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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

Lansoprazole

Indication

  • Management of erosive esophagitis associated with gastroesophageal reflux disease (GERD)

  • Symptomatic  management of GERD

Pharmacology

  • Lansoprazole suppresses gastric acid secretion in the parietal cells through inhibition of the H+/K+ ATPase pump. It is therefore referred to as a proton pump inhibitor (PPI)
  • Lansoprazole is metabolized in the liver by the following cytochrome P450 enzymes (CYP 450): CYP2C19 , CYP3A4 (both major) as well as by CYP2C9 (minor)

  • Biliary excretion is the major route of elimination; feces (67%) and urine 33% (mostly as inactive metabolites)

Side Effects

  • Generally well tolerated

  • GI: abdominal pain, cramps, bloating, constipation, diarrhea, vomiting, mildly elevated AST/ALT
  • CV: hypertension, hypotension

  • Dermatologic: urticaria, prutitus

  • Hematologic: thrombocytopenia, leucopenia, leukocytosis, anemia

  • Endocrine: hyperglycemia, hyperlipidemia

Drug Interactions

  • Fluconazole: may increase the serum concentrations of PPIs (manage by monitoring therapy)

  • Ferrous sulfate: the absorption of iron salts may be decreased because gastric acid secretion is inhibited by PPIs

Dose

 

 
  • Dose for neonates/infants less than 10 weeks of age:

    0.2-0.3 mg/kg/dose PO once daily

     

    Dose for infants over 10 weeks of age:

     

    1-2 mg/kg/dose PO once daily

  • Oral liquid doses will be automatically dose standardized to one of the LHSC standard doses (0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 45 mg, 60 mg)

*The appropriate pharmacy substituted dose will be determined by the pharmacist from the list to ensure the dose is still appropriate for the patient’s age and weight (New medical orders are not necessary to reflect the pharmacy rounded dose as this is a LHSC automatic substitution policy).

Supplied

  • 3.3 mg/mL oral suspension (keep refrigerated, SHAKE WELL before using) , dispensed unit dose  as one of the standard doses above

This is an extemporaneous product which is specially prepared by the Department of Pharmacy.

Please note that lansoprazole is the LHSC proton pump inhibitor of choice and all orders for other oral proton pump inhibitors will be automatically converted to lansoprazole at the appropriate dose.

 

References

  1. Lansoprazole Monograph, Lexicomp database, accessed online at http://online.lexi.com/lco/action/search?q=lansoprazole&t=name  on December 6th, 2013

  2. Lansoprazole Monograph, Neofax  23rd edition, Thomson Reuters 2010, p. 258-9.

  3. Zhang W, Kukulka M, Witt G, et al, "Age-Dependent Pharmacokinetics of Lansoprazole in Neonates and Infants," Paediatr Drugs, 2008, 10(4):265-74

Prepared by: Emily Ung, BScPhm (Dec 2013)

Reviewed by:    Venita Harris, BSCPhm, Pharm D (Dec 2013)

                            Henry Roukema MD FRCPC (Dec 2013)




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