Zoton

Action

Inhibits activity of proton pump in gastric parietal cells, decreasing gastric acid production

Availability

Capsules (delayed-release): 15 mg, 30 mg

Granules for oral suspension (delayed-release, enteric-coated): 15 mg, 30 mg

Prevpac (combination product for Helicobacter pylori infection): daily pack containing two 30-mg lansoprazole capsules, four 500-mg amoxicillin capsules, and two 500-mg clarithromycin tablets

Prevacid NapraPAC 375 (combination product for reducing risk of ulcers from nonsteroidal anti-inflammatory drugs [NSAIDs]): weekly pack containing seven 15-mg Prevacid capsules and fourteen 375-mg Naprosyn tablets

Prevacid NapraPAC 500 (combination product for reducing risk of ulcers from NSAIDs): weekly pack containing seven 15-mg Prevacid capsules and fourteen 500-mg Naprosyn tablets

Prevacid SoluTab (delayed-release, orally disintegrating tablet): 15 mg, 30 mg

Indications and dosages

➣ Active duodenal ulcer

Adults: 15 mg P.O. daily for 4 weeks

➣ Maintenance of healed duodenal ulcer

Adults: 15 mg P.O. daily

➣ H. pylori eradication, to reduce risk of duodenal ulcer recurrence

Adults: In triple therapy, 30 mg lansoprazole P.O., 1 g amoxicillin P.O., and 500 mg clarithromycin P.O. q 12 hours for 10 or 14 days. In dual therapy, 30 mg lansoprazole P.O. and 1 g amoxicillin P.O. q 8 hours for 14 days.

➣ Benign gastric ulcer

Adults: 30 mg P.O. daily for up to 8 weeks

➣ Gastric ulcer associated with NSAIDs

Adults: 30 mg P.O. once daily for up to 8 weeks

➣ To reduce risk of NSAID-associated gastric ulcer

Adults: 15 mg P.O. daily for up to 12 weeks

➣ Gastroesophageal reflux disease

Adults and children ages 12 to 17: 15 mg P.O. daily for up to 8 weeks

Children ages 1 to 11 weighing more than 30 kg (66 1b): 30 mg P.O. daily for up to 12 weeks

Children ages 1 to 11 weighing 30 kg (66 lb) or less: 15 mg P.O. daily for up to 12 weeks

➣ Erosive esophagitis

Adults and children ages 12 to 17: 30 mg P.O. daily for up to 8 weeks. Some patients may require 8 additional weeks.

Children ages 1 to 11 weighing more than 30 kg (66 lb): 30 mg P.O. daily for up to 12 weeks

Children ages 1 to 11 weighing 30 kg (66 lb) or less: 15 mg P.O. daily for up to 12 weeks

➣ To maintain healing of erosive esophagitis

Adults: 15 mg P.O. daily

➣ Pathologic hypersecretory conditions (including Zollinger-Ellison syndrome)

Adults: Initially, 60 mg P.O. daily, to a maximum of 90 mg P.O. b.i.d. Divide daily dosages over 120 mg.

➣ Frequent heartburn (two or more times a week)

Adults: 15 mg P.O. (delayed-release capsule) daily up to 14 days

Dosage adjustment

• Significant hepatic insufficiency

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• phenylketonuria (orally disintegrating tablets), severe hepatic impairment

• elderly patients

• pregnant or breastfeeding patients

• children younger than age 18.

Administration

• Give oral form before meals.

• If patient has difficulty swallowing delayed-release capsule, open it and sprinkle contents onto small amount of soft food, such as applesauce or pudding. Don't crush or let patient chew drug.

• When giving orally disintegrating tablet, place tablet on patient's tongue and let it disintegrate until particles can be swallowed.

• Know that orally disintegrating tablet contains phenylalanine.

• When giving oral suspension, empty packet contents into container with 2 tbsp water. Stir contents well, and have patient drink immediately. Don't give oral suspension through nasogastric (NG) tube.

• When injecting contents of delayed-release capsule through NG tube, open capsule and mix granules with 40 ml apple juice. Then rinse tube with additional apple juice to clear.

Adverse reactions

CNS: headache, confusion, anxiety, malaise, paresthesia, abnormal thinking, depression, dizziness, syncope, cerebrovascular accident

CV: chest pain, hypertension, hypotension, myocardial infarction, shock

EENT: visual field deficits, otitis media, tinnitus, epistaxis

GI: nausea, diarrhea, abdominal pain, cholelithiasis, ulcerative colitis, esophageal ulcer, hematemesis, stomatitis, dysphagia, GI hemorrhage

GU: renal calculi, erectile dysfunction, abnormal menses, breast tenderness, gynecomastia

Hematologic: anemia

Musculoskeletal: hip, wrist, spine fractures (with long-term daily use)

Respiratory: cough, bronchitis, asthma

Skin: urticaria, alopecia, acne, pruritus, photosensitivity

Interactions

Drug-drug. Drugs requiring acidic pH (such as ampicillin esters, digoxin, iron salts, itraconazole, ketoconazole): decreased absorption of these drugs

Sucralfate: decreased lansoprazole absorption

Theophylline: increased theophylline clearance

Drug-food. Any food: decreased rate and extent of GI drug absorption

Drug-herbs. Male fern: inactivation of herb

St. John's wort: increased risk of photosensitivity

Patient monitoring

• Monitor for GI adverse reactions.

• Assess nutritional status and fluid balance to identify significant problems.

Patient teaching

• Instruct patient to take before meals.

• If patient has difficulty swallowing, tell him to open delayed-release capsule and sprinkle contents onto small amount of soft food (such as applesauce or pudding). Emphasize that he must not crush or chew drug.

• Tell patient to take orally disintegrating tablet by placing it on tongue and letting it disintegrate.

• Instruct patient to take oral suspension by emptying packet contents into container with 2 tbsp water. Tell him to stir contents well and drink immediately.

• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above.