Therapeutic: antiulcer agents
Pharmacologic: proton-pump inhibitors
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.
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.
Adverse Reactions/Side Effects
CNS: dizziness, headache. GI: diarrhea, abdominal pain, nausea. Derm: rash.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
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.
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.
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).
Absorption: 80% absorbed after oral administration.
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).
Contraindicated in: Hypersensitivity.
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).
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).