Hyperacidity, GERD, and ulcers:
Indications for PREVACID:
Triple therapy (w. amoxicillin + clarithromycin) or dual therapy (w. amoxicillin; use only if allergic, intolerant, or resistant to clarithromycin) for H. pylori eradication in duodenal ulcer disease. Short-term treatment of active duodenal ulcer, active benign gastric ulcer, erosive esophagitis (EE), symptomatic GERD, and NSAID-associated gastric ulcers when NSAID use is continued. To reduce risk of NSAID-associated gastric ulcer in patients with history of gastric ulcer who need an NSAID. Maintenance of healing of duodenal ulcer, EE. Long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome).
Take before eating. Do not crush or chew granules. Caps: swallow whole, or sprinkle granules and mix contents with food or juice (see full labeling) and take immediately. May open caps and mix granules in 40mL apple juice and give via NG tube; flush tube with more juice. SoluTabs: dissolve on tongue; swallow with or without water. May give via oral syringe or NG tube (see full labeling). ≥18yrs: Triple therapy: lansoprazole 30mg + amoxicillin 1g + clarithromycin 500mg, all every 12hrs for 10 or 14 days. Dual therapy: lansoprazole 30mg + amoxicillin 1g, both every 8hrs for 14 days. Duodenal ulcer: 15mg once daily for 4 weeks. Gastric ulcer treatment: 30mg once daily for up to 8 weeks. EE treatment: 30mg once daily for up to 8 weeks; may repeat for 8 more weeks. If relapse occurs, may repeat 8-week course. GERD: 15mg once daily for up to 8 weeks. Maintenance of healing of duodenal ulcer or EE: 15mg once daily. Healing of NSAID-associated gastric ulcer: 30mg once daily for 8 weeks; NSAID ulcer risk reduction: 15mg once daily for up to 12 weeks. Hypersecretory conditions: Initially 60mg once daily, adjust as needed; give daily doses >120mg in divided doses. Severe hepatic impairment: 15mg once daily.
Take before eating. Do not crush or chew granules. Caps: swallow whole, or sprinkle granules and mix contents with food or juice (see full labeling) and take immediately. May open caps and mix granules in 40mL apple juice and give via NG tube; flush tube with more juice. SoluTabs: dissolve on tongue; swallow with or without water. May give via oral syringe or NG tube (see full labeling). GERD or EE: ≤1yr: not recommended. 1–11yrs: ≤30kg: 15mg once daily; >30kg: 30mg once daily. For both: give for up to 12 weeks; doses up to 30mg twice daily have been used. Severe hepatic impairment: 15mg once daily.
Concomitant rilpivirine-containing products.
Symptomatic response does not preclude gastric malignancy. Discontinue and evaluate if acute tubulointerstitial nephritis, cutaneous/systemic lupus erythematosus occurs. Long-term therapy (eg, >3yrs) may lead to malabsorption/deficiency of Vit. B12. Monitor magnesium levels during prolonged therapy. Increased risk for fundic gland polyps with long-term use (esp. >1yr) or risk for osteoporosis-related fractures (hip, wrist or spine) with long-term (>1yr) and multiple daily dose PPI therapy. Use lowest dose for shortest duration appropriate to condition. SoluTabs: phenylketonuria. Severe hepatic impairment: reduce dose. Risk of heart valve thickening (in children <1yr old). Pregnancy. Nursing mothers.
Proton pump inhibitor.
Concomitant St. John's wort, rifampin, atazanavir, nelfinavir: not recommended. May potentiate digoxin, tacrolimus, methotrexate, saquinavir; monitor. Potentiated by voriconazole. May alter absorption of pH-dependent drugs (eg, ketoconazole/itraconazole, iron salts, erlotinib, mycophenolate mofetil, dasatinib, nilotinib). Concomitant digoxin, diuretics may predispose patients to hypomagnesemia. Monitor theophylline, warfarin. Give at least 30 mins before sucralfate. May give antacids concomitantly. May interfere with neuroendocrine tumor diagnostic tests; discontinue lansoprazole at least 14 days prior to CgA level assessment. Interrupt therapy at least 28 days before secretin stimulation test. May cause false (+) urine screening tests for THC.
Diarrhea, abdominal pain, nausea, constipation, headache, bone fracture; possible C. difficile-associated diarrhea (esp. if hospitalized); rare: hypomagnesemia.
See Amoxil entry for more information on amoxicillin. See Biaxin entry for more information on clarithromycin.
Generic Drug Availability:
Caps 15mg—30, 100, 1000; 30mg—100, 1000; SoluTabs—100