Proton pump inhibitors include-

    Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole

    Refer - Omeprazole

  Interacting drugs- summary

   Lansoprazole +
            
   Lanzoprazole  +  Theophylline
   when admin. concomittantly, minor increase of   theophylline noticed

  Sucralfate + Lanzoprazole
  coadmin. delayed absorption of lansoprazole  bioavailiability .Take lansoprazole 30 minutes  prior to sucralfate

Duodenal and gastric ulcer. Reflux osesophagitis 

Proton pump inhibitors include-

Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole

Refer - Omeprazole 

Lansoprazole treatment has been well tolerated in short and long term trials.

The following adverse events were reported in 1% or more of patients

Diarrhea 3.8%
Abdominal pain 2.1%
Nausea 1.3%
Constipation 1%
 

General- Diarrhea, abdominal pain, nausea, headache.

Cardiovascular- angina, cerebrovascular accident, hypertension/hypotension, myocardial infarction,  palpitations, shock, (circulatory failure), vasodilation

CNS- agitation, anxiety, apathy, confusion, depression, dizziness/syncope, paresthesia, abnormal  thinking

Dermatologic- Acne, alopecia, priritus, rash, urticaria

Endocrine- Diabetes,mellitus, goiter, hyperglycemia/hypoglycemia

GI- melena, anorexia, bezoar, cardiospasm, cholelithiasis, constipation, dry mouth/ thirst, dyspepsia, dysphagia, eructation, esophageal stenosis, esophageal ulcer,esophagitis,fecal discoloration, flatulence, gastric nodules/fundic gland polyps, gastroenteritis, GI haemorrhage, hematesis, increased appetite, increased salivation, rectal haemorrhage stomatitis, ulcerative colitis.

GU- abnormal menses, albuminuria, breast enlargement/gynaecomastia, breast tenderness,  glycosuria, hematuria,impotence, kidney calculus

Hematologic- Anemia, hemolysis

Metabolic/Nutrional- Gout, weight gain/loss

Musculoskeletal- Arthiritis/arthalgia, mucucloskeletal pain, myalgia

Respiratory- Asthma, bronchitis, increased cough, dyspnea, epistaxis, hemoptysis, hiccups, pneumonia, upper respiratory inflammation/infection.

Special senses- amblyopia, deafness, eye pain, visual field defect, otitis media, taste perversion,  tinnitus.

Miscellaneous- asthenia, candidiasis, chest pain, edema, fever, flu syndrome, halitosis, infection,  malaise.

Lab Test abnormalities-
Abnormal liver function tests, increased AST, ALT, creatinine alkaline phosphatase, globulins, GGTP,  glucocorticoids,  LDH, gastrin levels, increased/decreased /abnormal WBC and platelets,abnormal  AG ratio, abnormal RBC, bilirubinemia, eosinophilia, hyperlipemia, increrased/decreased  electrolytes, increased/decreased cholesterol.

History of hyersensitivity to the drug,pregnacy and lactation,gastric malignancy should
be ruled in children.

Special Precautions:
Prolonged use,liver disease.

Maintenance therapy- Do not use as maintenance therapy for treatment of patients with
duodenal ulcer  diseases or erosive esophagitis

Carconigenesis- Longer term data are needed to rule out the possibility of an increased
 risk of the development of gastric tumors in patients receiving long term therapy
 with lansoprazole.

Elderly- Ulcer healing rates and rates of adverse events in elderly patients are similar
 to those in a younger age group.
The initial dosing regimen need not be altered,but subsequent doses > 30mg/day
 should not be  administered unless additional gastric supression is necessary.

Preganancy- No adeqiuate and well  controlled studies establishedin pregnant women.
Use during pregnancy only if clearly needed

Lactation-  It is not known whether lansoprazole is excrteted in human breast milk.
Decide whether to  discontinue nursing or discontinue the drug taking into account
 the importance of the drug to the mother.

Children- Safety and efficacy have not been established.

Approved by FDA  on December 1994

Indication-

Duodenal and gastric ulcer.
Reflux osesophagitis

Dosage-
Adults- At first,15mg once a day,preferably taken in the morning before a meal.
Children up to 18years- dosage to be decided by the doctor

For gastroesophageal disease
Adults- 30mg once a day,preferably taken in the morning before a meal

For conditions in which the stomach produces too much acid
Adults- 60mg once a day,preferably  taken before a meal

Children up to 16years,in both cases- dosage to be decided by the doctor

Overdosage-  Symptom/Treatment
In one case of overdose the patient consumed 600 mg of lanzoprazole with
no adverse reaction. Lanzoprazole is not removed from the circulation by
hemodialysis.
        
Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.
2. However, if it is almost time for next dose, skip the missed dose and go back to your
   regular dosing schedule.
3. Do not double doses. 

For Availability/supplies 

Gastro Osephageal Reflux Disease (GORD)

Evidence Based Medicine (MIMS- March 2003)

Beneficial

1. Proton Pump Inhibitors such as omeprazole, Lansoprazole, pantoprazole

2. H-2 Antagonists such as cimetidine, ranitidine, famotidine, (less than proton pump inhibitors)

3. Fundoplication

Likely to be beneficial

1. Medical and surgical tretment of GORD in selected patients with extraoesophageal manifestations.

Unknown effectiveness

1. Medical and surgical treatment of GORD in patients with Barrets oesophagus

2. Surgical treatment for non erosive oesophagitis

Key Points

1. One systemic review of randomised clinical trials has found proton inhibitors to be more effective than H-2 antagonists in both erosive and non-erosive oesophagitis. One trial has found no significant differences in the effectiveness of different proton pump inhibitors

2. Surgical treatment has not been adequately evaluated in controlled clinical trials. Medical and surgical treatments have not been adequately compared

3. It is not clear whether patients with Barretts oesophagitis benefit from medical or surgical treatment of their gastro oesophageal reflux

4. There is limited, conflicting evidence on the basis on the benefits of treating gastro oesophageal reflux in patients with extra oesophageal manifestations (such as asthma)

   
  Refer - Omeprazole

1.Take Lanzoprazole before a meal,preferably in the morning.
2. Swallow the capsule whole .Do not crush,break or chew the capsule
3.Take the medicine for the full time of treatment, even  if you begin to feel better

4.Allergies- tell your doctor if you have ever had any unusual or allergic reaction to
   lanzoprazole.   Also tell your doctor if you are allergic to any other substances,
   such as foods, preservatives or dyes.
  
5.Pregnancy - studies not done in humans. However, studies in animals have not shown that lanzoprazole  causes harm to the fetus. 

6.Breast feeding-  since this medicine has been shown to cause unwanted effects in animals,  it may be  necesary to take another medicine or stop breast feeding during treatment.

7 Children - no specific information comparing use of indapamide in children with use in other age  groups
 
8. Elderly-  lanzoprazole did not cause different side effects or problems than it did in younger adults.
   
9. Other medicines -     Let your doctor know what other medicines you are taking, other medicines so that he can advice you accordingly.  
    Sucralfate - lanzoprazole should be taken at least 30 minutes before sucralfate so
    that lanzoprazole  will be  properly absorbed
   

10. Missed dose -
    If you miss a dose of this medicine, take it as soon as possible. however, if it is almost time  for the next dose, skip the missed dose. Do not double doses.

11. Storage -  Keep out of reach of children. Store away from heat or direct sunlight. Do not store   the capsule in bathroom, near the kitchen sink, or in other damp places.

12. Outdated medicines -   Do not keep outdated medicine or medicine no longer needed. Be sure that any  discarded medicine is out of reach of children.

Pharmacology:

Lansoprazole is used to to treat certain conditions in which there is too much acid in the stomach. It is used to treat duodenal ulcers and gastroesophageal reflux disease(GERD),a condition in which the stomach washes back up into the esophagus. Lansoprazole acts by decreasing the amount of acid produced in the stomach.

Pharmacokinetics:

Absorption is rapid with mean plasma levels occuring after about 1.7 hours and is relatively complete with absolute bioavailability of 80%. Lansoprazole is extensively metabolised in the liver. The plasma elimination half-life is about 2 hrs, while the acid inhibitory effect lasts more than 24 hours.

No significant food effect if the drug is given before meals.

Pregnancy:

Use during pregnancy only if needed.

Lactation:

Not known whether Lansoprazole is excreted in human breast milk.

Use with caution and decide whether to discontinue the drug or discontinue nursing.

Children

Safety and efficacy have not been established.