Dexlansoprazole

INTRODUCTION

Indications

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

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.

Adverse Reactions/Side Effects

GI: abdominal pain, diarrhea, flatulence, nausea, vomiting.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

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 GI side effects such as nausea, vomiting, diarrhea, flatulence, and abdominal pain.

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Unknown.

Protein Binding: 96–99%.

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.

Half-life: 1–2 hr.

Contraindications/Precautions

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

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

Interactions

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.

Route/Dosage

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.

Hepatic Impairment

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

Availability

Delayed-release capsules: 30 mg, 60 mg.