Medical term:

Prevacid


lansoprazole

Prevacid, Prevacid SoluTab, Prevacid 24HR, Zoton (UK)

Pharmacologic class: Gastric acid pump inhibitor

Therapeutic class: Antiulcer drug

Pregnancy risk category B

Action

Inhibits activity of proton pump in gastric parietal cells, decreasing gastric acid production

Availability

Capsules (delayed-release): 15 mg, 30 mg

Granules for oral suspension (delayed-release, enteric-coated): 15 mg, 30 mg

Prevpac (combination product for Helicobacter pylori infection): daily pack containing two 30-mg lansoprazole capsules, four 500-mg amoxicillin capsules, and two 500-mg clarithromycin tablets

Prevacid NapraPAC 375 (combination product for reducing risk of ulcers from nonsteroidal anti-inflammatory drugs [NSAIDs]): weekly pack containing seven 15-mg Prevacid capsules and fourteen 375-mg Naprosyn tablets

Prevacid NapraPAC 500 (combination product for reducing risk of ulcers from NSAIDs): weekly pack containing seven 15-mg Prevacid capsules and fourteen 500-mg Naprosyn tablets

Prevacid SoluTab (delayed-release, orally disintegrating tablet): 15 mg, 30 mg

Indications and dosages

➣ Active duodenal ulcer

Adults: 15 mg P.O. daily for 4 weeks

➣ Maintenance of healed duodenal ulcer

Adults: 15 mg P.O. daily

➣ H. pylori eradication, to reduce risk of duodenal ulcer recurrence

Adults: In triple therapy, 30 mg lansoprazole P.O., 1 g amoxicillin P.O., and 500 mg clarithromycin P.O. q 12 hours for 10 or 14 days. In dual therapy, 30 mg lansoprazole P.O. and 1 g amoxicillin P.O. q 8 hours for 14 days.

➣ Benign gastric ulcer

Adults: 30 mg P.O. daily for up to 8 weeks

➣ Gastric ulcer associated with NSAIDs

Adults: 30 mg P.O. once daily for up to 8 weeks

➣ To reduce risk of NSAID-associated gastric ulcer

Adults: 15 mg P.O. daily for up to 12 weeks

➣ Gastroesophageal reflux disease

Adults and children ages 12 to 17: 15 mg P.O. daily for up to 8 weeks

Children ages 1 to 11 weighing more than 30 kg (66 1b): 30 mg P.O. daily for up to 12 weeks

Children ages 1 to 11 weighing 30 kg (66 lb) or less: 15 mg P.O. daily for up to 12 weeks

➣ Erosive esophagitis

Adults and children ages 12 to 17: 30 mg P.O. daily for up to 8 weeks. Some patients may require 8 additional weeks.

Children ages 1 to 11 weighing more than 30 kg (66 lb): 30 mg P.O. daily for up to 12 weeks

Children ages 1 to 11 weighing 30 kg (66 lb) or less: 15 mg P.O. daily for up to 12 weeks

➣ To maintain healing of erosive esophagitis

Adults: 15 mg P.O. daily

➣ Pathologic hypersecretory conditions (including Zollinger-Ellison syndrome)

Adults: Initially, 60 mg P.O. daily, to a maximum of 90 mg P.O. b.i.d. Divide daily dosages over 120 mg.

➣ Frequent heartburn (two or more times a week)

Adults: 15 mg P.O. (delayed-release capsule) daily up to 14 days

Dosage adjustment

• Significant hepatic insufficiency

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• phenylketonuria (orally disintegrating tablets), severe hepatic impairment

• elderly patients

• pregnant or breastfeeding patients

• children younger than age 18.

Administration

• Give oral form before meals.

• If patient has difficulty swallowing delayed-release capsule, open it and sprinkle contents onto small amount of soft food, such as applesauce or pudding. Don't crush or let patient chew drug.

• When giving orally disintegrating tablet, place tablet on patient's tongue and let it disintegrate until particles can be swallowed.

• Know that orally disintegrating tablet contains phenylalanine.

• When giving oral suspension, empty packet contents into container with 2 tbsp water. Stir contents well, and have patient drink immediately. Don't give oral suspension through nasogastric (NG) tube.

• When injecting contents of delayed-release capsule through NG tube, open capsule and mix granules with 40 ml apple juice. Then rinse tube with additional apple juice to clear.

Adverse reactions

CNS: headache, confusion, anxiety, malaise, paresthesia, abnormal thinking, depression, dizziness, syncope, cerebrovascular accident

CV: chest pain, hypertension, hypotension, myocardial infarction, shock

EENT: visual field deficits, otitis media, tinnitus, epistaxis

GI: nausea, diarrhea, abdominal pain, cholelithiasis, ulcerative colitis, esophageal ulcer, hematemesis, stomatitis, dysphagia, GI hemorrhage

GU: renal calculi, erectile dysfunction, abnormal menses, breast tenderness, gynecomastia

Hematologic: anemia

Musculoskeletal: hip, wrist, spine fractures (with long-term daily use)

Respiratory: cough, bronchitis, asthma

Skin: urticaria, alopecia, acne, pruritus, photosensitivity

Interactions

Drug-drug. Drugs requiring acidic pH (such as ampicillin esters, digoxin, iron salts, itraconazole, ketoconazole): decreased absorption of these drugs

Sucralfate: decreased lansoprazole absorption

Theophylline: increased theophylline clearance

Drug-food. Any food: decreased rate and extent of GI drug absorption

Drug-herbs. Male fern: inactivation of herb

St. John's wort: increased risk of photosensitivity

Patient monitoring

• Monitor for GI adverse reactions.

• Assess nutritional status and fluid balance to identify significant problems.

Patient teaching

• Instruct patient to take before meals.

• If patient has difficulty swallowing, tell him to open delayed-release capsule and sprinkle contents onto small amount of soft food (such as applesauce or pudding). Emphasize that he must not crush or chew drug.

• Tell patient to take orally disintegrating tablet by placing it on tongue and letting it disintegrate.

• Instruct patient to take oral suspension by emptying packet contents into container with 2 tbsp water. Tell him to stir contents well and drink immediately.

• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

lansoprazole

(lan-soe-pra-zole) ,

Prevacid

(trade name),

Prevacid 24 Hr

(trade name)

Classification

Therapeutic: antiulcer agents
Pharmacologic: proton pump inhibitors
Pregnancy Category: B

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.OTC: Heartburn occurring ≥twice/wk.

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.

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).

Time/action profile (acid suppression)

ROUTEONSETPEAKDURATION
POrapid 1.7 hrmore than 24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: Solutabs contain aspartame; use caution when used in phenylketonurics;Severe hepatic impairment (not to exceed 30 mg/day in these patients);Patients using high-doses for >1 year (↑ risk of hip, wrist, or spine fractures); Obstetric / Lactation: Safety not established; Pediatric: Safety not established in children <1 yr; Geriatric: Maintenance dose not to exceed 30 mg/day unless additional acid suppression is required.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • headache (most frequent)

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea (most frequent)
  • abdominal pain
  • nausea

Dermatologic

  • rash

Fluid and Electrolyte

  • hypomagnesemia (especially if treatment duration ≥3 mo)

Musculoskeletal

  • bone fracture

Interactions

Drug-Drug interaction

Sucralfate ↓ absorption of lansoprazole (take 30 min before sucralfate).May ↓ absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavirampicillin, iron salts, and digoxin.May ↑ risk of bleeding with warfarin (monitor INR/PT).Hypomagnesemia ↑ risk of digoxin toxicity.May ↑ methotrexate levels

Route/Dosage

Oral (Adults and children ≥12 yr) Short-term treatment of duodenal ulcer—15 mg once daily for 4 wk; H. pylori eradication to reduce the risk of duodenal ulcer recurrence—30 mg twice daily with clarithromycin 500 mg twice daily and amoxicillin 1000 mg twice daily for 10–14 days (triple therapy) or 30 mg 3 times daily with 1000 mg amoxicillin 3 times daily for 14 days (dual therapy); maintenance of healed duodenal ulcers—15 mg once daily; short-term treatment of gastric ulcers/healing of NSAID-associated gastric ulcer—30 mg once daily for up to 8 wk; risk reduction of NSAID-associated gastric ulcer—15 mg once daily for up to 12 wk; short-term treatment of symptomatic GERD—15 mg once daily for up to 8 wk; short-term treatment of erosive esophagitis—30 mg once daily for up to 8 wk (8 additional weeks may be necessary); maintenance of healing of erosive esophagitis—15 mg once daily; pathologic hypersecretory conditions—60 mg once daily intially, up to 90 mg twice daily (daily dose >120 m g should be given in divided doses).
Oral (Adults) OTC—15 mg once daily for up to 14 days (14 day course may be repeated every 4 mo).
Oral (Children 1–11 yr and >30 k g) GERD—30 mg once to twice daily.
Oral (Children 1–11 yr and 10–30 kg) GERD—15 mg once or twice daily.
Oral (Children 1–11 yr and <10 kg) GERD—7.5 mg once daily.

Availability (generic available)

Delayed-release capsules: 15 mgRx, OTC, 30 mg
Delayed-release orally disintegrated tablets (SoluTabs): 15 mg, 30 mg
In combination with: amoxicillin and clarithromycin as part of a compliance package (Prevpac). See combination drugs.

Nursing implications

Nursing assessment

  • Assess patient routinely for epigastric or abdominal pain and for frank or occult blood in stool, emesis, or gastric aspirate.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Lab Test Considerations: May cause abnormal liver function tests, including ↑ AST, ALT, alkaline phosphatase, LDH, and bilirubin.
    • May cause ↑ serum creatinine and ↑ or ↓ electrolyte levels.
    • May alter RBC, WBC, and platelet levels.
    • May also cause ↑ gastrin levels, abnormal A/G ratio, hyperlipidemia, and ↑ or ↓ cholesterol.
    • Monitor INR and prothrombin time in patients taking warfarin.
    • May cause hypomagnesemia. Monitor serum magnesium prior to and periodically during therapy.

Potential Nursing Diagnoses

Acute pain (Indications)

Implementation

  • Oral: Delayed-release capsules: Administer before meals. Swallow whole; do not crush or chew capsule contents. Capsules may be opened and sprinkled on 1 tbsp of applesauce, Ensure pudding, cottage cheese, yogurt or strained pears and swallowed immediately for patients with difficulty swallowing.
    • For patients with an NG tube, capsules may be opened and intact granules may be mixed in 40 mL of apple juice and injected through the NG tube into stomach. Flush NG tube with additional apple juice to clear tube.
    • Orally disintegrating tablets may be placed on tongue, allowed to disintegrate and swallowed with or without water. Do not cut or break tablet. For administration via oral syringe or nasogastric tube, Prevacid SoluTab can be administered by placing a 15-mg tablet in oral syringe and drawing up 4 mL of water, or a 30-mg tablet in oral syringe and drawing up 10 mL of water. Shake gently to allow for a quick dispersal. After tablet has dispersed, administer the contents within 15 minutes. Refill syringe with 2 mL (5 mL for the 30-mg tablet) of water, shake gently, and administer any remaining contents and flush nasogastric tube .
    • Antacids may be used concurrently.

Patient/Family Teaching

  • Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered unless almost time for next dose; do no double doses.
  • May occasionally cause dizziness. Caution patient to avoid driving and other activities that require alertness until response to medication is known.
  • Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
  • Advise patient to report onset of black, tarry stools; diarrhea; or abdominal pain to health care professional promptly. Instruct patient to notify health care professional immediately if rash, diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professional.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decrease in abdominal pain or prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be seen on x-ray examination or endoscopy. Therapy is continued for at least 2–4 wk. Therapy for pathologic hypersecretory conditions may be long term.
  • Healing in patients with erosive esophagitis. Therapy is continued for up to 8 wk, and an additional 8-wk course may be used for patients who do not heal in 8 wk or whose ulcer recurs.
Drug Guide, © 2015 Farlex and Partners

Prevacid

(prĕv′ə-sĭd′)
A trademark for the drug lansoprazole.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

Prevacid®

Lansoprazole Internal medicine A proton pump inhibitor used to manage–heal and relieve active duodenal ulcers, erosive esophagitis, long-term treatment of gastric hypersecretion–eg, Zollinger-Ellison syndrome, short-term treatment of GERD. See GERD.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

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