lansoprazole: clinical use

Prescribing considerations

• Exclude or investigate gastric malignancy where appropriate because symptom suppression can delay diagnosis.
• Regularly reassess the indication and benefit–risk balance during long-term treatment.
• Use caution in moderate or severe hepatic impairment and consider reduced clearance in older adults.
• Restrict NSAID-ulcer prophylaxis to patients at increased gastrointestinal risk who need continued NSAID treatment.
• Consider fracture risk, enteric infection, vitamin B12 deficiency, microscopic colitis, severe cutaneous reactions and acute tubulointerstitial nephritis.
• Chromogranin A may be increased and interfere with neuroendocrine-tumour investigations.

Contraindications and cautions

• Hypersensitivity to lansoprazole or any formulation excipient.
• The selected capsule information contraindicates co-administration with atazanavir; selected orodispersible products describe pH-dependent HIV protease inhibitors as combinations that are not recommended.
• Check excipients: selected orodispersible products contain aspartame and may be unsuitable in phenylketonuria; some contain lactose or sucrose with relevant hereditary intolerance warnings.

Monitoring

• Consider magnesium before and periodically during prolonged treatment, particularly with digoxin, diuretics or other medicines that can lower magnesium.
• Assess vitamin B12 status when risk factors, reduced stores or compatible symptoms are present.
• Monitor INR with warfarin and concentrations of tacrolimus or digoxin when clinically indicated.
• Promptly investigate severe or persistent diarrhoea and suspected liver, renal, cutaneous or electrolyte toxicity.

Clinical pharmacology

Lansoprazole is an acid-labile benzimidazole PPI supplied in gastro-resistant form. After absorption, it concentrates and becomes activated in acidic parietal-cell canaliculi, inhibiting gastric H+/K+-ATPase. It is principally metabolised through CYP2C19 and CYP3A4; food reduces and delays absorption.

Formulation and product differences

• Orodispersible tablets release gastro-resistant microgranules on the tongue; selected products can also be dispersed in water for an oral syringe or suitable nasogastric tube.
• Hard gastro-resistant capsules contain enteric-coated pellets. Selected capsules may be opened, but their contents must not be crushed or chewed.
• Excipient profiles differ by product, including aspartame, lactose and sucrose.
• Contraindication and interaction wording differs between selected products, particularly for atazanavir.

Dispersible tablet

Route: Oral

Strengths: 15 mg, 30 mg

Gastro-resistant capsule

Route: Oral

Strengths: 15 mg, 30 mg