Diarrhea lansoprazole

The effect of lansoprazole on roxithromycin concentrations in plasma and gastric tissue have been investigated in 12 healthy volunteers who took lansoprazole 30 mg bd with or without roxithromycin 300 mg bd over 6 days (3). The medications were well tolerated, with only mild adverse events. The more frequent adverse events were nausea, bloating, and diarrhea. Lansoprazole and roxithromycin did not alter the systemic availability of each other. However, lansoprazole increased the local concentration of the antibiotic in the stomach. 

Konijeti GG, Deshpande V, Bunker CJ. An unusual case of chronic diarrhea. Lansoprazole-induced microscopic colitis. Gastroenterology 2013 144 696-857. 

Sucralfate 1 g tds in combination with amoxicillin 500 mg tds and clarithromycin 400 mg bd for 2 weeks was as effective as a combination of lansoprazole 30 mg bd plus amoxicillin 500 mg tds and clarithromycin 400 mg bd for 2 weeks for H. pylori eradication in a randomized, multicenter trial in 150 patients (9). There was no significant difference in adverse effects between the two groups. Diarrhea, abdominal pain, glossitis, and taste disturbance were the adverse effects commonly reported. 

Lansoprazole is a proton pump inhibitor. Its safety profile has been reviewed based on premarketing chnical studies, and has to be regarded with the reservations appropriate to this type of material. In 4749 patients the most frequent adverse effects were headache (4.7%), diarrhea (3.2%), abdominal pain (2.2%), pharyngitis (1.8%), and nausea (1.4%) some patients had upper respiratory complaints or suffered anxiety or depression, or myalgia (1). The adverse reaction profile appears to be closely similar to that of omeprazole. 

Lansoprazole 15 and 30 mg/day were more effective than placebo, but not misoprostol 200 micrograms qds, for the prevention of NSAID-induced gastric ulcers in a multicenter, double-blind, placebo-controUed trial in 537 patients without Helicobacter pylori infection who were long-term users of NSAIDs (2). However, adverse effects were significantly more frequent (31% versus less than 20%) and treatment adherence significantly less (71% versus more than 90%) in patients taking misoprostol. The most commonly reported adverse effects in aU groups were diarrhea, abdominal pain, and nausea. 

An unblinded questionnaire survey has been carried out to determine patients perceptions of differences in the efficacy, adverse effects, and value of omeprazole versus lansoprazole for gastro-esophageal reflux disease maintenance therapy (5). The patients had been taking omeprazole for at least 2 months and then switched to lansoprazole for a minimum of 2 months. There was no significant difference between median symptom scores with the two drugs, but 64% of patients preferred omeprazole to lansoprazole. The most commonly reported adverse effects with both drugs were flatulence, headache, and diarrhea. Significantly more patients reported adverse effects with lansoprazole than with omeprazole. 

The results of a therapeutic interchange program, in which 78 patients with acid peptic disease requiring proton pump inhibitor therapy (both newly diagnosed patients and those previously stabilized on omeprazole) were treated with lansoprazole, have been retrospectively analysed (12). Although the switch was associated with considerable pharmaceutical savings, there was an overall lansoprazole-associated failure rate of 28%. Reported lack of efficacy required withdrawal of lansoprazole in 15%, while adverse effects required withdrawal of lansoprazole in 13% of patients (versus none with omeprazole). The main adverse effect was diarrhea. 

The clinical and fiscal impact of replacing omeprazole with lansoprazole as the only proton pump inhibitor has been assessed by reviewing the medical records of 3833 patients requiring long-term proton pump inhibitor therapy (2224 were started on lansoprazole and 1479 were converted from omeprazole to lansoprazole) (13). There were considerable pharmaceutical savings. The true lansoprazole failure rate (requiring conversion to omeprazole) was 5.3%. Withdrawal of lansoprazole was due to poor symptom control (in 69%) and/or adverse effects (in 22%). The most common adverse effects were diarrhea (10%), abdominal pain (5%), and urticaria (1%). 

Omeprazole 40 mg/day for 6 weeks and lansoprazole 30 mg bd have been compared for sjmptom control in a randomized study in 96 patients with gastro-esophageal reflux disease who had earher failed to respond to lansoprazole 30 mg/day (14). The two drugs were equally effective in symptom control. There were no significant differences in adverse events between the two groups. The most frequent adverse events reported were diarrhea, abdominal pain/discomfort, bloating/gas, vomiting, and headache. 

Omeprazole multiple unit pellet system (MUPS) 20 mg/day and pantoprazole 40 mg/day for 8 weeks were more effective than lansoprazole 30 mg/day in relieving heartburn in a randomized, double-bhnd trial in 461 patients with sjmptomatic reflux esophagitis (15). Patient satisfaction and adverse effects were similar in the three groups. The most common adverse effects were diarrhea, headache, and nausea. 

Lansoprazole 30 mg/day and omeprazole 20 mg/day for 8 weeks have been compared in the rehef of heartburn in a multicenter, randomized, double-blind trial in 3510 patients with erosive esophagitis (22). Symptom control was significantly more effective and faster with lansoprazole than omeprazole. Both drugs were weh tolerated. The most common adverse effect was diarrhea. 

Lansoprazole 30 mg/day, lansoprazole 15 mg/day, and ranitidine 150 mg/day have been compared in a randomized, double-bhnd, multicenter trial in the prevention of relapse of duodenal ulcer and symptom control over 12 months in 359 patients (25). Both doses of lansoprazole were superior to ranitidine. There was no significant difference between the two lansoprazole groups, although there was a trend in favor of lansoprazole 30 mg/day. There were no differences in adverse effects profiles in the three groups. The adverse effects included diarrhea, abdominal pain, viral infections, headache, and vomiting. 

Lansoprazole 15 or 30 mg/day and ranitidine 150 mg bd for 8 weeks have been compared in the treatment of non-erosive gastro-esophageal reflux disease in two double-bhnd, multicenter trials in 901 patients (27). Overall symptom control was significantly better with either dose of lansoprazole than with ranitidine or placebo. There was no significant difference in reported adverse events between the treatment groups. The more commonly reported were abdominal pain and diarrhea. 

The adverse effects profile of the proton pump inhibitors during short-term administration (under 12 weeks) is similar to that reported with short-term use of histamine receptor antagonists. The type and frequency of adverse effects reported with lansoprazole, omeprazole, pantoprazole, and rabeprazole are comparable. The most common adverse effects include headache, diarrhea, nausea, abdominal pain, constipation, dizziness, and skin rashes. 

A 77-year-old man who had taken lansoprazole for 6 years for gastroesophageal reflux disease took clarithromycin for 2 weeks to treat bronchitis, and then 3 months later began to have watery diarrhea, with 5-10 bowel movements a day and 4 kg of weight loss [59 ]. Colonoscopy showed disappearance of vascular networks and several red spots in the sigmoid and descending colons. 

All colonic biopsies showed erosions with severe infiltration by inflammatory cells. Masson s trichrome staining identified subepithelial collagen bands as thick as 25 pm in every specimen, consistent with collagenous colitis. Lansoprazole was withdrawn, and within a few days the watery diarrhea disappeared. Colonoscopy 2 months later showed a reduction in the number of red spots. Biopsies from the cecum, ascending, transverse, and descending colons, and rectum, showed no collagen bands. 

Gastrointestinal Lansoprazole has been associated with diarrhea and microscopic colitis, but this association has not been clearly established with other proton pump inhibitors. Microscopic colitis has been reported after treatment with esomeprazole (two cases) and omeprazole (two cases) [57 ]. 

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