Lansoprazole infections

Ogasrtro (Lansoprazole) Duodenal ulcer Gastro-oesophageal reflux Helicobacter infections 2.3 0.8 1994 - UK 1995 - US Once daily, except when used as part of combination therapy for H. pylori and for hypersectetory conditions. Twice-daily when dose >120 mg. 

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. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

H. pylori infection PO 1 g twice a day in combination with clarithromycin and lansoprazole for 14 days. 

The study population consisted of CYP2C19-genotyped patients infected with H. pylori who had completed initial treatment with omeprazole 20 mg or lansoprazole 30 mg twice daily, and clarithromycin 200 mg and amoxicillin 500 mg three times a day for 1 week. Patients in whom the infection was not eradicated after initial treatment were retreated with lansoprazole 30 mg and amoxicillin 500 mg four times a day for 2 weeks. 

Pantoprazole sodium, a substituted benzimidazole derivative, is an irreversible proton pump inhibitor, and was developed for the treatment of acid-related gastrointestinal disorders. As with other drugs of its class (e. g. omeprazol or lansoprazole), pantoprazole reduces gastric acid secretion through inhibition of the portion on the gastric parietal cell. In combination with other drugs, pantoprazole can be used for the initial treatment of H. Pylori infection [1],... 

Miwa H, Ohkura R, Murai T, Sato K, Nagahara A, Hirai S, Watanabe S, Sato N. Impact of rabeprazole, a new proton pump inhibitor, in triple therapy for Helicobacter pylori infection—comparison with omeprazole and lansoprazole. Aliment Pharmacol Ther 1999 13(6) 741-6. 

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. 

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. 

Miki I, Aoyama N, Sakai T, Shirasaka D, Wambura CM, Maekawa S, et al. Impact of clarithromycin resistance and CYP2C19 genetic polymorphism on treatment efficacy of Helicobacter pylori infection with lansoprazole- or rabeprazole-based triple therapy in Japan. Eur J Gastroenterol Hepatol 2003 15 27-33. 

Regarding proton pump inhibitors, the effect of CYP2C19 PM status is not limited to pharmacokinetic alterations. The difference in the pharmacokinetics has been shown to influence the outcome of H. Pylori eradication therapy. Furuta et al. showed that in patients with confirmed H. Pylori infection treated with omeprazole or lansoprazole plus clarithromycin and amoxicillin, CYP2C19 PMs had an eradication rate of 97.8% compared with a rate of 72.7% (P < 0.001) for CYP2C19 EMs (51). 

Placebo-controDed studies In a 4-week multicenter, double-blind, parallel-group, randomized study of lansoprazole in 162 infants aged 1-12 months with persistent symptoms attributed to gastroesophageal reflux disease there was no difference between lansoprazole and placebo in terms of efficacy [59 ]. However, serious adverse events, particularly lower respiratory tract infections, occurred in 12 infants, and were significantly more common with lansoprazole. 

The odds ratio for upper respiratory infections in poor and extensive metabolizers was 2.46 (95% Confidence Interval (Cl) 1.02-5.96 p = 0.046) and 1.55 (95% Cl 0.86-2.79 NS), respectively. The odds ratio for sore throat in extensive and poor metabolizers was 2.94 (95% Cl 1.23-7.05, p = 0.016) and 1.97 (95% Cl 1.09-3.55, p = 0.024), respectively. Mean plasma concentrations of lansoprazole were significantly higher in poor metabolizers tiian in extensive metabolizers (P = 0.04). These findings suggest that lansoprazole-associated respiratory infections in children might be mitigated by lowering the conventional dose in poor metabolizers [42 ]. 

---