Lansoprazole

Prescription Uses

Prescription-strength lansoprazole is used to treat and prevent various conditions related to stomach acid, including:

• Gastroesophageal reflux disease (GERD): A condition where stomach acid flows back into the esophagus, causing heartburn and potential injury.
• Erosive esophagitis: Healing and maintaining the healing of the esophagus after it has been damaged by acid.
• Ulcers: Treating and preventing the recurrence of stomach (gastric) and intestinal (duodenal) ulcers, including those caused by nonsteroidal anti-inflammatory drugs (NSAIDs).
• H. pylori infections: Used in combination with antibiotics to treat bacterial infections that can cause ulcers.
• Zollinger-Ellison syndrome: A rare condition where the stomach produces too much acid.

Over-the-Counter (OTC) Uses

Lansoprazole is available over-the-counter for the treatment of frequent heartburn that occurs two or more days per week. It is not intended for immediate relief of occasional heartburn symptoms, as it may take one to four days to reach its full effect.

Mechanism of Action

Lansoprazole belongs to a class of drugs known as proton pump inhibitors (PPIs). It works by decreasing the amount of acid produced in the stomach.

The medication targets specific enzyme systems in the stomach lining called proton pumps. These pumps are responsible for the final step of secreting acid into the stomach. By inhibiting these pumps, lansoprazole effectively lowers the acidity of the digestive juices.

Reducing stomach acid helps the body in several ways:

• Healing: It allows the lining of the esophagus and stomach to recover from damage caused by excess acid or ulcers.
• Prevention: It helps prevent the formation of new ulcers in the digestive tract.
• Symptom Relief: It reduces the frequency and severity of symptoms like heartburn and difficulty swallowing.

Common Side Effects

Some people may experience mild side effects while taking lansoprazole. These often include:

• Diarrhea
• Stomach pain or nausea
• Constipation
• Headache

Serious Side Effects

Seek medical help immediately if you experience any of the following serious symptoms:

• Severe diarrhea with watery or bloody stools, which may be accompanied by a fever or stomach cramps
• Signs of an allergic reaction, such as a skin rash, hives, or swelling of the eyes, face, lips, tongue, or throat
• Difficulty breathing or swallowing
• Irregular, fast, or pounding heartbeat
• Muscle spasms, tremors, or uncontrollable shaking
• Seizures
• New or worsening joint pain or a skin rash on the cheeks or arms that worsens in the sun
• Kidney issues, such as blood in the urine or changes in how often you urinate

Long-term Use Considerations

Using lansoprazole for a long period of time may increase the risk of certain health conditions, including:

• Bone fractures of the hip, wrist, or spine
• Vitamin B12 deficiency
• Low magnesium levels in the blood

Serious Allergic Reactions

Lansoprazole can cause severe allergic reactions. Symptoms may include rash, swelling of the face, throat tightness, or difficulty breathing. Some people may develop serious skin conditions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, which require immediate medical attention.

Kidney Problems

Acute tubulointerstitial nephritis, a type of kidney inflammation, can occur at any time during treatment with lansoprazole. This condition may lead to kidney failure if not addressed.

Diarrhea and Infections

Proton pump inhibitors like lansoprazole may increase the risk of Clostridioides difficile-associated diarrhea (CDAD). This condition causes severe watery diarrhea, stomach pain, and fever that does not go away. It is important to seek medical help if these symptoms occur, especially if the diarrhea is bloody.

Long-Term Use Risks

Using lansoprazole for a long time, typically more than one year, may increase the risk of certain health issues:

• Bone Fractures: There is an increased risk of hip, wrist, or spine fractures, particularly in people taking high doses or using the medication for a year or longer.
• Low Magnesium: Long-term use (usually more than three months, but more commonly after a year) can lead to low magnesium levels in the blood. This can cause tremors, seizures, or irregular heartbeats.
• Vitamin B12 Deficiency: Taking acid-suppressing medications for more than three years can interfere with the body's ability to absorb Vitamin B12.
• Fundic Gland Polyps: Long-term use is associated with an increased risk of developing small growths in the stomach lining called fundic gland polyps.

Lupus Erythematosus

Lansoprazole has been linked to the development or worsening of autoimmune conditions, including cutaneous lupus erythematosus and systemic lupus erythematosus. Symptoms may include joint pain or a skin rash on the cheeks or arms that worsens in sunlight.

Interactions and Monitoring

Lansoprazole can interact with other medications, such as methotrexate, warfarin, or digoxin. Healthcare providers may monitor magnesium levels or kidney function in patients who require long-term treatment.

Pregnancy

There are no adequate and well-controlled studies regarding the use of lansoprazole in pregnant women. While animal studies have generally not shown evidence of harm to the fetus, results from animal research do not always predict how a drug will affect humans. If you are pregnant or planning to become pregnant, discuss the potential risks and benefits of this medication with your healthcare provider. Lansoprazole should be used during pregnancy only if it is clearly needed.

Breastfeeding

It is not known whether lansoprazole passes into human breast milk. Because many medications can be excreted in breast milk and may cause side effects in a nursing infant, caution is advised. You and your doctor should decide whether to continue breastfeeding or stop taking the medication, based on the importance of the treatment to your health.

Oral Formulations

Lansoprazole is primarily available in oral forms designed to release the medication after it passes through the stomach. These include:

• Delayed-release capsules: These are typically swallowed whole.
• Delayed-release orally disintegrating tablets: These tablets are designed to melt on the tongue and can be taken with or without water.
• Delayed-release oral suspension: This form consists of granules that are mixed with a small amount of water before being swallowed.

Injectable Form

For patients who cannot take oral medication, lansoprazole is available as a powder for injection. This form is reconstituted and administered intravenously by a healthcare professional in a medical setting.

Over-the-Counter Options

Certain forms of lansoprazole are available without a prescription for the treatment of frequent heartburn. These are typically found as delayed-release capsules or tablets.

FDA Approval and Indications

Lansoprazole was first approved by the U.S. Food and Drug Administration (FDA) as a prescription medication to treat conditions caused by excess stomach acid. It is approved for the following uses in adults and, in some cases, children:

• Short-term treatment of active duodenal and gastric ulcers.
• Treatment of gastroesophageal reflux disease (GERD) and erosive esophagitis.
• Long-term maintenance of healed erosive esophagitis.
• Treatment of pathological hypersecretory conditions, such as Zollinger-Ellison syndrome.
• Reduction of the risk of gastric ulcers associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
• Eradication of H. pylori infection to reduce the risk of duodenal ulcer recurrence, often used in combination with antibiotics like amoxicillin and clarithromycin.

Over-the-Counter Status

The FDA has also approved lansoprazole for over-the-counter (OTC) use. The OTC version is specifically indicated for the treatment of frequent heartburn occurring two or more days per week. It is intended for a 14-day course of treatment and is not meant for immediate relief of occasional heartburn symptoms.

Safety Communications

The FDA has issued safety communications regarding the long-term use of proton pump inhibitors (PPIs), the class of drugs to which lansoprazole belongs. A significant warning involves the risk of low magnesium levels (hypomagnesemia) in patients who take these medications for prolonged periods, typically longer than one year. In some cases, this condition may require magnesium supplementation or discontinuation of the medication. The FDA also monitors reports of other potential risks associated with long-term PPI use, such as increased risk of certain infections or bone fractures.

Rebound Acid Production

If you have been taking lansoprazole for a long time, stopping the medication suddenly can cause your stomach to produce more acid than normal. This is often called rebound acid hypersecretion. This increase in acid can cause your original symptoms to return or feel worse for a short period.

Symptoms

When stopping lansoprazole, you may experience symptoms such as:

• Heartburn
• Acid reflux
• Stomach pain
• Indigestion

How to Stop Safely

It is important to follow your healthcare provider's instructions when discontinuing this medication. They may suggest the following strategies:

• Gradual Tapering: Instead of stopping all at once, your doctor might have you slowly reduce your dose or take the medication every other day before stopping completely.
• Short-term Alternatives: Your doctor may recommend using over-the-counter antacids or other acid-reducing medications temporarily to manage symptoms while your body adjusts.
• Medical Supervision: Always consult a healthcare professional before stopping a prescribed course of lansoprazole to ensure your underlying condition is fully treated.