Formulary
Lansoprazole: Indications, Dosing, Side Effects and Interactions
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system...
MedNext Academy | 6 min read
Lansoprazole: Indications, Dosing, Side Effects and Interactions
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system...
Drug action
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the 'proton pump') of the gastric parietal cell.
Indications and dose
**Helicobacter pylorieradication [in combination with other drugs]**
- **Adult** (By Mouth): Helicobacter pylori eradication [in combination with other drugs] 30 mg twice daily for 7 days for first- and second-line eradication therapy; 10 days for third-line eradication therapy.
**Benign gastric ulcer**
- **Adult** (By Mouth): 30 mg once daily for 8 weeks, dose to be taken in the morning.
**Duodenal ulcer**
- **Adult** (By Mouth): 30 mg once daily for 4 weeks, dose to be taken in the morning; maintenance 15 mg once daily, dose to be taken in the morning.
**NSAID-associated duodenal ulcer,NSAID-associated gastric ulcer**
- **Adult** (By Mouth): 30 mg once daily for 4 weeks, continued for further 4 weeks if not fully healed.
**Prophylaxis of NSAID-associated duodenal ulcer,Prophylaxis of NSAID-associated gastric ulcer**
- **Adult** (By Mouth): 15-30 mg once daily.
**Zollinger-Ellison syndrome**
- **Adult** (By Mouth): Initially 60 mg once daily, to be adjusted according to response, dose can be increased if necessary up to 180 mg per day, doses above 120 mg per day should be given in 2 divided doses.
**Gastro-oesophageal reflux disease**
- **Adult** (By Mouth): 30 mg once daily for 4 weeks, continued for further 4 weeks if not fully healed, dose to be taken in the morning; maintenance 15-30 mg once daily, dose to be taken in the morning.
**Severe oesophagitis**
- **Adult** (By Mouth): 30 mg once daily for 8 weeks, continue as maintenance treatment if appropriate.
**Severe oesophagitis, refractory to initial treatment**
- **Adult** (By Mouth): 30 mg twice daily.
**Functional dyspepsia**
- **Adult** (By Mouth): 15 mg once daily for 4 weeks.
**Uninvestigated dyspepsia**
- **Adult** (By Mouth): 30 mg once daily for 4 weeks.
**Benign gastric ulcer for lansoprazole**
- **Child (body-weight up to 30 kg)** (By mouth): 0.5-1 mg/kg once daily (max. per dose 15 mg), dose to be taken in the morning.
- **Child (body-weight 30 kg and above)** (By mouth): 15-30 mg once daily, dose to be taken in the morning.
**Duodenal ulcer for lansoprazole**
- **Child (body-weight up to 30 kg)** (By mouth): 0.5-1 mg/kg once daily (max. per dose 15 mg), dose to be taken in the morning.
- **Child (body-weight 30 kg and above)** (By mouth): 15-30 mg once daily, dose to be taken in the morning.
**NSAID-associated duodenal ulcer, NSAID-associated gastric ulcer for lansoprazole**
- **Child (body-weight up to 30 kg)** (By mouth): 0.5-1 mg/kg once daily (max. per dose 15 mg), dose to be taken in the morning.
- **Child (body-weight 30 kg and above)** (By mouth): 15-30 mg once daily, dose to be taken in the morning.
**Gastro-oesophageal reflux disease for lansoprazole**
- **Child (body-weight up to 30 kg)** (By mouth): 0.5-1 mg/kg once daily (max. per dose 15 mg), dose to be taken in the morning.
- **Child (body-weight 30 kg and above)** (By mouth): 15-30 mg once daily, dose to be taken in the morning.
**Acid-related dyspepsia for lansoprazole**
- **Child (body-weight up to 30 kg)** (By mouth): 0.5-1 mg/kg once daily (max. per dose 15 mg), dose to be taken in the morning.
- **Child (body-weight 30 kg and above)** (By mouth): 15-30 mg once daily, dose to be taken in the morning.
**Fat malabsorption despite pancreatic enzyme replacement therapy in cystic fibrosis for lansoprazole**
- **Child (body-weight up to 30 kg)** (By mouth): 0.5-1 mg/kg once daily (max. per dose 15 mg), dose to be taken in the morning.
- **Child (body-weight 30 kg and above)** (By mouth): 15-30 mg once daily, dose to be taken in the morning.
Cautions
For all proton pump inhibitors Can increase the risk of fractures (particularly when used at high doses for over a year in the elderly); may increase the risk of gastro-intestinal infections (including Clostridioides difficile infection); may mask the symptoms of gastric cancer; may reduce absorption of vitamin B 12 with long-term treatment; patients at risk of osteoporosis Cautions, further information Risk of osteoporosis Patients at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D, and if necessary, receive other preventative therapy. Gastric cancer Particular care is required in those presenting with 'alarm features', in such cases gastric malignancy should be ruled out before treatment. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate for uncomplicated peptic ulcer disease or erosive peptic oesophagitis at full therapeutic dosage for longer than 8 weeks (dose reduction or earlier discontinuation indicated).
Side effects
For all proton pump inhibitors Common or very common Abdominal pain; constipation; diarrhoea; dizziness; dry mouth; gastrointestinal disorders; headache; insomnia; nausea; skin reactions; vomiting Uncommon Arthralgia; bone fractures; confusion; depression; drowsiness; leucopenia; malaise; myalgia; paraesthesia; peripheral oedema; thrombocytopenia; vertigo; vision disorders Rare or very rare Agranulocytosis; alopecia; gynaecomastia; hallucination; hepatic disorders; hyperhidrosis; hyponatraemia; nephritis tubulointerstitial; pancytopenia; photosensitivity reaction; severe cutaneous adverse reactions (SCARs); stomatitis; taste altered Frequency not known Gastrointestinal infection; hypomagnesaemia (more common after 1 year of treatment, but sometimes after 3 months of treatment); subacute cutaneous lupus erythematosus Side-effects For lansoprazole Common or very common Dry throat; fatigue Uncommon Eosinophilia; oedema Rare or very rare Anaemia; angioedema; appetite decreased; erectile dysfunction; fever; glossitis; oesophageal candidiasis; pancreatitis; restlessness; tremor
Interactions
**Severe interactions:**
- Effects of lansoprazole on other medicinal products Medicinal products with pH dependent absorption Lansoprazole may interfere with the absorption of other medicinal products where gastric pH is an...
- No clinically significant interactions of lansoprazole with nonsteroidal anti-inflammatory medicinal products have been demonstrated, although no formal interactions studies have been performed.
**Other interactions (22):**
- Ketoconazole and itraconazole: The absorption of ketoconazole and itraconazole from the gastrointestinal tract is enhanced by the presence of gastric acid.
- Administration of lansoprazole may result in sub-therapeutic concentrations of ketoconazole and itraconazole and the combination should be avoided.
- Digoxin: Co-administration of lansoprazole and digoxin may lead to increased digoxin plasma levels.
- The plasma levels of digoxin should therefore be monitored and the dose of digoxin adjusted if necessary when initiating and ending lansoprazole treatment.
- Methotrexate: Concomitant use with high-dose Methotrexate may elevate and prolong serum levels of methotrexate and/or its metabolite, possibly leading to methotrexate toxicities.
- Therefore, in settings where highdose methotrexate is used a temporary withdrawal of lansoprazole may need to be considered.
Pregnancy
Manufacturer advises avoid.
Breast feeding
Specialist sources indicate use with caution-no human data available. Likely to be present in milk, but amount probably too small to be harmful.
Hepatic impairment
Manufacturer advises caution in moderate to severe impairment (risk of increased exposure). Dose adjustments Manufacturer advises dose reduction of 50% in moderate to severe impairment.
Medicinal forms
Solution,Tablet,Capsule
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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