Lansoprazole

INTRODUCTION

Indications

Erosive esophagitis. Duodenal ulcers (with or without anti-infectives for Helicobacter pylori). Active benign gastric ulcer. Short-term treatment of symptomatic GERD. Healing and risk reduction of NSAID-associated gastric ulcer. Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome.

Action

Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic Effects: Diminished accumulation of acid in the gastric lumen, with lessened acid reflux. Healing of duodenal ulcers and esophagitis.

Adverse Reactions/Side Effects

CNS: dizziness, headache. GI: diarrhea, abdominal pain, nausea. Derm: rash.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor improvements in GI symptoms (gastritis, heartburn, and so forth) to help determine if drug therapy is successful.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• In cases of NSAID-induced gastritis, implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for aspirin and other NSAIDs.

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

• Instruct patient to report bothersome or prolonged side effects, including headache, skin rash, or GI effects (nausea, diarrhea, abdominal pain).

Pharmacokinetics

Absorption: 80% absorbed after oral administration.

Distribution: Unknown.

Protein Binding: 97%.

Metabolism and Excretion: Extensively metabolized by the liver to inactive compounds. Converted intracellularly to at least two other antisecretory compounds.

Half-life: Children: 1.2–1.5 hr; Adults: 1.3–1.7 hr (↑ in geriatric patients and patients with impaired hepatic function).

Contraindications/Precautions

Contraindicated in: Hypersensitivity.

Use Cautiously in: Geri: Maintenance dose should not exceed 30 mg/day unless additional acid suppression is required; SoluTabs contain aspartame; use caution when used in phenylketonurics; Severe hepatic impairment (not to exceed 30 mg/day in these patients); OB/Lactation/Pedi: Pregnancy, lactation, or children <1 yr (safety not established).

Interactions

Drug-Drug: Sucralfate ↓ absorption of lansoprazole (take 30 min before sucralfate). May ↓ absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavir, ampicillin esters, iron salts, and digoxin. May ↑ risk of bleeding with warfarin (monitor ...