Lansoprazole nausea

The histamine2-receptor antagonists or H2RAs (cimetidine, famotidine, nizatidine, and ranitidine) and proton pump inhibitors (omeprazole, esomeprazole, lansoprazole, pantopra-zole, and rabeprazole) reduce the amount of acid secreted into the stomach by gastric parietal cells. These agents are also helpful for nausea and vomiting related to gastric acid secretion. 

An 89-year-old man, who was taking aspirin 325 mg/ day, clopidogrel 75 mg/day, atenolol 25 mg/day, and lansoprazole 30 mg/day, developed depression and was given citalopram 20 mg/day (35). His depressive symptoms started to improve, but after 12 days he developed malaise, nausea, and headache. His serum sodium concentration had fallen from 138 mmol/1 before citalopram to 117 mmol/1. This was due to inappropriate secretion of antidiuretic hormone. Citalopram was withdrawn, he was given intravenous saline, and 72 hours later his serum sodium was normal and his symptoms of malaise, nausea, and headache had resolved. However, his depressive symptoms worsened, so citalopram (20 mg/day) was restarted with close monitoring of the serum sodium. Within 2 days his serum sodium had fallen to 126 mmol/1. Citalopram was withdrawn and mirtazapine was used as an alternative antidepressant with good effect and without any reduction in serum sodium. 

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. 

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. 

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. 

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. 

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