Lansoprazole disease

Most patients require standard doses to prevent relapses. H2RAs may be an effective maintenance therapy in patients with mild disease. The PPIs are the drugs of choice for maintenance treatment of moderate to severe esophagitis. Usual once-daily doses are omeprazole 20 mg, lansoprazole 30 mg, rabeprazole 20 mg, or esomeprazole 20 mg. Lower doses of a PPI or alternate-day regimens may be effective in some patients with less severe disease. 

Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole, are commonly prescribed to treat symptoms of heartburn, acid reflux, chest pain, dyspepsia, and chronic cough. PPIs inhibit the transfer of protons into the stomach lumen. Pharmacological acid suppression is thus used to treat gastroesophageal reflux disease (GERD) and esophagitis, peptic ulcers, and Helicobacter pylori infection as well as to prevent ulcer development with concurrent nonsteroidal anti-inflammatory drug use. 

Richter, J. E., Campbell, D. R., Kahrilas, P. J., Huang, B., and Eludas, C. (2000) Lansoprazole compared with ranitidine for the treatment of nonerosive gastroesophageal reflux disease. Arch. Intern. Med. 160, 1803-1809. 

Furuta, T., Shirai, N., Watanabe, F., et al. (2002) Effect of cytochrome P4502C19 genotypic differences on cure rates for gastroesophageal reflux disease by lansoprazole. Clin. Pharmacol. Ther. 72, 453-460. 

Omeprazole (p. 167) can cause maximal inhibition of HCl secretion. Given orally in gastric juice-resistant capsules, it reaches parietal cells via the blood. In the acidic milieu of the mucosa, an active metabolite is formed and binds covalently to the ATP-driven proton pump (H+/K+ ATPase) that transports H+ in exchange for IC into the gastric juice. Lansoprazole and pantoprazole produce analogous effects. The proton pump inhibitors are first-line drugs for the treatment of gastroesophageal reflux disease. 

Swallow lansoprazole delayed-release capsules whole. Do not chew or crush. Dosage adjustment For naproxen/lansoprazole, no adjustment of the 15 mg lansoprazole component is necessary in patients with renal insufficiency or for the elderly. However, consider dose adjustment for the naproxen component for patients with renal insufficiency, liver disease, or the elderly. 

Patients with healed GERD were treated for up to 40 months with rabeprazole and monitored with serial gastric biopsies. Approximately 4% of patients had intestinal metaplasia at some point during follow-up, but no consistent changes were seen. Hepatic effects In patients with various degrees/types of hepatic disease, the AUC was prolonged (lansoprazole, esomeprazole, rabeprazole, pantoprazole), half-life was prolonged (lansoprazole, omeprazole, rabeprazole, pantoprazole), increased bioavailability was observed (omeprazole), decreased clearance with rabeprazole and increased maximum pantoprazole concentrations. 

Proton pump inhibitors (PPIs), eg, omeprazole, lansoprazole Irreversible blockade of H +, K+-ATPase pump in active parietal cells of stomach Long-lasting reduction of stimulated and nocturnal acid secretion Peptic ulcer, gastroesophageal reflux disease, erosive gastritis Half-lives much shorter than duration of action low toxicity reduction of stomach acid may reduce absorption of some drugs and increase that of others... 

Hypersensitivity of lansoprazole or any of its components Caution in phenylketonurics Oral disintegrating tables contain phenylalanine Caution in liver disease (dose reduction may be required)... 

In a similar study in 221 patients with peptic ulcer disease associated with H. pylori, rabeprazole has been compared with omeprazole and lansoprazole (combining them with amoxicillin plus clarithromycin for 1 week) (6). Rabeprazole was as effective as omeprazole and lansoprazole in eradicating H. pylori (84-88% each). There were no differences in reported adverse events. Common adverse effects were soft stools, glossitis, taste disturbances, and skin rashes. 

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. 

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. 

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. 

Condra LJ, Morreale AP, Stolley SN, Marcus D. Assessment of patient satisfaction with a formulary switch from omeprazole to lansoprazole in gastroesophageal reflux disease maintenance therapy. Am J Manag Care 1999 5(5) 631-8. 

Gerson LB, Hatton BN, Ryono R, Jones W, Pulliam G, Sampliner RE, TriadafUopoulos G, Fass R. Clinical and fiscal impact of lansoprazole intolerance in veterans with gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2000 14(4) 397 6. 

Fass R, Murthy U, Hayden CW, Malagon IB, Pulliam G, Wendel C, Kovacs TO. Omeprazole 40 mg once a day is equally effective as lansoprazole 30 mg twice a day in symptom control of patients with gastro-oesophageal reflux disease (GERD) who are resistant to conventional-dose lansoprazole therapy—a prospective, randomized, multi-centre study. Aliment Pharmacol Ther 2000 14(12) 1595-603. 

AIN is a relatively uncommon cause of kidney disease, accounting for only 2-3% of all renal biopsies [33-35]. However, in patients with acute kidney injury (AKl) who have normal sized kidneys on ultrasound, AIN is much more common, accounting for up to 27% of biopsies [36]. Omeprazole was fhe first PPl described to cause AIN. In this case, a 74 year old female on omeprazole therapy for 6 months developed fatigue, malaise and was noted to have hematuria, proteinuria and eosinophiluiia [17]. Over the next 12 years, 29 cases of AIN associated with omeprazole were published, 23 of which were biopsy proven [18-23]. In 2004 other PPls were implicated in two large case series that included omeprazole, lansoprazole and pantoprazole [24, 25]. 

Welage LS, Berardi RR. Evaluation of omeprazole, lansoprazole, panto-prazole, and rabeprazole in the treatment of acid-related diseases. J Am Pharm Assoc 2000 40 52-62. 

Chronic renal failure does not lead to drug accumulation with once-a-day dosing of the proton-pump inhibitors. Hepatic disease substantially reduces the clearance of esomeprazole and lansoprazole. Thus, in patients with severe hepatic disease, dose reduction is recommended for esomeprazole and should be considered for lansoprazole. 

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