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INTRODUCTION

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lansoprazole (lan-soe-pra-zole)

Prevacid

Classification

Therapeutic: antiulcer agents

Pharmacologic: proton-pump inhibitors

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Indications
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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.

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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. Healing of duodenal ulcers and esophagitis.

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Adverse Reactions/Side Effects
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CNS: dizziness, headache. GI: diarrhea, abdominal pain, nausea. Derm: rash.

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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.

  • 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.

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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 side effects, including headache, skin rash, or GI effects (nausea, diarrhea, abdominal pain).

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Pharmacokinetics
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Absorption: 80% absorbed after oral administration.

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Distribution: Unknown.

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Protein Binding: 97%.

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

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

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TIME/ACTION PROFILE (acid suppression)

ROUTE ONSET PEAK DURATION
PO rapid 1.7 hr >24 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity.

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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).

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Interactions
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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 INR/PT).

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Route/Dosage
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PO (Adults and Children ≥12 ...

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