the mother and the baby of breastfeeding.

---

Lansoprazole (Prevacid) Dose in Kidney Disease:

No dosage adjustment is necessary.

Lansoprazole (Prevacid) Dose in Liver disease:

• Mild or moderate impairment (Child-Pugh class A or B):
  • No dosage adjustment is necessary.
• Severe impairment (Child-Pugh class C):
  • 15 mg once daily.

Note:

• The dosage recommendation is based on pharmacokinetic data using a single 30 mg dose.

---

Side Effects of Lansoprazole (Prevacid):

• Central nervous system:

  • Headache
  • Dizziness

• Gastrointestinal:

  • Diarrhea
  • Abdominal pain
  • Constipation
  • Nausea

Side effects of lansoprazole (frequency not defined):

• Endocrine & Metabolic:

  • Abnormal Albumin-Globulin Ratio
  • Albuminuria
  • Decreased Serum Cholesterol
  • Hyperlipidemia
  • Increased Gamma-Glutamyl Transferase
  • Increased Gastrin
  • Increased Lactate Dehydrogenase
  • Increased Serum Glucocorticoids
  • Increased Serum Potassium

• Gastrointestinal:

  • Occult Blood In Stools

• Genitourinary:

  • Crystalluria
  • Hematuria

• Hematologic & Oncologic:

  • Abnormal Erythrocytes
  • Blood Platelet Disorder (Abnormal Platelets)
  • Leukocyte Disorder
  • Leukocytosis

• Hepatic:

  • Abnormal Hepatic Function Tests
  • Hyperbilirubinemia
  • Increased Serum Alkaline Phosphatase
  • Increased Serum ALT
  • Increased Serum AST

• Immunologic:

  • Increased Serum Globulins

• Renal:

  • Acute Interstitial Nephritis
  • Increased Blood Urea Nitrogen
  • Increased Serum Creatinine

---

Contraindications to Lansoprazole Include:

• Hypersensitivity to lansoprazole and any component thereof (eg anaphylaxis.
• concomitant use with products that contain rilpivirine.

Warnings and precautions

• Carcinoma

  • No reports of enterochromaffin-like (ECL) cell carcinoids, dysplasia, or neoplasia has occurred.

• Clostridium difficile-associated diarrhea (CDAD), formerly Clostridium, is now Clostridioides

  • Proton pump inhibitors (PPIs), especially when used in hospitals, may increase the risk for CDAD.
  • Patients with persistent diarrhea should be diagnosed with CDAD if their condition does not improve.
  • The best PPI therapy for your condition is the one that has the lowest dosage and longest duration.

• Cutaneous and systemic Lupus Erythematosus

  • This condition has been described as a new onset of or an exacerbation autoimmune disease.
  • Most cases were cutaneous lupus erythematosus, but subacute CLE was more common.
  • Systemic lupus is less common and usually occurs within days to many years of starting treatment.
  • It mostly affects young adults, but can also occur in older patients.
  • If you notice any signs or symptoms of CLE/SLE, discontinue treatment and consult a specialist.
  • Most patients feel better within 4 to 12 weeks.

• Fractures

  • Proton pump inhibitor (PPI), therapy may increase the incidence of osteoporosis-related fractures of bones in the hip, spine and wrist.
  • Monitor patients receiving long-term or high-dose therapy.
  • To reduce fractures, you should use the lowest possible dose for the shortest time.

• Polyps of the fundic gland:

  • Long-term PPI use for more than one year increases the risk of fundic polyps.
  • It may not be apparent, but it may cause nausea, vomiting, abdominal pain, and GI bleeding.
  • A diagnosis of polyps can increase the likelihood of small intestinal obstruction.
  • The best PPI therapy for your condition is the one that has the lowest dosage and longest duration.

• Hypomagnesemia:

  • Rarely reported, often with prolonged PPI usage of >=3 month (most cases of therapy >1 year).
  • Hypomagnesemia can be either symptomatic, or asymptomatic.
  • Severe cases can cause seizures, tetany, and heart arrhythmias.
  • It is important to obtain serum magnesium levels before you begin long-term treatment, particularly if you are taking digoxin, diuretics or any other drugs that can cause hypomagnesemia.
  • Also, it is important to check your blood regularly thereafter.
  • Magnesium supplementation may be used to correct hypomagnesemia.
  • However, discontinuation of lansoprazole might be necessary. Magnesium levels usually return to normal within one week.

• Interstitial nephritis:

  • Patients taking PPIs have been known to experience acute interstitial nephritis.
  • This can occur at any stage of therapy and is usually due to an idiopathic hypersensitivity reaction.
  • If acute interstitial Nephritis occurs, discontinue use.

• Vitamin B deficiency:

  • Long-term treatment (>=2 year) can lead to vitamin B malabsorption or subsequent vitamin B deficiency.
  • The severity of the deficiency depends on the dose. It is more common in women than in men (30 years old) and it is less common after stopping therapy.

• Gastric cancer:

  • Gastric malignancy can still be present despite symptoms being relieved.

• Gastrointestinal infection (eg, Salmonella, Campylobacter):

  • These infections may be more likely if you use PPIs.

• Hepatic impairment

  • Patients suffering from severe liver dysfunction might need to reduce their dosage.

Lansoprazole: Drug Interaction

Risk Factor C (Monitor therapy)
Amphetamine	Proton Pump Inhibitors may increase the absorption of Amphetamine.
Bisphosphonate Derivatives	Proton Pump Inhibitors may diminish the therapeutic effect of Bisphosphonate Derivatives.
Bosentan	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Capecitabine	Proton Pump Inhibitors may diminish the therapeutic effect of Capecitabine.
Cefpodoxime	Proton Pump Inhibitors may decrease the serum concentration of Cefpodoxime.
Clopidogrel	Lansoprazole may decrease serum concentrations of the active metabolite(s) of Clopidogrel.
CYP2C19 Inducers (Moderate)	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers).
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Cysteamine (Systemic)	Proton Pump Inhibitors may diminish the therapeutic effect of Cysteamine (Systemic).
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Dexmethylphenidate	Proton Pump Inhibitors may increase the absorption of Dexmethylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption.
Dextroamphetamine	Proton Pump Inhibitors may increase the absorption of Dextroamphetamine. Specifically, the dextroamphetamine absorption rate from mixed amphetamine salt extended release (XR) capsules may be increased in the first hours after dosing.
Doxycycline	Proton Pump Inhibitors may decrease the bioavailability of Doxycycline.
Erdafitinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Fluconazole	May increase the serum concentration of Proton Pump Inhibitors.
Imatinib	Lansoprazole may enhance the dermatologic adverse effect of Imatinib.
Indinavir	Proton Pump Inhibitors may decrease the serum concentration of Indinavir.
Iron Preparations	Proton Pump Inhibitors may decrease the absorption of Iron Preparations. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Isomaltoside; Iron Sucrose.
Ivosidenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Methotrexate	Proton Pump Inhibitors may increase the serum concentration of Methotrexate.
Methylphenidate	Proton Pump Inhibitors may increase the absorption of Methylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption.
Multivitamins/Minerals (with ADEK, Folate, Iron)	Proton Pump Inhibitors may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be decreased.
Mycophenolate	Proton Pump Inhibitors may decrease the serum concentration of Mycophenolate. Specifically, concentrations of the active mycophenolic acid may be reduced.
Raltegravir	Proton Pump Inhibitors may increase the serum concentration of Raltegravir.
Riociguat	Proton Pump Inhibitors may decrease the serum concentration of Riociguat.
Saquinavir	Proton Pump Inhibitors may increase the serum concentration of Saquinavir.
Sarilumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Siltuximab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
SORAfenib	Proton Pump Inhibitors may decrease the absorption of SORAfenib.
Tipranavir	May decrease the serum concentration of Proton Pump Inhibitors. These data are derived from studies with Ritonavir-boosted Tipranavir.
Tocilizumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Vitamin K Antagonists (eg, warfarin)	Lansoprazole may increase the serum concentration of Vitamin K Antagonists.
Voriconazole	May increase the serum concentration of Proton Pump Inhibitors. Proton Pump Inhibitors may increase the serum concentration of Voriconazole.
Risk Factor D (Consider therapy modification)
Atazanavir	Proton Pump Inhibitors may decrease the serum concentration of Atazanavir. Management: See full drug interaction monograph for details.
Bosutinib	Proton Pump Inhibitors may decrease the serum concentration of Bosutinib. Management: Consider alternatives to proton pump inhibitors, such as short-acting antacids or histamine-2 receptor antagonists. Administer alternative agents more than 2 hours before or after bosutinib.
Cefditoren	Proton Pump Inhibitors may decrease the serum concentration of Cefditoren. Management: If possible, avoid use of cefditoren with proton pump inhibitors (PPIs). Consider alternative methods to minimize/control acid reflux (eg, diet modification) or alternative antimicrobial therapy if use of PPIs can not be avoided.
CYP2C19 Inducers (Strong)	May increase the metabolism of CYP2C19 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
CYP3A4 Inducers (Strong)	May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
Dabrafenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Dabrafenib	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP2C19 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Enzalutamide	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring.
Enzalutamide	May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Conversely, concentrations of active metabolites may be increased for those drugs activated by CYP2C19. Management: Concurrent use of enzalutamide with CYP2C19 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C19 substrate should be performed with caution and close monitoring.
Gefitinib	Proton Pump Inhibitors may decrease the serum concentration of Gefitinib. Management: Avoid use of proton pump inhibitors (PPIs) with gefitinib when possible. If required, administer gefitinib 12 hours after administration of the PPI or 12 hours before the next dose of the PPI.
Itraconazole	Proton Pump Inhibitors may increase the serum concentration of Itraconazole. Proton Pump Inhibitors may decrease the serum concentration of Itraconazole. Management: Exposure to Tolsura brand itraconazole may be increased by PPIs; consider itraconazole dose reduction. Exposure to Sporanox brand itraconazole capsules may be decreased by PPIs. Give Sporanox brand itraconazole at least 2 hrs before or 2 hrs after PPIs
Ketoconazole (Systemic)	Proton Pump Inhibitors may decrease the absorption of Ketoconazole (Systemic). Ketoconazole (Systemic) may increase the serum concentration of Proton Pump Inhibitors. Management: Administer ketoconazole with an acidic beverage, such as non-diet cola, to increase gastric acidity and improve absorption if concomitant use with proton pump inhibitors is necessary.
Ledipasvir	Proton Pump Inhibitors may decrease the serum concentration of Ledipasvir. Management: PPI doses equivalent to omeprazole 20 mg or lower may be given with ledipasvir under fasted conditions. Administration with higher doses of PPIs, 2 hours after a PPI, or in combination with food and PPIs may reduce ledipasvir bioavailability.
Lorlatinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.
Mesalamine	Proton Pump Inhibitors may diminish the therapeutic effect of Mesalamine. Proton pump inhibitor-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Consider avoiding concurrent administration of high-dose proton pump inhibitors (PPIs) with sustainedrelease mesalamine products.
Mitotane	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.
Nilotinib	Proton Pump Inhibitors may decrease the serum concentration of Nilotinib. Management: Avoid this combination when possible since separation of doses is not likely to be an adequate method of minimizing the interaction.
Posaconazole	Proton Pump Inhibitors may decrease the serum concentration of Posaconazole.
Risedronate	Proton Pump Inhibitors may diminish the therapeutic effect of Risedronate. Proton Pump Inhibitors may increase the serum concentration of Risedronate. This applies specifically to use of delayed-release risedronate.
Secretin	Proton Pump Inhibitors may diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of proton pump inhibitors (PPIs) and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details.
Tacrolimus (Systemic)	Proton Pump Inhibitors may increase the serum concentration of Tacrolimus (Systemic). Management: Tacrolimus dose adjustment may be required. Rabeprazole, pantoprazole, or selected H2-receptor antagonists (i.e., ranitidine or famotidine) may be less likely to interact. Genetic testing may predict patients at highest risk.
Risk Factor X (Avoid combination)
Acalabrutinib	Proton Pump Inhibitors may decrease the serum concentration of Acalabrutinib.
Cefuroxime	Proton Pump Inhibitors may decrease the absorption of Cefuroxime.
Dacomitinib	Proton Pump Inhibitors may decrease the serum concentration of Dacomitinib. Management: Avoid concurrent use of dacomitinib with proton pump inhibitors. Antacids may be used. Histamine H2-receptor antagonists (HR2A) may be used if dacomitinib is given at least 6 hours before or 10 hours after the H2RA.
Dasatinib	Proton Pump Inhibitors may decrease the serum concentration of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of the proton pump inhibitor if some acid-reducing therapy is needed.
Delavirdine	Proton Pump Inhibitors may decrease the serum concentration of Delavirdine. Management: Chronic therapy with proton pump inhibitors (PPIs) should be avoided in patients treated with delavirdine. The clinical significance of short-term PPI therapy with delavirdine is uncertain, but such therapy should be undertaken with caution.
Erlotinib	Proton Pump Inhibitors may decrease the serum concentration of Erlotinib.
Nelfinavir	Proton Pump Inhibitors may decrease serum concentrations of the active metabolite(s) of Nelfinavir. Proton Pump Inhibitors may decrease the serum concentration of Nelfinavir.
Neratinib	Proton Pump Inhibitors may decrease the serum concentration of Neratinib. Specifically, proton pump inhibitors may reduce neratinib absorption.
PAZOPanib	Proton Pump Inhibitors may decrease the serum concentration of PAZOPanib.
Pexidartinib	Proton Pump Inhibitors may decrease the serum concentration of Pexidartinib. Management: If acid-reduction is needed, consider administering an antacid 2 hours before or after pexidartinib, or administer pexidartinib 2 hours before or 10 hours after an H2 receptor antagonist.
Rilpivirine	Proton Pump Inhibitors may decrease the serum concentration of Rilpivirine.
Velpatasvir	Proton Pump Inhibitors may decrease the serum concentration of Velpatasvir.

 

Monitoring parameters:

• Patients with Zollinger-Ellison syndrome should be monitored for gastric acid output, which should be maintained at ≤10 mEq/hour during the last hour before the next lansoprazole dose;
• bone loss and fractures,
• CBC,
• CDAD,
• liver function,
• renal function,
• magnesium (baseline and periodically thereafter), and
• serum gastrin levels

---

How to administer Lansoprazole (Prevacid)?

Oral:

• Dosage: 30 minutes before eating if you are on a daily dose.
• You should take the first dose at breakfast and the second at dinner.
• You should not chew the granules.
• Other options may be available if the patient is unable or unwilling to swallow the capsule.
• Open the capsule and sprinkle 1 tbsp cottage yogurt or applesauce with the granules.
• Capsules can be opened and emptied into approximately 60 mL orange juice or apple juice. Mix and then swallow.
• To ensure complete delivery, rinse the glass with at least 2 ounces of juice.

Tablets that can be taken orally:

• Do not swallow whole, break, chew, or chew the tablet. Allow the tablet to dissolve on your tongue, with or without water, until it is swallowable.
• Orally-disintegrating tablets may also be administered via an oral syringe:
  • Oral syringes can be used to draw up the 15 mg tablet.
  • Once the tablet is dispersed, you can administer it within 15 minutes.
  • Fill the syringe up with water (2 mL to take the 15 mg tablet, 5 mL to take the 30 mg tablet), shake the container gently, and then give any remaining contents.

Administration of the naogastric tube:

• Capsule
  • You can open the capsule and mix the granules (but not crush) with 40mL of apple juice.
  • The granules can then be administered through the NG tube to the stomach. After that, flush the tube with more apple juice.
  • Mix with other liquids.
  • Thirty milligrams can also be suspended in 10mL of 8.4% sodium carbonate solution (or apple cider), or broken into four equal parts, flushed with warm water, and then administered via an NG tube.
• Tablet that can be taken orally:
  • French:
    • You can either place a 15 mg tablet into a syringe to draw up 4mL of water or the 30 mg tablet into a syringe to draw up 10mL.
    • Once the tablet is dispersed, you can administer it within 15 minutes.
    • Then, fill the syringe again with 5mL of water and shake it gently. Finally, flush the nasogastric tube.

---

Mechanism of action of Lansoprazole (Prevacid):

Inhibits H+ and K+ ATPase enzyme system leading to decreased acid secretion from parietal cells.

The onset of action:

• Gastric acid suppression: Oral: 1 to 3 hours

Duration:

• Gastric acid suppression: Oral: >1 day

Absorption:

• Rapid

Protein binding:

• 97%

Metabolism:

• Hepatic via CYP2C19 and 3A4 to inactive metabolites, and in parietal cells to two active metabolites that are not present in the systemic circulation

Bioavailability:

• >80%;
• decreased 50% to 70% if given 30 minutes after food

Half-life elimination:

• Children: 1.2 to 1.5 hours;
• Adults: 1.5 ± 1 hour;
• Elderly: 1.9 to 2.9 hours;
• Hepatic impairment: 4 to 7.2 hours

Time to peak, plasma:

• 1.7 hours

Excretion:

• Feces (67%);
• urine (33%; 14% to 25% as metabolites and <1% as unchanged drug)

---

International Brand Names of Lansoprazole:

• GoodSense Lansoprazole
• Heartburn Treatment 24 Hour
• Prevacid
• Prevacid 24HR
• Prevacid SoluTab
• APO-Lansoprazole
• DOM-Lansoprazole
• MYLAN-Lansoprazole
• PMS-Lansoprazole
• Prevacid
• Prevacid FasTab
• RAN-Lansoprazole
• RIVA-Lansoprazole
• SANDOZ Lansoprazole
• TEVALansoprazole
• Agopton
• Amdory
• Betalans
• Chexid
• Dakar
• Dapuaa
• Daxar
• Digest
• Dispepci
• Emlansa
• Estomil
• Gastevin
• Gastriben
• Gastrocure
• Gastrovex
• Hiza
• Ilsatec
• Imidex
• Inhipraz
• Julphasole
• Krovane
• Lacopen
• Lagas 30
• Lan30
• Lancerol
• Lancid
• Lanfast
• Langaton
• Lanodizol
• Lanpraz
• Lanpro
• Lanprol
• Lanproton
• Lans OD
• Lans-OD
• Lansal
• Lansale
• Lanso
• Lansodin
• Lansofast
• Lansol-30
• Lansomid
• Lansomylan
• Lansone
• Lansopep
• Lansopram
• Lansoprol
• Lansor
• Lansozole
• Lanspro-30
• Lanster
• Lanston
• Lanton
• Lanvell
• Lanxid-OD
• Lanximed
• Lanz
• Lanzap
• Lanzo
• Lanzo Melt
• Lanzol
• Lanzol-30
• Lanzole
• Lanzopra
• Lanzopral
• Lanzopran
• Lanzor
• Lanzostad
• Lanzul
• Lapraz
• Laproton
• Lasgan
• Lasoprol
• Laz
• Lazo
• Lazol
• Loprezol
• Monolitum
• Ogast
• Ogastro
• Olan
• Opiren
• Palatrin
• Prazex
• Prevacid
• Prevacid FDT/IV
• Prezal
• Prilosan
• Prolanzo
• Prosogan fd
• Protonexa
• Pysolan
• Quitulcer
• Razolager
• Safemar
• Solox
• Sopralan30
• Sopranix
• Soprazol
• Sorifran
• Takepron
• Takepron OD
• Taquidine
• Uldapril
• Ulpax
• Versacid
• Xizhixin
• Zolcer
• Zomel
• Zopral
• Zopraz
• Zoton
• Zoton Fastab

---

Lansoprazole Brand Names in Pakistan:

Lansoprazole Injection 30 Mg in Pakistan
Anso	Shaigan Pharmaceuticals (Pvt) Ltd
Belenz	Wellborne Pharmachem And Biologicals
Lansogen	Fassgen Pharmaceuticals
Lanspro	Safe Pharmaceutical (Pvt) Ltd.
Lanzit	S.J. & G. Fazul Ellahie (Pvt) Ltd.
Prevazol	Mediceena Pharma (Pvt) Ltd.
Q-Pro	Bosch Pharmaceuticals (Pvt) Ltd.
Ulcozol-L	Friends Pharma (Pvt) Ltd
W.Lansop	Welwrd Pharmaceuticals

 

Lansoprazole Injection 30 Mg in Pakistan
Qpro	Bosch Pharmaceuticals (Pvt) Ltd.

 

Lansoprazole Tablets 30 Mg in Pakistan
Crolanz	Crown Pharmaceuticals
Duzol	Honig Pharmaceuticals Laboratories
Exazole	Amarant Pharmaceuticals (Pvt)
Fitcid	Shawan Pharmaceuticals
Lansopal	Alson Pharmaceuticals
Lansopal	Alson Pharmaceuticals
Lantol	Genome Pharmaceuticals (Pvt) Ltd
Lanzel	Hygeia Pharmaceuticals
Naxim	Navegal Laboratories
Ocify	Webros Pharmaceuticals
Pixasol	Pliva Pakistan (Pvt) Limited
Sepraz	Usawa Pharmaceuticals

 

Lansoprazole Tablets 40 Mg in Pakistan
Zotec	Pulse Pharmaceuticals

 

Lansoprazole Capsules 30 in Pakistan
Doudcer-Nil	Global Pharmaceuticals

 

Lansoprazole Capsules 15 Mg in Pakistan
Agopton	Helix Pharma (Private) Limited
Allest	Wise Pharmaceuticals (Pvt) Ltd
Caralans	Caraway Pharmaceuticals
Lanso	Winilton Pharmaceuticals (Pvt) Ltd
Previd	Platinum Pharmaceuticals (Pvt.) Ltd.
Qpro	Bosch Pharmaceuticals (Pvt) Ltd.

 

Lansoprazole Capsules 30 Mg in Pakistan
Accion	Envoy Pharma
Agopton	Helix Pharma (Private) Limited
Aksoton	Akson Pharmaceuticals (Pvt) Ltd.
Alberta	Tagma Pharma (Pvt) Ltd.
Allest	Wise Pharmaceuticals (Pvt) Ltd
Allest	Wise Pharmaceuticals (Pvt) Ltd
Anzole Capsule	Shawan Pharmaceuticals
Arcozol	Pakistan Pharmaceutical Products (Pvt) Ltd.
Bestolens	Elko Organization (Pvt) Ltd.
Caralans	Caraway Pharmaceuticals
Cistus	Zephyr Pharmatec (Pvt) Ltd.
D-Burn	Nexus Pharma (Pvt) Ltd
Epent-L	Eros Pharmaceuticals
Everzole	Everest Pharmaceuticals
Everzole	Everest Pharmaceuticals
Flan	Fozan Pharmaceuticals Industriers (Pvt) Ltd
Flanso	Farm Aid Group Pak Ltd.
Fonsizole	Tg Pharma
Gaszole	Medera Pharmaceuticals (Pvt) Ltd.
Gerd	Rakaposhi Pharmaceutical (Pvt) Ltd.
Gerdis	Candid Pharmaceuticals
H2 Zol	Flow Pharmaceuticals (Pvt) Ltd.
Indpro	Indus Pharma (Pvt) Ltd.
Inhibitol	Highnoon Laboratories Ltd.
Kaylan	Polyfine Chempharma (Pvt) Ltd.
L-Sol	Pakheim Internanational Pharma
La Cap	Bio Labs (Pvt) Ltd.
Ladazole	Gray`S Pharmaceuticals
Lancas	Spl Pharmaceuticals (Pvt) Ltd
Lancet	Nimrall Laboratories
Lancro	Crown Pharmaceuticals
Lanex	Cherwel Pharmaceuticals (Pvt) Ltd
Lanosh	Shaheen Pharmaceuticals
Lanpraz	Zanctok Pharmaceuticals
Lanprol	Reko Pharmacal (Pvt) Ltd.
Lanrest	Universal Enterprises
Lansa	Medera Pharmaceuticals (Pvt) Ltd.
Lansazole	Advanced Pharmaceuticals
Lanso-Zol	Jawa Pharmaceuticals(Pvt) Ltd.
Lansofin	Medifine Laboratories
Lansoft	Shrooq Pharmaceuticals
Lansogen	Fassgen Pharmaceuticals
Lansolive	Olive Pharmaceuticals
Lansoloc	Eg Pharmaceuticals
Lansomed	Mediate Pharmaceuticals (Pvt) Ltd
Lansomer	Miracle Pharmaceuticals(Pvt) Ltd
Lansonen	Nenza Pharmaceuticals (Pvt) Limited
Lansopulse	Pulse Pharmaceuticals
Lansor	Pharmedic (Pvt) Ltd.
Lansorex	Biorex Pharmaceuticals
Lansotech	Hygeia Pharmaceuticals
Lansoval	Valor Pharmaceuticals
Lansowan	Swan Pharmaceuticals(Pvt) Ltd
Lansowin	Wns Field Pharmaceuticals
Lansoyan	Roryan Pharmaceutical Industries (Pvt) Ltd
Lanstop	Panacea Pharmaceuticals
Lanz	Mcolson Research Laboratories
Lanzac	Don Valley Pharmaceuticals (Pvt) Ltd.
Lanzac	Don Valley Pharmaceuticals (Pvt) Ltd.
Lanzan	Medizan Labs (Pvt) Ltd
Lanzit	S.J. & G. Fazul Ellahie (Pvt) Ltd.
Lanzol	Pharmatec Pakistan (Pvt) Ltd.
Lanzop	Danas Pharmaceuticals (Pvt) Ltd
Lapis	Goodman Laboratories
Lapravis	Global Pharmaceuticals
Laprazole	Nova Med Pharmaceuticals
Laprole	Jawa Pharmaceuticals(Pvt) Ltd.
Laprosyd	Sayyed Pharmaceuticals
Laproz	Bloom Pharmaceuticals (Pvt) Ltd.
Laproz	Bloom Pharmaceuticals (Pvt) Ltd.
Lazol	Fynk Pharmaceuticals
Le	Unimark Pharmaceuticals
Letzol	Lowitt Pharmaceuticals (Pvt) Ltd
Lexical	Ferroza International Pharmaceuticals (Pvt) Ltd.
Lezola	Linear Pharma
Lintox	Medicaids Pakistan (Pvt) Ltd.
Losazole	Lotus Pharmaceuticals (Pvt) Ltd
Losin	Aries Pharmaceuticals (Pvt) Ltd
Losp	Genome Pharmaceuticals (Pvt) Ltd
Losyd	Saydon Pharmaceutical Industries (Pvt) Ltd.
Manpro	Macquins International
Navezole	Navegal Laboratories
Nexole	Akhai Pharmaceuticals.
Nopra	Breeze Pharma (Pvt) Ltd
Nsolop	Medicraft Pharmaceuticals (Pvt) Ltd.
Obzole	Obsons Pharmaceuticals
Opagis	Rotex Medica Pakistan (Pvt) Ltd
Osilan	Florence Farmaceuticals (Pvt) Ltd
Pastrazol	Karachi Pharmaceutical Laboratory
Pazmol	Unipharma (Pvt) Ltd.
Peptic-L	Arsons Pharmaceuticals Industries (Pvt) Ltd
Prevacid	Paramount Pharmaceuticals
Previd	Platinum Pharmaceuticals (Pvt.) Ltd.
Pumin	Karachi Chemical Industries
Pylohib	Stalwart Pharmaceuticals (Pvt) Ltd
Qpro	Bosch Pharmaceuticals (Pvt) Ltd.
Ranso	Rock Pharmaceuticals
Sancid	Hassan Pharmaceuticals (Pvt) Ltd.
Sepzo	Weather Folds Pharmaceuticals
Sopra Capsule	Siza International (Pvt) Ltd.
Sopra Praz	Evergreen Pharmaceuticals Pvt Limited
Sopran	Amros Pharmaceuticals.
Suprazole	Epharm Laboratories
Syzol	Albro Pharma
Ulcozol	Friends Pharma (Pvt) Ltd
Ultozone	Mass Pharma (Private) Limited
Vanzole	Vega Pharmaceuticals Ltd.
Wezol	Webros Pharmaceuticals
Winslet	Everest Pharmaceuticals
Winslet	Everest Pharmaceuticals
Zeton	Shazals Pharmaceuticals
Zolard	Davis Pharmaceutical Laboratories
Zolat Plus	English Pharmaceuticals Industries

 

Lansoprazole Capsules SR 30 Mg in Pakistan
Selanz	Searle Pakistan (Pvt.) Ltd.
Selanz	Searle Pakistan (Pvt.) Ltd.

 

Lansoprazole Pellets 30 Mg in Pakistan
Zolet Plus	English Pharmaceuticals Industries