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INTRODUCTION

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dexlansoprazole (deks-lan-soe-pra-zole)

Kapidex

Classification

Therapeutic: antiulcer agents

Pharmacologic: proton-pump inhibitors

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Indications
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Healing/maintenance of healing of erosive esophagitis (EE). Treatment of heartburn from nonerosive gastroesophageal reflux disease (GERD).

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Action
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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.

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Adverse Reactions/Side Effects
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GI: abdominal pain, diarrhea, flatulence, nausea, vomiting.

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PHYSICAL THERAPY IMPLICATIONS

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

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Interventions
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  • 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.

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Patient/Client-Related Instruction
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  • Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

  • Instruct patient to report bothersome or prolonged GI side effects such as nausea, vomiting, diarrhea, flatulence, and abdominal pain.

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Pharmacokinetics
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Absorption: Well absorbed following oral administration.

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Distribution: Unknown.

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Protein Binding: 96–99%.

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Metabolism and Excretion: Extensively metabolized by the liver (CYP2C19 and CYP3A4 enzyme systems are involved); patients who are poor metabolizers may have higher blood levels; no active metabolites. No renal elimination.

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Half-life: 1–2 hr.

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TIME/ACTION PROFILE (blood levels)

ROUTE ONSET PEAK* DURATION
PO unknown 1–2 hr (1st); 4–5 hr (2nd) 24 hr

*Reflects effects of delayed release capsule.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Severe hepatic impairment; Geri: Avoid nursing.

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Use Cautiously in: Moderate hepatic impairment (daily dose should not exceed 30 mg); Safe use in children <18 yr not established.

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Interactions
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Drug-Drug: ↓ levels of atazanavir; do not administer concurrently. May ↓ absorption of drugs requiring acid pH for absorption, including ampicillin, digoxin, iron salts, and ketoconazole. May ↑ effect of warfarin.

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Route/Dosage
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PO (Adults): Healing of EE—60 mg once daily for up to 8 wk; maintenance of healing of EE—30 mg once daily for up to 6 mo; GERD—30 mg once daily for 4 wk.

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Hepatic Impairment
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PO (Adults): Moderate hepatic impairment—daily dose should not exceed 30 mg.

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Availability
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Delayed-release capsules: 30 mg, 60 mg.

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