Lansoprazole

Lansoprazole is a proton pump inhibitor (PPI) used to treat heartburn, gastroesophageal reflux disease (GERD), and gastric/duodenal ulcers. It is available under the brand name Agopton® and as a generic.

Lansoprazole is available as a capsule and as an orally disintegrating tablet (orodispersible), which makes it easier to take if you have difficulty swallowing.

Like all PPIs, lansoprazole inhibits stomach acid production and is used for the short- and long-term treatment of acid-related conditions.

Lansoprazole irreversibly inhibits the proton pump of the parietal cells in the stomach:

Mechanism of action:

• Prodrug, activated in the acidic environment of the parietal cell
• Irreversible binding to H+/K+-ATPase
• Blocks acid production at the final step
• Reduction of stomach acid by up to 90%

Special features:

• High bioavailability
• Half-life approx. 1-2 hours, but duration of action 24+ hours

Lansoprazole is suitable for:

• Gastroesophageal reflux disease (GERD)
• Reflux esophagitis
• Gastric and duodenal ulcers
• Helicobacter pylori eradication
• Stomach protection during NSAID use
• Zollinger-Ellison syndrome
• Patients with difficulty swallowing (orally disintegrating tablet available)

Not suitable:

• For unexplained upper abdominal complaints without a diagnostic workup
• As long-term therapy without a medical indication

Available strengths:

• 15 mg capsules/orally disintegrating tablets
• 30 mg capsules/orally disintegrating tablets

Usual dosages:

• Heartburn/mild reflux: 15-30 mg 1x daily
• Reflux esophagitis: 30 mg 1x daily for 4-8 weeks
• Gastric ulcer: 30 mg 1x daily for 4 weeks
• Duodenal ulcer: 30 mg 1x daily for 2-4 weeks
• Helicobacter eradication: 30 mg 2x daily (with antibiotics)
• Maintenance: 15 mg 1x daily

How to take:

• In the morning, 30 minutes before breakfast
• Swallow capsules whole without chewing

Orally disintegrating tablet (FasTab):

• Place on the tongue and let it disintegrate
• Can be taken without water
• Ideal for difficulty swallowing

Notes:

• Take regularly, not only when symptoms occur
• Do not stop abruptly after long-term therapy
• Regular medical check-ups during continuous use

Lansoprazole must not be taken in cases of:

• Hypersensitivity to lansoprazole or other PPIs

Caution in cases of:

• Concomitant use of atazanavir or nelfinavir (not recommended)
• Moderate or severe hepatic insufficiency (reduction of the daily dose by 50%, regular monitoring)
• Long-term use (standard risks of the PPI class)
• Suspected stomach cancer

Pregnancy/breastfeeding: Only if there is an urgent indication. Limited data.

Common (1-10%):

• Headache
• Dizziness
• Diarrhea
• Nausea
• Abdominal pain
• Constipation
• Flatulence

Uncommon:

• Skin rash
• Dry mouth
• Joint pain
• Fatigue

Long-term risks (all PPIs):

• Magnesium deficiency
• Vitamin B12 deficiency
• Increased risk of fractures
• Risk of Clostridium difficile infection

Reduced absorption due to increased pH:

• Ketoconazole, itraconazole
• Iron preparations, vitamin B12
• Atazanavir, nelfinavir (combination not recommended)

Lansoprazole inhibits CYP2C19 (moderately):

• Interaction potential between that of omeprazole and pantoprazole
• Caution with clopidogrel (pantoprazole may be preferable)

Theophylline: Accelerated elimination possible. Monitor levels.