Drug Monograph
Lansoprazole
Prevacid, Prevacid SoluTab
Pharmacokinetic Profile
Half-Life
1.3–2.1 h
Metabolism
Hepatic (CYP2C19, CYP3A4)
Protein Binding
97%
Bioavailability
>80%
Tmax
~1.7 h
Clinical Information
Drug Class
Proton Pump Inhibitor
Available Doses
15 mg, 30 mg capsules; 15 mg, 30 mg ODT
Route
Oral
Renal Adjustment
Not required
Hepatic Adjustment
Yes — 15 mg daily (Child-Pugh C)
Pregnancy
Caution — animal data suggest possible fetal bone effects
Lactation
Unknown if excreted; use caution
Schedule
Rx / OTC (15 mg)
Generic Available
Yes
Indications
| Indication | Approved Population | Therapy Type | Status |
|---|---|---|---|
| Active duodenal ulcer | Adults | Monotherapy | FDA Approved |
| H. pylori eradication (duodenal ulcer) | Adults | Triple therapy (with amoxicillin + clarithromycin) or dual therapy (with amoxicillin) | FDA Approved |
| Maintenance of healed duodenal ulcer | Adults | Monotherapy | FDA Approved |
| Active benign gastric ulcer | Adults | Monotherapy | FDA Approved |
| NSAID-associated gastric ulcer — healing | Adults | Monotherapy | FDA Approved |
| NSAID-associated gastric ulcer — risk reduction | Adults (history of gastric ulcer) | Monotherapy | FDA Approved |
| Symptomatic GERD | Adults and pediatric patients ≥1 year | Monotherapy | FDA Approved |
| Erosive esophagitis — healing | Adults and pediatric patients ≥1 year | Monotherapy | FDA Approved |
| Erosive esophagitis — maintenance of healing | Adults | Monotherapy | FDA Approved |
| Zollinger-Ellison syndrome and other hypersecretory conditions | Adults | Monotherapy | FDA Approved |
Lansoprazole is one of the most widely prescribed proton pump inhibitors, with FDA-approved indications spanning the full spectrum of acid-related disorders. It occupies a central role in peptic ulcer management, both for healing and prevention, and serves as a backbone of H. pylori eradication regimens. In GERD, it is effective for both symptom control and mucosal healing across adults and children aged one year and above.
Off-Label Uses
Stress ulcer prophylaxis in ICU patients — Evidence quality: Moderate. PPIs including lansoprazole are commonly used for stress ulcer prevention in critically ill patients, supported by meta-analyses showing reduced clinically significant bleeding compared to no prophylaxis.
Functional dyspepsia — Evidence quality: Moderate. PPIs provide modest symptom improvement in functional dyspepsia, particularly for patients with epigastric pain syndrome.
Laryngopharyngeal reflux — Evidence quality: Low. Empiric PPI therapy is commonly trialled, though robust evidence of benefit is limited. Response rates are inconsistent.
Dosing
Adult Dosing by Clinical Scenario
| Clinical Scenario | Starting Dose | Maintenance Dose | Maximum Dose | Notes |
|---|---|---|---|---|
| Active duodenal ulcer — healing | 15 mg once daily | 15 mg once daily | 15 mg/day | 4-week course; take before a meal Most patients heal within 4 weeks |
| Healed duodenal ulcer — relapse prevention | 15 mg once daily | 15 mg once daily | 15 mg/day | Controlled studies up to 12 months |
| H. pylori eradication — triple therapy | 30 mg twice daily | 30 mg twice daily | 60 mg/day | With amoxicillin 1 g BID + clarithromycin 500 mg BID for 10–14 days |
| H. pylori eradication — dual therapy (clarithromycin-intolerant) | 30 mg three times daily | 30 mg three times daily | 90 mg/day | With amoxicillin 1 g TID for 14 days For patients allergic/intolerant to clarithromycin or with known resistance |
| Active benign gastric ulcer — healing | 30 mg once daily | 30 mg once daily | 30 mg/day | Up to 8-week course |
| NSAID-associated gastric ulcer — healing | 30 mg once daily | 30 mg once daily | 30 mg/day | 8-week course; continue NSAID use Controlled studies did not extend beyond 8 weeks |
| NSAID-associated gastric ulcer — prevention | 15 mg once daily | 15 mg once daily | 15 mg/day | Up to 12 weeks; requires history of documented gastric ulcer |
| Symptomatic GERD — short-term treatment | 15 mg once daily | 15 mg once daily | 15 mg/day | Up to 8 weeks in adults |
| Erosive esophagitis — healing | 30 mg once daily | 30 mg once daily | 30 mg/day | Up to 8 weeks; additional 8 weeks if unhealed (5–10% of patients) Recurrence may warrant a further 8-week course |
| Erosive esophagitis — maintenance of healing | 15 mg once daily | 15 mg once daily | 15 mg/day | Controlled studies up to 12 months |
| Zollinger-Ellison syndrome | 60 mg once daily | Titrate to clinical response | 180 mg/day | Doses >120 mg/day should be divided; some patients treated continuously >4 years |
Pediatric Dosing
| Clinical Scenario | Starting Dose | Maintenance Dose | Maximum Dose | Notes |
|---|---|---|---|---|
| GERD / Erosive esophagitis — ages 1–11 years, ≤30 kg | 15 mg once daily | 15 mg once daily | 15 mg/day | Up to 12 weeks Higher doses used in clinical studies but not specified in approved labelling |
| GERD / Erosive esophagitis — ages 1–11 years, >30 kg | 30 mg once daily | 30 mg once daily | 30 mg/day | Up to 12 weeks |
| Non-erosive GERD — ages 12–17 years | 15 mg once daily | 15 mg once daily | 15 mg/day | Up to 8 weeks |
| Erosive esophagitis — ages 12–17 years | 30 mg once daily | 30 mg once daily | 30 mg/day | Up to 8 weeks |
Hepatic Impairment
| Clinical Scenario | Starting Dose | Maintenance Dose | Maximum Dose | Notes |
|---|---|---|---|---|
| Severe hepatic impairment (Child-Pugh C) | 15 mg once daily | 15 mg once daily | 15 mg/day | Clearance significantly reduced; AUC and half-life increased |
Clinical Pearl: Administration
Lansoprazole must be taken before meals — bioavailability drops by 50–70% when given 30 minutes after food. Capsules should be swallowed whole or opened and sprinkled on applesauce, yogurt, cottage cheese, or strained pears. For nasogastric administration, granules can be mixed with apple juice. Take at least 30 minutes before sucralfate to avoid reduced absorption.
Pharmacology
Mechanism of Action
Lansoprazole is a substituted benzimidazole prodrug that suppresses gastric acid secretion by irreversibly inhibiting the hydrogen-potassium ATPase (H+/K+-ATPase) enzyme system — the proton pump — at the secretory surface of gastric parietal cells. After oral absorption, the drug accumulates selectively in the acidic canalicular space of active parietal cells, where it undergoes acid-catalysed conversion to its active sulfenamide form. This reactive intermediate then forms covalent disulfide bonds with cysteine residues on the proton pump, producing dose-dependent and long-lasting inhibition of both basal and stimulated acid secretion. Because the pharmacological effect depends on irreversible enzyme inactivation and subsequent de novo pump synthesis, the duration of acid suppression substantially outlasts plasma elimination — acid output remains suppressed for over 24 hours despite a plasma half-life of approximately 1.5 hours.
ADME Profile
| Parameter | Value | Clinical Implication |
|---|---|---|
| Absorption | Rapid; Tmax ~1.7 h; absolute bioavailability >80%; enteric-coated formulation | Food reduces Cmax and AUC by 50–70% if given after meals; always dose before eating |
| Distribution | 97% plasma protein bound; concentrates in parietal cell canaliculi | High protein binding is consistent across therapeutic concentrations (0.05–5.0 mcg/mL); not removed by haemodialysis |
| Metabolism | Extensive hepatic metabolism via CYP2C19 (to 5-hydroxylansoprazole) and CYP3A4 (to lansoprazole sulfone); metabolites inactive | CYP2C19 poor metabolisers have higher AUC; severe hepatic impairment requires dose reduction to 15 mg/day |
| Elimination | t½ 1.3–2.1 h; 15–23% excreted renally as metabolites; significant biliary excretion; no unchanged drug in urine | Short plasma half-life but >24 h acid suppression due to irreversible pump binding; no renal dose adjustment needed |
Side Effects
≥10%
Very Common
No individual adverse effect exceeded a 10% incidence rate in placebo-controlled monotherapy trials of lansoprazole. In the NSAID-associated gastric ulcer risk-reduction trial, diarrhoea occurred in 5% of lansoprazole-treated patients versus 22% with misoprostol and 3% with placebo. In H. pylori triple-therapy regimens, diarrhoea reached 7%, headache 6%, and taste disturbance 5%, though these rates reflect the combined antibiotic regimen rather than lansoprazole alone.
1–10%
Common
| Adverse Effect | Incidence | Clinical Note |
|---|---|---|
| Diarrhoea | 3.8% (vs 2.3% placebo) | Dose-related: placebo 2.9%, 15 mg 1.4%, 30 mg 4.2%, 60 mg 7.4%; most common reason for discontinuation in maintenance therapy |
| Abdominal pain | 2.1% (vs 1.2% placebo) | Usually mild and self-limiting; evaluate for other causes if persistent |
| Nausea | 1.3% (vs 1.2% placebo) | Minimally above placebo rate; rarely requires discontinuation |
| Constipation | 1.0% (vs 0.4% placebo) | Increase dietary fibre and fluid intake; usually resolves with continued use |
| Headache | ~1% | Occurred at similar or higher rates in placebo groups in monotherapy trials; more prominent in triple-therapy regimens (6%) |
Serious
Serious (Regardless of Frequency)
| Adverse Effect | Estimated Frequency | Typical Onset | Required Action |
|---|---|---|---|
| Clostridioides difficile-associated diarrhoea | Rare | Days to months after initiation | Stool testing; discontinue PPI if confirmed; initiate targeted antibiotic therapy |
| Acute tubulointerstitial nephritis | Rare | Weeks to months; any point during therapy | Discontinue lansoprazole; evaluate renal function; may require biopsy for diagnosis |
| Hypomagnesaemia | Rare | Usually after ≥3 months; most cases after ≥1 year | Check magnesium levels; may cause secondary hypocalcaemia and hypokalaemia; supplement and consider PPI discontinuation |
| Osteoporosis-related fractures (hip, wrist, spine) | Rare; increased with long-term use | After ≥1 year of high-dose or long-term use | Use lowest effective dose for shortest duration; manage patients at fracture risk per guidelines |
| Severe cutaneous adverse reactions (SJS, TEN, DRESS, AGEP) | Very rare | Days to weeks | Immediate discontinuation; emergency dermatological and supportive care; permanent avoidance |
| Cutaneous and systemic lupus erythematosus | Very rare | Weeks to years | Discontinue PPI; refer to specialist; most cases resolve within 4–12 weeks of discontinuation |
| Cyanocobalamin (Vitamin B12) deficiency | Rare; associated with use >3 years | After ≥3 years of continuous use | Monitor B12 levels in prolonged users; supplement if deficient |
| Fundic gland polyps | Uncommon; risk increases with >1 year use | Months to years | Usually asymptomatic and found incidentally on endoscopy; use shortest PPI duration appropriate |
| Anaphylaxis / anaphylactoid reactions | Very rare | Any time | Emergency care; permanent discontinuation; avoid all lansoprazole formulations |
| Hepatotoxicity | Very rare (post-marketing) | Variable | Monitor liver function; discontinue if hepatic injury suspected |
| Blood dyscrasias (agranulocytosis, aplastic anaemia, pancytopenia, thrombocytopenia) | Very rare (post-marketing) | Variable | CBC if unexplained infections or bleeding; discontinue and consult haematology |
Discontinuation
Discontinuation Rates
Short-Term Monotherapy (Adults)
Low vs comparable placebo rate
Top reasons: Diarrhoea, abdominal pain, nausea. Overall, lansoprazole was well tolerated across >10,000 patients in phase 2/3 trials, with adverse-event rates leading to withdrawal comparable to placebo.
Triple Therapy (H. pylori Regimen)
Moderate — driven by antibiotic side effects
Top reasons: Diarrhoea (7%), headache (6%), taste perversion (5%). These primarily reflect clarithromycin and amoxicillin contributions rather than lansoprazole alone.
| Reason for Discontinuation | Incidence | Context |
|---|---|---|
| Diarrhoea | Most common reason | Dose-related; rates highest at 60 mg (7.4%); primary driver in maintenance studies |
| Abdominal pain | Uncommon | Usually mild; exclude other GI pathology before attributing to lansoprazole |
| Nausea | Uncommon | Marginally above placebo in monotherapy trials |
Managing Diarrhoea — The Most Common Adverse Effect
Diarrhoea with lansoprazole is dose-dependent, occurring in about 3.8% of patients at standard doses but rising to 7.4% at 60 mg daily. In most cases, the diarrhoea is mild and self-limiting. Consider reducing the dose if clinically appropriate. Persistent or severe diarrhoea should prompt evaluation for C. difficile, particularly in hospitalised patients or those concurrently receiving antibiotics.
Drug Interactions
Lansoprazole is metabolised primarily by CYP2C19 and CYP3A4. It also raises intragastric pH, which can alter the absorption of pH-dependent drugs. Formal interaction studies with warfarin, phenytoin, diazepam, theophylline, and propranolol showed no clinically significant changes, though clinical vigilance remains advisable with narrow-therapeutic-index drugs.
Major
Rilpivirine
MechanismElevated gastric pH reduces rilpivirine absorption
EffectSubstantially decreased rilpivirine plasma levels, risk of HIV treatment failure and resistance
ManagementContraindicated — do not co-administer. Use alternative antiretroviral or acid suppressant (e.g., famotidine with timing restrictions)
FDA PI
Major
Atazanavir / Nelfinavir
MechanismElevated gastric pH markedly reduces absorption of these HIV protease inhibitors
EffectReduced antiviral plasma concentrations; risk of virological failure
ManagementAvoid concomitant use. If acid suppression is essential, consult HIV specialist for alternative regimen
FDA PI
Major
Methotrexate (high-dose)
MechanismPPIs may inhibit renal tubular secretion of methotrexate and its metabolite, though exact mechanism incompletely understood
EffectElevated and prolonged serum methotrexate levels; risk of methotrexate toxicity
ManagementConsider temporary withdrawal of lansoprazole during high-dose methotrexate cycles. Low-dose methotrexate interaction not demonstrated in a formal study
FDA PI / Case Reports
Moderate
Clopidogrel
MechanismLansoprazole inhibits CYP2C19 in vitro; clopidogrel requires CYP2C19 for bioactivation
Effect~14% decrease in active metabolite AUC in a healthy-volunteer study; pharmacodynamic impact modest. Observational studies show conflicting cardiovascular outcomes data
ManagementFDA PI states no dose adjustment needed. However, if concern persists, consider pantoprazole (weaker CYP2C19 inhibition) or an H2-receptor antagonist
FDA PI / Observational Data
Moderate
Warfarin
MechanismPPIs may alter warfarin metabolism; formal studies with lansoprazole show no significant PK interaction
EffectPost-marketing reports of increased INR and prothrombin time, with risk of bleeding
ManagementMonitor INR when initiating, adjusting, or stopping lansoprazole in warfarin-treated patients
FDA PI
Moderate
Tacrolimus
MechanismPPIs may increase tacrolimus whole blood trough concentrations, particularly in CYP2C19 intermediate or poor metabolisers
EffectPotential for tacrolimus toxicity (nephrotoxicity, neurotoxicity)
ManagementMonitor tacrolimus trough levels when lansoprazole is started, stopped, or dose-adjusted
FDA PI
Moderate
Digoxin
MechanismElevated gastric pH increases digoxin oral bioavailability; PPI-induced hypomagnesaemia may increase digoxin sensitivity
EffectModestly increased digoxin levels; potential for digoxin toxicity especially if concurrent hypomagnesaemia
ManagementMonitor digoxin levels and magnesium in long-term concurrent use
FDA PI / Lexicomp
Moderate
Sucralfate
MechanismSucralfate delays absorption and reduces bioavailability of lansoprazole by approximately 17%
EffectReduced lansoprazole efficacy
ManagementAdminister lansoprazole at least 30 minutes before sucralfate
FDA PI
Minor
Theophylline
MechanismMinor CYP1A2 interaction potential
EffectA minor (~10%) increase in theophylline clearance was reported; unlikely to be clinically significant for most patients
ManagementMay require theophylline dose titration when lansoprazole is started or stopped, particularly for patients at the upper end of the therapeutic range
FDA PI
Moderate
pH-dependent drugs (ketoconazole, itraconazole, iron salts, erlotinib, mycophenolate mofetil)
MechanismReduced gastric acidity decreases dissolution and absorption of drugs requiring acidic pH
EffectReduced plasma levels and potentially diminished therapeutic effect of the affected drug
ManagementConsider alternative antifungals not requiring acidic pH; separate administration; monitor clinical efficacy
FDA PI / LexicompMonitoring
-
Magnesium
Baseline and periodically if use >3 months
Routine Serum magnesium prior to initiation and periodically during prolonged use. Particularly important when co-prescribed with digoxin or diuretics. Also check calcium and potassium, as hypomagnesaemia can drive secondary deficits. -
Vitamin B12
Consider after ≥3 years of use
Trigger-based Monitor if symptoms consistent with B12 deficiency appear (fatigue, paraesthesias, macrocytic anaemia). Long-term acid suppression impairs B12 absorption from food-protein sources. -
Renal Function
If signs of interstitial nephritis
Trigger-based Monitor serum creatinine and urinalysis if unexplained rise in creatinine, malaise, nausea, or fever develop. Acute tubulointerstitial nephritis can occur at any point during therapy. -
Bone Density
Per osteoporosis guidelines
Trigger-based Consider DXA scan for patients on long-term, high-dose PPI therapy who have additional risk factors for osteoporosis-related fractures. Use lowest effective dose and shortest duration. -
Chromogranin A
Hold PPI ≥14 days before testing
Trigger-based PPI-induced hypergastrinaemia elevates CgA, causing false positives in neuroendocrine tumour workups. Discontinue lansoprazole at least 14 days before CgA testing. Repeat if initially elevated. -
INR (if on warfarin)
At initiation and dose changes
Routine Post-marketing reports of increased INR with concurrent PPI and warfarin use. Monitor INR when starting, adjusting, or stopping lansoprazole in anticoagulated patients. -
Symptom Response
4–8 weeks after initiation
Routine Assess symptom resolution at end of treatment course. In adults, a suboptimal response does not exclude gastric malignancy — consider endoscopy, especially in older patients or those with alarm features.
Contraindications & Cautions
Absolute Contraindications
- Known severe hypersensitivity to lansoprazole or any component of the formulation (reactions include anaphylaxis, angioedema, bronchospasm, urticaria, and acute tubulointerstitial nephritis)
- Concomitant use with rilpivirine-containing products — substantially decreased rilpivirine concentrations with risk of HIV treatment failure and resistance development
Relative Contraindications (Specialist Input Recommended)
- Severe hepatic impairment (Child-Pugh C) — if use is essential, reduce dose to 15 mg daily; monitor closely for adverse effects given substantially increased drug exposure
- Concurrent high-dose methotrexate — consider temporary withdrawal of lansoprazole to avoid elevated methotrexate levels and toxicity; oncology input recommended
- Patients on atazanavir or nelfinavir — avoid combination as PPI-induced pH elevation substantially reduces protease inhibitor absorption; consult HIV specialist for alternatives
Use with Caution
- Long-term use (>1 year) — increased risks of hypomagnesaemia, B12 deficiency, bone fractures, and fundic gland polyps; use the lowest effective dose for the shortest necessary duration
- Patients at risk for osteoporosis-related fractures — particularly with high-dose or multiple daily dose PPI therapy; manage per osteoporosis guidelines
- Patients with pre-existing hypomagnesaemia or hypocalcaemia — monitor electrolytes before and during treatment; supplement as needed
- Hospitalised patients or those on antibiotics — increased risk of C. difficile-associated diarrhoea; promptly evaluate any new diarrhoea
- Paediatric patients <1 year of age — not recommended due to risk of heart valve thickening demonstrated in nonclinical studies in juvenile rats
- Pregnancy — animal data suggest potential adverse effects on fetal bone growth; use only if clearly needed
FDA Class-Wide Regulatory Warning
PPI Class: Long-Term Risk Advisory
The FDA has issued safety communications regarding the class-wide risks of long-term PPI use, including increased risk of Clostridioides difficile-associated diarrhoea, bone fractures with long-term and high-dose therapy, hypomagnesaemia (particularly after ≥1 year of treatment), vitamin B12 deficiency with prolonged use (>3 years), cutaneous and systemic lupus erythematosus, fundic gland polyps, and the potential for severe cutaneous adverse reactions (SJS, TEN, DRESS, AGEP). Clinicians are advised to prescribe PPIs at the lowest effective dose for the shortest clinically appropriate duration.
Patient Counselling
Purpose of Therapy
Lansoprazole reduces stomach acid production to help heal ulcers, protect the stomach lining, and relieve symptoms of acid reflux and heartburn. Depending on the condition being treated, the medication may be needed for a short defined course (typically 4–8 weeks) or for longer-term maintenance. It does not work immediately — full symptom relief may take one to four days, though some patients notice improvement within 24 hours.
How to Take
Take lansoprazole before a meal, ideally in the morning. Swallow the capsule whole — do not crush or chew. If swallowing is difficult, the capsule may be opened and the granules sprinkled on a tablespoon of soft food such as applesauce or yogurt, then swallowed immediately without chewing. The orally disintegrating tablet can be placed on the tongue and allowed to dissolve, with or without water.
Diarrhoea
Tell patient
Loose stools are the most common side effect and are usually mild. Stay well hydrated. This tends to improve as the body adjusts to the medication.
Call prescriber
If diarrhoea is severe, persistent, watery, or bloody, or if accompanied by fever or abdominal cramping — these may indicate C. difficile infection.
Long-Term Use Risks
Tell patient
If lansoprazole is prescribed for an extended period, there are small but real risks affecting bone strength, magnesium levels, and vitamin B12 absorption. The prescriber will monitor for these with periodic blood tests.
Call prescriber
Report unexplained muscle cramps, palpitations, tingling in hands or feet, or unusual fatigue — these may signal low magnesium or B12.
Skin Reactions
Tell patient
Severe skin reactions are extremely rare but can occur with any PPI. Watch for any new rash, especially if it blisters, peels, or involves the mouth or eyes.
Call prescriber
Seek immediate medical attention for any widespread rash, blistering, peeling skin, mouth sores, or swelling of the face, lips, or tongue.
Missed Doses & Stopping
Tell patient
If a dose is missed, take it as soon as remembered unless the next dose is nearly due — do not double up. Do not stop taking the medication early without discussing with the prescriber, even if symptoms have resolved, as the full course may be needed for complete healing.
Call prescriber
Contact the prescriber if symptoms return after completing the course, or if original symptoms fail to improve within the expected treatment window.
Drug & Supplement Interactions
Tell patient
Inform all healthcare providers that you are taking lansoprazole. It can interact with blood thinners, certain HIV medications, and some antifungal drugs. Take lansoprazole at least 30 minutes before sucralfate. Antacids can be taken at the same time if needed.
Call prescriber
Notify the prescriber before starting any new medication, including over-the-counter drugs and supplements.
Sources
Regulatory (PI / SmPC)
- Lansoprazole delayed-release capsules prescribing information. Dr. Reddy’s Laboratories, Inc. Revised 12/2022. drugs.com/pro/lansoprazole Current FDA-approved prescribing information — primary source for indications, dosing, adverse reactions, drug interactions, and pharmacokinetics.
- PREVACID (lansoprazole) prescribing information. Takeda Pharmaceuticals America, Inc. FDA label 2017. accessdata.fda.gov Brand-name label with complete clinical pharmacology data, including antisecretory activity tables and paediatric study results.
- DailyMed — Lansoprazole capsule, delayed release label. U.S. National Library of Medicine. dailymed.nlm.nih.gov Continuously updated label source; confirms clopidogrel interaction data, sucralfate timing guidance, and warfarin monitoring recommendations.
Key Clinical Trials
- FDA Pediatric BPCA review for lansoprazole. Studies M97-640 and M00-158 in adolescent GERD. fda.gov FDA medical review establishing paediatric GERD dosing for ages 12–17 and summarising pharmacokinetic-pharmacodynamic data in adolescents.
- Barradell LB, Faulds D, McTavish D. Lansoprazole: a review of its pharmacodynamic and pharmacokinetic properties and its therapeutic efficacy in acid-related disorders. Drugs. 1992;44(2):225-250. doi:10.2165/00003495-199244020-00007 Comprehensive early review establishing the clinical profile of lansoprazole, including comparative efficacy against H2-receptor antagonists and omeprazole.
Guidelines
- Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017;112(2):212-239. doi:10.1038/ajg.2016.563 Current ACG guideline informing H. pylori triple therapy regimen selection and duration recommendations.
- Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27-56. doi:10.14309/ajg.0000000000001538 Definitive GERD management guideline addressing PPI step-down strategies, long-term use assessment, and erosive esophagitis maintenance.
Mechanistic / Basic Science
- Shin JM, Sachs G. Pharmacology of proton pump inhibitors. Curr Gastroenterol Rep. 2008;10(6):528-534. doi:10.1007/s11894-008-0098-4 Detailed review of PPI activation chemistry and proton pump binding kinetics, explaining why acid suppression duration exceeds plasma half-life.
- Andersson T. Pharmacokinetics, metabolism and interactions of acid pump inhibitors. Clin Pharmacokinet. 1996;31(1):9-28. doi:10.2165/00003088-199631010-00002 Foundational paper describing CYP2C19 and CYP3A4 metabolic pathways for lansoprazole and other PPIs.
Pharmacokinetics / Special Populations
- Langtry HD, Wilde MI. Lansoprazole: an update of its pharmacological properties and clinical efficacy in the management of acid-related disorders. Drugs. 1997;54(3):473-500. doi:10.2165/00003495-199754030-00007 Updated PK review including data on elderly, hepatic impairment, and renal failure populations; confirms no renal dose adjustment needed.
- Gerloff J, Mignot A, Barth H, Heintze K. Pharmacokinetics and absolute bioavailability of lansoprazole. Eur J Clin Pharmacol. 1996;50(4):293-297. doi:10.1007/s002280050111 Crossover study establishing 81–91% absolute bioavailability for enteric-coated lansoprazole formulations.
- Wedemeyer RS, Blume H. Pharmacokinetic drug interaction profiles of proton pump inhibitors: an update. Drug Saf. 2014;37(4):201-211. doi:10.1007/s40264-014-0144-0 Comprehensive review of PPI drug interaction profiles published 2007–2012, including clopidogrel and methotrexate data; notes lansoprazole has fewer interaction concerns than omeprazole.