Eosinophilic esophagitis (off-label use): Oral: 30 mg twice daily for an 8-week trial (Bonis 2021; Laserna-Mendieta 2020; Lucendo 2016; Vazquez-Elizondo 2013). Once 8-week trial is complete and remission is achieved, the dose may be gradually lowered to an individualized maintenance level (Laserna-Mendieta 2020). Some experts initiate with once-daily dosing and increase to twice-daily dosing after 4 weeks if symptoms fail to improve (Bonis 2021).
Gastroesophageal reflux disease (GERD), treatment: Note: Administer 30 to 60 minutes before a meal (breakfast is preferred). Lifestyle and dietary modifications are also recommended (ACG [Katz 2013]).
Initial therapy:
Mild and intermittent symptoms (<2 episodes/week), and no evidence of erosive esophagitis: Note: Some experts consider PPI use in these patients only if symptoms persist following standard-doses of histamine 2 receptor antagonists (Kahrilas 2019). Oral: 15 mg once daily for 8 weeks; if symptoms persist after 8 weeks, increase to 30 mg once daily; once symptoms are controlled, continue treatment for at least 8 weeks. Discontinue therapy when asymptomatic for 8 weeks with therapy (consider tapering before discontinuing) (Kahrilas 2019).
Severe or frequent symptoms (≥2 episodes/week), erosive esophagitis, or Barrett esophagus: Oral: 30 mg once daily; once symptoms are controlled, continue treatment for at least 8 weeks. In patients with severe erosive esophagitis or Barrett esophagus, long-term maintenance therapy with 30 mg once daily is warranted. In patients without severe erosive esophagitis or Barrett esophagus, continue at the lowest dose for the shortest duration appropriate, discontinue therapy in all asymptomatic patients (consider tapering before discontinuing) (Kahrilas 2019; Ramakrishnan 2002).
Refractory:
Persistent symptoms despite 30 mg once daily dosing regimen: Note: Referral to a specialist is recommended: Oral: 30 mg twice daily (before breakfast and dinner) (ACG [Katz 2013]; Fass 2019; Hershcovici 2010) or some experts consider splitting the 30 mg once daily dose and administering 15 mg twice daily before breakfast and dinner (Fass 2019).
Recurrent symptoms after discontinuing acid suppression:
Recurrent symptoms ≥3 months: Repeat an 8-week course at the previously effective dose (Kahrilas 2019).
Recurrent symptoms <3 months: Long-term maintenance at the lowest effective dose necessary; upper endoscopy is also recommended (if not already performed) (ACG [Katz 2013]; Kahrilas 2019).
OTC labeling (patient-guided therapy): Heartburn, frequent symptoms (≥2 episodes/week): 15 mg once daily for 14 days (maximum: 15 mg/day); may repeat a 14-day course every 4 months, if needed.
Hypersecretory conditions: Oral: Initial: 60 mg once daily; adjust dose based upon patient response and to reduce acid secretion to <10 mEq/hour (5 mEq/hour in patients with prior gastric surgery); doses of 90 mg twice daily have been used; administer doses >120 mg/day in divided doses
Peptic ulcer disease:
Duodenal ulcer: Oral: Short-term treatment: 15 mg once daily for 4 weeks; maintenance therapy: 15 mg once daily
Dyspepsia (off label use): Oral: 15 or 30 mg once daily for up to 8 weeks (Peura 2004; Pinto-Sanchez 2017; Suzuki 2013)
Gastric ulcer: Oral: Short-term treatment: 30 mg once daily for up to 8 weeks. Some clinical trial data suggests a dose of 15 mg once daily for up to 8 weeks may also be effective.
Helicobacter pylori eradication: Oral: 30 mg 3 times daily administered with amoxicillin 1,000 mg 3 times daily for 14 days or 30 mg twice daily administered with amoxicillin 1,000 mg and clarithromycin 500 mg twice daily for 10 to 14 days
American College of Gastroenterology guidelines (Chey 2007; Chey 2017):
Clarithromycin triple regimen: 30 to 60 mg twice daily in combination with clarithromycin 500 mg twice daily and either amoxicillin 1 g twice daily or metronidazole 500 mg 3 times per day for 14 days. Note: Avoid use of clarithromycin triple therapy in patients with risk factors for macrolide resistance (eg, prior macrolide exposure, local clarithromycin resistance rates ≥15%, eradication rates with clarithromycin-based regimens ≤85%) (ACG [Chey 2017]; Fallone 2016).
Sequential regimen: 30 mg twice daily plus amoxicillin 1 g twice daily for 5 to 7 days; then follow with clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, and lansoprazole 30 mg twice daily for 5 to 7 days
Levofloxacin triple regimen: 30 mg twice daily in combination with amoxicillin 1 g twice daily and levofloxacin 500 mg once daily for 10 to 14 days
Bismuth quadruple regimen: 30 mg twice daily in combination with tetracycline 500 mg 4 times daily, metronidazole 250 mg 4 times daily or 500 mg 3 or 4 times daily, and either bismuth subcitrate 120 to 300 mg 4 times daily or bismuth subsalicylate 300 mg 4 times daily for 10 to 14 days
Concomitant regimen: 30 mg twice daily in combination with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily for 10 to 14 days
Hybrid regimen: 30 mg twice daily plus amoxicillin 1 g twice daily for 7 days; then follow with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, and lansoprazole 30 mg twice daily for 7 days
NSAID-associated gastric ulcer (healing): Oral: 30 mg once daily for 8 weeks; controlled studies did not extend past 8 weeks
NSAID-associated gastric ulcer (to reduce risk): Oral: 15 mg once daily for up to 12 weeks; controlled studies did not extend past 12 weeks
Stress ulcer prophylaxis in critically-ill patients (off-label use): Oral: 30 mg once daily (Brophy 2010; Olsen 2008). Note: Intended for patients with associated risk factors (eg, coagulopathy, mechanical ventilation for >48 hours, sepsis/septic shock); discontinue use once risk factors have resolved (Rhodes 2017).
Discontinuation of therapy: Oral: Some experts recommend a step-down approach in order to avoid worsening or rebound symptoms. One strategy is to decrease the dose by 50% over 2 to 4 weeks. If the patient is already on the lowest possible dose, alternate-day therapy may be considered. If symptoms worsen during treatment or after discontinuation, patient should be re-evaluated (Kim 2018).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
No dosage adjustment necessary.
Mild or moderate impairment (Child-Pugh class A or B): No dosage adjustment necessary.
Severe impairment (Child-Pugh class C): 15 mg once daily. Note: Dosage recommendation is based on pharmacokinetic data using a single 30 mg dose.
(For additional information see "Lansoprazole: Pediatric drug information")
Gastroesophageal reflux disease (GERD), symptomatic: Note: Guidelines recommend a 4- to 8-week treatment course; if improvement seen after 4 to 8 weeks, consider possible wean; if no response after 4 to 8 weeks, reevaluate diagnosis and consider referral to pediatric GI specialist (NASPGHAN/ESPGHAN [Rosen 2018]). The manufacturer recommends not using lansoprazole in infants due to lack of clinical efficacy data and the potential for adverse effects (ie, heart valve thickening) observed in animal models (rats).
Weight-based dosing:
Infants: Oral: 2 mg/kg/day (NASPGHAN/ESPGHAN [Rosen 2018]); a dose of 1 mg/kg/day has also been shown to increase gastric pH in infants and decrease frequency of GERD symptoms (eg, regurgitation/vomiting, feeding refusal, crying, back arching) from baseline (Springer 2008).
Children and Adolescents: Oral: 0.7 to 3 mg/kg/day (AAP [Lightdale 2013]); maximum daily dose: 30 mg/day (NASPGHAN/ESPGHAN [Rosen 2018]).
Fixed dosing:
Infants ≥3 months: 7.5 mg twice daily or 15 mg once daily was shown to provide better symptom relief compared to dietary management in 68 patients (Khoshoo 2008).
Children ≤11 years:
≤30 kg: 15 mg once daily.
>30 kg: 30 mg once daily.
Children ≥12 years and Adolescents: Oral: 15 mg once daily.
Erosive esophagitis, treatment: Note: Duration of therapy is dependent on age: Children ≤11 years recommended duration is up to 12 weeks and children ≥12 years and adolescent duration is up to 8 weeks.
Children ≤11 years:
≤30 kg: 15 mg once daily.
>30 kg: 30 mg once daily.
Children ≥12 years and Adolescents: Oral: 30 mg once daily.
Discontinuation of therapy: Oral: Based on experience in adults, some experts recommend a step-down approach in order to avoid worsening or rebound symptoms. One recommendation is to decrease the dose by 50% over 2 to 4 weeks. If the patient is already on the lowest possible dose, alternate day therapy may be considered. If symptoms worsen during treatment or after discontinuation, patient should be reevaluated (Kim 2018).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Children and Adolescents: No dosage adjustments are needed.
Children and Adolescents: Drug exposure is increased in hepatic impairment; consider dose reduction for severe impairment
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule Delayed Release, Oral:
GoodSense Lansoprazole: 15 mg [gluten free; contains brilliant blue fcf (fd&c blue #1), fd&c yellow #10 (quinoline yellow)]
Heartburn Treatment 24 Hour: 15 mg [DSC] [sodium free; contains brilliant blue fcf (fd&c blue #1), fd&c yellow #10 (quinoline yellow)]
Prevacid: 15 mg [DSC], 30 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]
Generic: 15 mg, 30 mg
Tablet Delayed Release Disintegrating, Oral:
Prevacid SoluTab: 15 mg, 30 mg [contains aspartame]
Generic: 15 mg, 30 mg
Yes
First-Lansoprazole suspension is a compounding kit. Refer to manufacturer's labeling for compounding instructions.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule Delayed Release, Oral:
Prevacid: 15 mg, 30 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, polysorbate 80]
Generic: 15 mg, 30 mg
Tablet Delayed Release Disintegrating, Oral:
Prevacid FasTab: 15 mg, 30 mg [contains aspartame]
An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:
Prevacid capsules, orally disintegrating tablets: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020406s092,021428s039lbl.pdf#page=44
Oral: Administer 30 to 60 minutes before a meal; best if taken before breakfast (ACG [Katz 2013]). If administering twice daily, first dose should be administered before breakfast and the second dose before dinner (ACG [Katz 2013]; Hershcovici 2010). The intact granules should not be chewed or crushed; however, several options are available for those patients unable to swallow capsules:
Capsules may be opened and the intact granules sprinkled on 1 tablespoon of applesauce, Ensure pudding, cottage cheese, yogurt, or strained pears. The granules should then be swallowed immediately.
Capsules may be opened and emptied into ~60 mL orange juice, apple juice, or tomato juice; mix and swallow immediately. Rinse the glass with 2 or more volumes of juice and swallow immediately to assure complete delivery of the dose.
Orally disintegrating tablets: Should not be swallowed whole, broken, cut, or chewed. Place tablet on tongue; allow to dissolve (with or without water) until particles can be swallowed. Orally-disintegrating tablets may also be administered via an oral syringe: Place the 15 mg tablet in an oral syringe and draw up ~4 mL water, or place the 30 mg tablet in an oral syringe and draw up ~10 mL water. After tablet has dispersed, administer within 15 minutes. Refill the syringe with water (2 mL for the 15 mg tablet; 5 mL for the 30 mg tablet), shake gently, then administer any remaining contents.
Nasogastric tube administration:
Capsule: Capsule can be opened, the granules mixed (not crushed) with 40 mL of apple juice and then administered through the NG tube into the stomach, then flush tube with additional apple juice. Do not mix with other liquids. Thirty milligrams has also been suspended in 10 mL of 8.4% sodium bicarbonate solution (or apple juice) or divided into 4 equal parts and flushed with water and administered via NG tube (Brophy 2010; Tsai 2000).
Orally disintegrating tablet: Nasogastric tube ≥8 French: Place a 15 mg tablet in a syringe and draw up ~4 mL water, or place the 30 mg tablet in a syringe and draw up ~10 mL water. After tablet has dispersed, administer within 15 minutes (gently shake syringe immediately prior to administration). Refill the syringe with ~5 mL water, shake gently, and then flush the nasogastric tube.
Oral: Administer before eating; best if taken 30 minutes before a meal (AAP [Lightdale 2013]); intact granules should not be chewed or crushed
Capsules: Swallow whole; do not chew or crush. For patients with difficulty swallowing the capsule, capsules may be opened and the intact granules sprinkled on 1 tablespoon of applesauce, Ensure pudding, cottage cheese, yogurt, or strained pears; the mixture should be swallowed immediately. Capsules may also be opened and emptied into ~60 mL of apple juice, orange juice, or tomato juice; mix and swallow immediately. Rinse the glass with additional juice and swallow to assure complete delivery of the dose.
For nasogastric tube ≥16 French: Capsule can be opened, the granules mixed (not crushed) with 40 mL of apple juice and then injected through the NG tube into the stomach, then flush tube with additional apple juice. Do not mix with other liquids based on manufacturer labeling; additional information may be available for NG administration; contact manufacturer to obtain current recommendations.
Tablet, orally-disintegrating: Should not be swallowed whole, broken, cut, or chewed. Splitting of orally-disintegrating tablets may result in significant differences in amount of lansoprazole containing microgranules in each half, clinical relevance of this difference is not well-described (Teitelbaum 2015). Place the tablet on the tongue and allow to disintegrate with or without water until the particles can be swallowed.
Administration via an oral syringe: Place the 15 mg tablet in an oral syringe and draw up ~4 mL water, or place the 30 mg tablet in an oral syringe and draw up ~10 mL water. Shake gently. After tablet has dispersed, administer within 15 minutes. Refill the syringe with water (2 mL for the 15 mg tablet; 5 mL for the 30 mg tablet), shake gently, then administer any remaining contents.
For nasogastric tube ≥8 French: Place a 15 mg tablet in a syringe and draw up ~4 mL water, or place the 30 mg tablet in a syringe and draw up ~10 mL water. Shake gently. After tablet has dispersed, administer within 15 minutes. Refill the syringe with ~5 mL water, shake gently, and then flush the nasogastric tube.
Gastroesophageal reflux disease (GERD): Short-term (up to 8 weeks) treatment of symptomatic GERD in children ≥1 year of age and adults; short-term (up to 8 weeks in children ≥12 years and adults; up to 12 weeks in children 1 to 11 years) treatment for all grades of erosive esophagitis; to maintain healing of erosive esophagitis in adults
Hypersecretory conditions: Long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome in adults
Peptic ulcer disease: Short-term (4 weeks) treatment of active duodenal ulcers in adults; maintenance treatment of healed duodenal ulcers in adults; as part of a multidrug regimen for Helicobacter pylori eradication to reduce the risk of duodenal ulcer recurrence in adults; short-term (up to 8 weeks) treatment of active benign gastric ulcer in adults; treatment of NSAID-associated gastric ulcer; to reduce the risk of NSAID-associated gastric ulcer in adults with a history of gastric ulcer who require an NSAID
OTC labeling: Relief of frequent heartburn (≥2 days/week)
Dyspepsia; Eosinophilic esophagitis; Stress ulcer prophylaxis in critically-ill patients
Lansoprazole may be confused with aripiprazole, dexlansoprazole
Prevacid may be confused with Pravachol, Prevpac, PriLOSEC, Prinivil
Beers Criteria: Proton pump inhibitors are identified in the Beers Criteria as potentially inappropriate medications to be avoided (as scheduled use for more than 8 weeks) in patients 65 years and older due to their risk of C. difficile infection and bone loss/fractures unless given for high-risk patients (eg, oral corticosteroid or chronic NSAID use), patients with erosive esophagitis, Barrett's esophagitis, a pathological hypersecretory condition, or if the patient has demonstrated a need for maintenance therapy (eg, failure of drug discontinuation trial or failure of H2 blockers) (Beers Criteria [AGS 2019]).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Gastrointestinal: Abdominal pain (adults and adolescents: 2% to 5%), constipation (children: 5%; adults 1%), diarrhea (adults: ≤7%), nausea (adolescents: 3%; adults <1%)
Nervous system: Dizziness (adolescents: 3%; adults: <1%), headache (children and adolescents: 3% to 7%)
<1%:
Cardiovascular: Acute myocardial infarction, angina pectoris, bradycardia, cardiac arrhythmia, cerebral infarction, cerebrovascular accident, chest pain, circulatory shock, edema, hypertension, hypotension, palpitations, peripheral edema, syncope, tachycardia, vasodilation
Dermatologic: Acne vulgaris, alopecia, contact dermatitis, diaphoresis, hair disease, maculopapular rash, nail disease, pruritus, skin rash, urticaria, xeroderma
Endocrine & metabolic: Decreased libido, dehydration, diabetes mellitus, goiter, gout, gynecomastia, heavy menstrual bleeding, hyperglycemia, hypoglycemia, hypothyroidism, increased libido, increased thirst, menstrual disease (including abnormal menses), vitamin deficiency, weight gain, weight loss
Gastrointestinal: Abdominal distention, abnormal stools, ageusia, anorexia, aphthous stomatitis, bezoar formation, cholelithiasis, colitis, dysgeusia, dyspepsia, dysphagia, enteritis, eructation, esophageal achalasia, esophageal stenosis, esophageal ulcer, esophagitis, fecal discoloration, flatulence, gastritis, gastroenteritis, gastrointestinal candidiasis, gastrointestinal hemorrhage, gingival hemorrhage, glossitis, halitosis, hematemesis, hiccups, increased appetite, melena, oral mucosa ulcer, rectal disease, sialorrhea, stomatitis, tenesmus, tongue disease, ulcerative colitis, vomiting, xerostomia
Genitourinary: Breast hypertrophy, breast tenderness, difficulty in micturition, dysmenorrhea, dysuria, impotence, leukorrhea, mastalgia, pelvic pain, penile disease, testicular disease, urethral pain, urinary frequency, urinary retention, urinary tract infection, urinary urgency, vaginitis
Hematologic & oncologic: Anemia, carcinoma, hemolysis, lymphadenopathy, malignant neoplasm of larynx, polyp (gastric nodules and fundic gland polyp), rectal hemorrhage, skin carcinoma
Hypersensitivity: Fixed drug eruption, hypersensitivity reaction
Infection: Candidiasis, infection
Nervous system: Abnormal dreams, abnormality in thinking, agitation, altered sense of smell, amnesia, anxiety, apathy, chills, confusion, dementia, depersonalization, depression, dizziness, drowsiness, emotional lability, hallucination, hemiplegia, hostility, hypertonia, hypoesthesia, insomnia, malaise, migraine, myasthenia, nervousness, neurosis, pain, paresthesia, seizure, sleep disorder, vertigo
Neuromuscular & skeletal: Arthralgia, arthritis, arthropathy, asthenia, back pain, bone disease, hyperkinetic muscle activity, lower limb cramp, musculoskeletal pain, myalgia, neck pain, neck stiffness, synovitis, tremor
Ophthalmic: Amblyopia, blepharitis, blepharoptosis, blurred vision, cataract, conjunctivitis, diplopia, dry eye syndrome, eye pain, glaucoma, photophobia, retinal degeneration, retinopathy, visual disturbance, visual field defect
Otic: Deafness, ear disease, otitis media, tinnitus
Renal: Nephrolithiasis, polyuria, renal pain
Respiratory: Asthma, bronchitis, cough, dyspnea, epistaxis, flu-like symptoms, hemoptysis, pharyngitis, pleural disease, pneumonia, pulmonary fibrosis, rhinitis, sinusitis, stridor, upper respiratory tract infection, upper respiratory tract inflammation
Miscellaneous: Fever
Frequency not defined:
Endocrine & metabolic: Abnormal albumin-globulin ratio, albuminuria, decreased serum cholesterol, electrolyte disorder (decreased/increased), glycosuria, hyperlipidemia, increased gamma-glutamyl transferase, increased gastrin, increased lactate dehydrogenase, increased serum glucocorticoids, increased serum potassium
Gastrointestinal: Occult blood in stools
Genitourinary: Crystalluria, hematuria
Hematologic & oncologic: Abnormal erythrocytes, eosinophilia, leukocyte disorder, leukocytosis, platelet disorder (abnormal platelets), quantitative disorders of platelets (decreased/increased)
Hepatic: Hyperbilirubinemia, increased serum alanine aminotransferase, increased serum alkaline phosphatase, increased serum aspartate aminotransferase
Immunologic: Increased serum globulins
Renal: Acute interstitial nephritis, increased blood urea nitrogen, increased serum creatinine
Postmarketing:
Dermatologic: Cutaneous lupus erythematosus, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis
Endocrine & metabolic: Hypomagnesemia
Gastrointestinal: Clostridioides difficile associated diarrhea, pancreatitis
Hematologic: Agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia, thrombotic thrombocytopenic purpura
Hepatic: Hepatoxicity (Chalasani 2021)
Hypersensitivity: Anaphylaxis, nonimmune anaphylaxis
Nervous system: Speech disturbance
Neuromuscular & skeletal: Bone fracture, myositis, systemic lupus erythematosus
Renal: Interstitial nephritis, renal disease (chronic; Lazarus 2016)
Hypersensitivity (eg, anaphylaxis, angioedema, anaphylactic shock, angioedema, bronchospasm, acute tubulointerstitial nephritis, urticaria) to lansoprazole or any component of the formulation; concomitant use with products that contain rilpivirine
Concerns related to adverse effects:
• Carcinoma: No reports of enterochromaffin-like (ECL) cell carcinoids, dysplasia, or neoplasia has occurred.
• Clostridioides difficile-associated diarrhea (CDAD): Use of proton pump inhibitors (PPIs) may increase risk of CDAD, especially in hospitalized patients; consider CDAD diagnosis in patients with persistent diarrhea that does not improve. Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.
• Cutaneous and systemic lupus erythematosus: Has been reported as new onset or exacerbation of existing autoimmune disease; most cases were cutaneous lupus erythematosus (CLE), most commonly, subacute CLE (occurring within weeks to years after continuous therapy). Systemic lupus erythematosus (SLE) is less common (typically occurs within days to years after initiating treatment) and occurred primarily in young adults up to elderly patients. Discontinue therapy if signs or symptoms of CLE or SLE occur and refer to a specialist for evaluation; most patients improve 4 to 12 weeks after discontinuation of lansoprazole.
• Fractures: Increased incidence of osteoporosis-related bone fractures of the hip, spine, or wrist may occur with PPI therapy. Patients on high-dose or long-term therapy should be monitored. Use the lowest effective dose for the shortest duration of time, use vitamin D and calcium supplementation, and follow appropriate guidelines to reduce risk of fractures in patients at risk.
• Fundic gland polyps: Use of PPIs increases risk of fundic gland polyps, especially with long-term use >1 year. May occur without symptoms, but nausea, vomiting, or abdominal pain may occur; GI bleeding and/or anemia may occur with ulcerated polyps. Diagnosis of polyps may also increase risk for small intestinal blockage. Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.
• Hypomagnesemia: Reported rarely, usually with prolonged PPI use of ≥3 months (most cases >1 year of therapy). May be symptomatic or asymptomatic; severe cases may cause tetany, seizures, and cardiac arrhythmias. Consider obtaining serum magnesium concentrations prior to beginning long-term therapy, especially if taking concomitant digoxin, diuretics, or other drugs known to cause hypomagnesemia; and periodically thereafter. Hypomagnesemia may be corrected by magnesium supplementation, although discontinuation of lansoprazole may be necessary; magnesium levels typically return to normal within 1 week of stopping.
• Tubulointerstitial nephritis: Acute tubulointerstitial nephritis has been observed in patients taking PPIs; may occur at any time during therapy. Patients may present with symptomatic hypersensitivity reaction to nonspecific symptoms of impaired renal function (eg, anorexia, malaise, nausea); may be diagnosed with biopsy and in the absence of extra-renal manifestations (eg, fever, rash, arthralgia). Discontinue and evaluate patients if acute tubulointerstitial nephritis is suspected.
• Vitamin B12 deficiency: Prolonged treatment (≥2 years) may lead to vitamin B12 malabsorption and subsequent vitamin B12 deficiency. The magnitude of the deficiency is dose-related and the association is stronger in females and those younger in age (<30 years of age); prevalence is decreased after discontinuation of therapy (Lam 2013).
Disease-related concerns:
• Gastric malignancy: Relief of symptoms does not preclude the presence of a gastric malignancy.
• Gastrointestinal infection (eg, Salmonella, Campylobacter): Use of PPIs may increase risk of these infections.
• Hepatic impairment: Patients with severe liver dysfunction may require dosage reductions.
Concurrent drug therapy issues:
• Clopidogrel: PPIs may diminish the therapeutic effect of clopidogrel thought to be due to reduced formation of the active metabolite of clopidogrel. The manufacturer of clopidogrel recommends either avoidance of both omeprazole (even when scheduled 12 hours apart) and esomeprazole or use of a PPI with comparatively less effect on the active metabolite of clopidogrel (eg, pantoprazole). Although lansoprazole exhibits the most potent CYP2C19 inhibition in vitro (Li 2004; Ogilvie 2011), an in vivo study of extensive CYP2C19 metabolizers showed less reduction of the active metabolite of clopidogrel by lansoprazole/dexlansoprazole compared to esomeprazole/omeprazole (Frelinger 2012). The manufacturer of lansoprazole states that no dosage adjustment is necessary for clopidogrel when used concurrently. In contrast to these warnings, others have recommended the continued use of PPIs, regardless of the degree of inhibition, in patients with a history of GI bleeding or multiple risk factors for GI bleeding who are also receiving clopidogrel since no evidence has established clinically meaningful differences in outcome; however, a clinically significant interaction cannot be excluded in those who are poor metabolizers of clopidogrel (Abraham 2010; Levine 2011).
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
• Phenylalanine: Some products may contain phenylalanine, which can be harmful to patients with phenylketonuria (PKU). Before prescribing, consider the combined daily amount of phenylalanine from all sources.
Other warnings/precautions:
• Appropriate use: Helicobacter pylori eradication: Short-term combination therapy (≤7 days) has been associated with a higher incidence of treatment failure. The American College of Gastroenterology recommends 10 to 14 days of therapy (triple or quadruple) for eradication of H. pylori (Chey 2017).
• Laboratory test interference: Serum chromogranin A (CgA) levels increase secondary to drug-induced decreases in gastric acid; may cause false-positive results in diagnostic investigations for neuroendocrine tumors. Temporarily stop lansoprazole treatment at least 14 days before CgA test; if CgA level is high, repeat test to confirm. Use same commercial laboratory for testing to prevent variable results.
• Self-medication (OTC use): When used for self-medication, patients should be instructed not to use if they have difficulty swallowing, are vomiting blood, or have bloody or black stools. Prior to use, patients should contact healthcare provider if they have liver disease, heartburn for >3 months, heartburn with dizziness, lightheadedness, or sweating, MI symptoms, frequent chest pain, frequent wheezing (especially with heartburn), unexplained weight loss, nausea/vomiting, stomach pain, or are taking antifungals, atazanavir, digoxin, tacrolimus, theophylline, or warfarin. Patients should stop use and consult a healthcare provider if heartburn continues or worsens, or if they need to take for >14 days or more often than every 4 months. Patients should be informed that it may take 1 to 4 days for full effect to be seen.
Use in neonatal and pediatric patients <12 months of age is not recommended in the product labeling; neonatal and infant animal models (rat) have shown mitral valve heart thickening in 2 nonclinical, oral toxicity studies. Heart valve thickening occurred at doses 6.2 times (neonates) and 4.2 times (infants) the pediatric daily dose of 15 mg; duration of treatment associated with valve thickening ranged from 5 days to 8 weeks. Valve thickening reversed or trended towards reversibility 4 weeks after discontinuation. The risk of heart valve thickening does not appear to occur at ≥1 year of age. Evaluate risk vs benefit when considering use in neonates and infants.
Use of gastric acid inhibitors, including proton pump inhibitors (PPIs) and H2 blockers, has been associated with an increased risk for development of acute gastroenteritis and community-acquired pneumonia in pediatric patients 4 to 36 months of age (Canani 2006). Routine use in preterm infants is not recommended (AAP [Eichenwald 2018]).
Gastric acid suppression medications have been associated with an increase in Clostridioides difficile infection (CDI) and recurrent CDI in pediatric patients (Nylund 2014). In a retrospective, observational, case control study of pediatric patients 1 to 18 years old who were hospitalized for diarrhea and abdominal pain, the use of PPIs was significantly higher in patients who tested positive for C. difficile compared to patients who tested negative for C. difficile (22.1% vs 5.9%) (Turco 2010). Consider CDI diagnosis in patients with persistent diarrhea that does not improve. Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.
A large retrospective cohort study reviewed records for patients with a low baseline risk for fractures who were initiated on acid suppression therapy in the first year of life and evaluated the fracture risk in the first 5 years of life; a total of 97,286 patients were prescribed acid suppression therapy; 73% were prescribed H2 blockers, 9% were prescribed PPIs, and 18% were prescribed both. H2 blocker use alone was not associated with an increased fracture hazard; however, PPI use was associated with a 21% increase and use of PPI plus H2 blocker was associated with a 30% increase. Longer duration of therapy and earlier age at initiation seemed to also increase the fracture hazard. Study findings do not establish a causal relationship between PPI use and fractures. If acid suppression therapy is necessary in the first year of life, limiting therapy to a single drug and limiting the duration should be considered (Malchodi 2019). A second large cohort study reviewed records for 115,933 children <18 years initiated on a PPI. PPI initiation was associated with a statistically significant 11% relative increase in risk of any fracture in patients ≥6 years. The increased risk also seemed to be more pronounced with a longer cumulative duration of PPI use (Wang 2020).
Substrate of CYP2C19 (major), CYP2C9 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Acalabrutinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Acalabrutinib. Risk X: Avoid combination
Amphetamine: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the absorption of Amphetamine. Risk C: Monitor therapy
Atazanavir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Atazanavir. Management: Avoid use in treatment-experienced patients. In treatment-naive patients, administer boosted atazanavir 12 hours after the PPI and the PPI dose should not exceed the equivalent of 20 mg omeprazole. Monitor for reduced atazanavir efficacy. Risk D: Consider therapy modification
Belumosudil: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Belumosudil. Management: Increase the dose of belumosudil to 200 mg twice daily when coadministered with proton pump inhibitors. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Bisphosphonate Derivatives. Risk C: Monitor therapy
Bosutinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Bosutinib. Management: Consider alternatives to proton pump inhibitors and potassium-competitive acid blockers, such as short-acting antacids or histamine-2 receptor antagonists. Administer alternative agents more than 2 hours before or after bosutinib. Risk D: Consider therapy modification
Capecitabine: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Capecitabine. Risk C: Monitor therapy
Cefditoren: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Cefditoren. Management: If possible, avoid use of cefditoren with proton pump inhibitors (PPIs) and potassium-competitive acid blockers (PCABs). Consider alternative methods to control acid reflux or use alternative antimicrobial therapy if coadministration is required. Risk D: Consider therapy modification
Cefpodoxime: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of Cefuroxime. Risk X: Avoid combination
Clopidogrel: Lansoprazole may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Risk C: Monitor therapy
CYP2C19 Inducers (Strong): May decrease the serum concentration of Lansoprazole. Risk X: Avoid combination
CYP2C19 Inhibitors (Moderate): May increase the serum concentration of Lansoprazole. Risk C: Monitor therapy
CYP2C19 Inhibitors (Strong): May increase the serum concentration of Lansoprazole. Risk C: Monitor therapy
Cysteamine (Systemic): Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy
Dacomitinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Dacomitinib. Management: Avoid concurrent use of dacomitinib with PPIs and PCABs. Antacids may be used. Histamine H2-receptor antagonists (HR2A) may be used if dacomitinib is given at least 6 hours before or 10 hours after the H2RA. Risk X: Avoid combination
Dasatinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of PPIs or PCABs if some acid-reducing therapy is needed. Risk X: Avoid combination
Delavirdine: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Delavirdine. Management: Chronic therapy with PPIs or PCABs should be avoided in patients treated with delavirdine. The clinical significance of short-term PPI or PCAB therapy with delavirdine is uncertain, but such therapy should be undertaken with caution. Risk X: Avoid combination
Dextroamphetamine: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the absorption of Dextroamphetamine. Specifically, the dextroamphetamine absorption rate from mixed amphetamine salt extended release (XR) capsules may be increased in the first hours after dosing. Risk C: Monitor therapy
Doxycycline: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the bioavailability of Doxycycline. Risk C: Monitor therapy
Enoxacin: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of Enoxacin. Risk C: Monitor therapy
Erlotinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Erlotinib. Risk X: Avoid combination
Gefitinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Gefitinib. Management: Avoid use of inhibitors of the proton pump (PPIs or PCABs) with gefitinib when possible. If required, administer gefitinib 12 hours after the PPI/PCAB or 12 hours before the next dose of the PPI/PCAB. Closely monitor clinical response to gefitinib. Risk D: Consider therapy modification
Imatinib: Lansoprazole may enhance the dermatologic adverse effect of Imatinib. Risk C: Monitor therapy
Immune Checkpoint Inhibitors: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy
Indinavir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Indinavir. Risk C: Monitor therapy
Infigratinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease serum concentrations of the active metabolite(s) of Infigratinib. Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Infigratinib. Risk X: Avoid combination
Itraconazole: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Itraconazole. Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Itraconazole. Management: Exposure to Tolsura brand itraconazole may be increased by PPIs or PCABs ; consider itraconazole dose reduction. Exposure to Sporanox brand itraconazole may be decreased. Give Sporanox brand itraconazole at least 2 hrs before or 2 hrs after PPIs or PCABs. Risk D: Consider therapy modification
Ketoconazole (Systemic): Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of Ketoconazole (Systemic). Ketoconazole (Systemic) may increase the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). Management: Administer ketoconazole with an acidic beverage, such as non-diet cola, to increase gastric acidity and improve absorption if concomitant use with proton pump inhibitors or potassium-competitive acid blockers is necessary. Risk D: Consider therapy modification
Ledipasvir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Ledipasvir. Management: PPI or PCAB doses equivalent to omeprazole 20 mg or lower may be given with ledipasvir under fasted conditions. Use of ledipasvir with higher doses or with food, or 2 hours after a these agents, may reduce ledipasvir bioavailability. Risk D: Consider therapy modification
Levoketoconazole: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of Levoketoconazole. Levoketoconazole may increase the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). Risk X: Avoid combination
Lumacaftor and Ivacaftor: May decrease the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). Risk C: Monitor therapy
Methotrexate: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Methotrexate. Management: Consider temporarily interrupting PPI or PCAB therapy in patients receiving high-dose methotrexate. If coadministered, monitor for increased methotrexate toxicity (eg, mucositis, myalgias) and/or delayed methotrexate elimination. Risk D: Consider therapy modification
Multivitamins/Minerals (with ADEK, Folate, Iron): Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be decreased. Risk C: Monitor therapy
Mycophenolate: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Mycophenolate. Specifically, concentrations of the active mycophenolic acid may be reduced. Risk C: Monitor therapy
Nelfinavir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease serum concentrations of the active metabolite(s) of Nelfinavir. Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Nelfinavir. Management: Due to potentially significant reductions in nelfinavir exposure, avoid concurrent use of nelfinavir with a PPI or PCAB when possible. If unavoidable, consider PPI or PCAB use for a short duration (less than 30 days) and closely monitor viral load. Risk D: Consider therapy modification
Neratinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Neratinib. Specifically, proton pump inhibitors may reduce neratinib absorption. Risk X: Avoid combination
Nilotinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Nilotinib. Management: Avoid this combination. Histamine H2 receptor antagonists (H2RAs) given 10 hours before or 2 hours after nilotinib, or antacids given 2 hours before or 2 hours after nilotinib are acceptable alternatives. Risk D: Consider therapy modification
Octreotide: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Octreotide. Risk C: Monitor therapy
Palbociclib: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Palbociclib. Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Palbociclib. Management: Carefully evaluate potential risks and benefits of coadministration of palbociclib and proton pump inhibitors or potassium-competitive acid blockers due to the risk of reduced palbociclib efficacy. Palbociclib capsules should be taken with food. Risk D: Consider therapy modification
PAZOPanib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of PAZOPanib. Risk X: Avoid combination
Pexidartinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Pexidartinib. Management: Avoid this combination. If acid-reduction is needed, consider administering an antacid 2 hours before or after pexidartinib, or administer pexidartinib 2 hours before or 10 hours after an H2 receptor antagonist. Risk X: Avoid combination
Posaconazole: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Posaconazole. Management: Avoid coadministration of PPIs or PCABs and posaconazole oral suspension. Posaconazole delayed-release tablets do not appear to be sensitive to this interaction and do not required dose adjustment if coadministered with PPIs or PCABs. Risk D: Consider therapy modification
Rilpivirine: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Rilpivirine. Risk X: Avoid combination
Riociguat: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Riociguat. Risk C: Monitor therapy
Risedronate: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Risedronate. Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Risedronate. This applies specifically to use of delayed-release risedronate. Management: Coadministration of PPIs or PCABs with delayed-release risedronate formulations is not recommended. Limit PPI/PCAB dose and duration during coadministration with risedronate as possible. Patients over age 70 are at higher risk of adverse effects. Risk D: Consider therapy modification
Saquinavir: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Saquinavir. Risk C: Monitor therapy
Secretin: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of PPIs or PCABs and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details. Risk D: Consider therapy modification
Selpercatinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Selpercatinib. Management: Coadministration of selpercatinib and PPIs or PCABs should be avoided. If coadministration cannot be avoided, selpercatinib and PPIs or PCABs should be administered simultaneously with food. Risk D: Consider therapy modification
SORAfenib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of SORAfenib. Risk C: Monitor therapy
Sotorasib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Sotorasib. Risk X: Avoid combination
St John's Wort: May decrease the serum concentration of Lansoprazole. Risk X: Avoid combination
Tacrolimus (Systemic): Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Tacrolimus (Systemic). Risk C: Monitor therapy
Tipranavir: May decrease the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). These data are derived from studies with Ritonavir-boosted Tipranavir. Risk C: Monitor therapy
Velpatasvir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Velpatasvir. Management: Sofosbuvir/velpatasvir should be administered with food and taken 4 hours before omeprazole 20 mg. Sofosbuvir/velpatasvir/voxilaprevir can be administered with omeprazole 20 mg. Use with other PPIs or PCABs has not been studied. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Lansoprazole may increase the serum concentration of Vitamin K Antagonists. Risk C: Monitor therapy
Voriconazole: May increase the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Voriconazole. Risk C: Monitor therapy
Prolonged treatment (≥2 years) may lead to malabsorption of dietary vitamin B12 and subsequent vitamin B12 deficiency (Lam 2013).
Available data have not shown an increased risk of major birth defects following maternal use of lansoprazole during pregnancy.
Recommendations for the treatment of GERD in pregnancy are available. As in nonpregnant patients, lifestyle modifications followed by other medications are the initial treatments (ACG [Katz 2013]; Body 2016; Huerta-Iga 2016; van der Woude 2014). Based on available data, proton pump inhibitors may be used when clinically indicated (Body 2016; Matok 2012; Pasternak 2010; van der Woude 2014).
It is not known if lansoprazole is present in breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
Should be taken before eating; best if taken before breakfast. Some products may contain phenylalanine.
Patients with Zollinger-Ellison syndrome should be monitored for gastric acid output, which should be maintained at ≤10 mEq/hour during the last hour before the next lansoprazole dose; bone loss and fractures, CBC, CDAD, liver function, renal function, magnesium (baseline and periodically thereafter), and serum gastrin levels
Decreases acid secretion in gastric parietal cells through inhibition of (H+, K+)-ATPase enzyme system, blocking the final step in gastric acid production.
Onset of action: Gastric acid suppression: Oral: 1 to 3 hours
Duration: Gastric acid suppression: Oral: >1 day
Absorption: Rapid
Distribution: Vd: Children: 0.61 to 0.9 L/kg; Adults: 15.7 ± 1.9 L
Protein binding: 97%
Metabolism: Hepatic via CYP2C19 and 3A4 to inactive metabolites, and in parietal cells to two active metabolites that are not present in systemic circulation
Bioavailability: >80%; decreased 50% to 70% if given 30 minutes after food
Half-life elimination: Children: 1.2 to 1.5 hours; Adults: 1.5 ± 1 hour; Elderly: 1.9 to 2.9 hours; Hepatic impairment: 4 to 7.2 hours
Time to peak, plasma: 1.7 hours
Excretion: Feces (67%); urine (33%; 14% to 25% as metabolites and <1% as unchanged drug)
Clearance:
Children: 0.57 to 0.71 L/hour/kg
Adults: 11.1 ± 3.8 L/hour; Hepatic impairment: 3.2 to 7.2 hours
Hepatic function impairment: In patients with mild (Child-Pugh class A) or moderate (Child-Pugh class B) hepatic impairment, AUC increased ~3-fold and half-life increased from 1.5 hours to 4 or 5 hours, respectively. In patients with compensated and decompensated cirrhosis, AUC increased 6- and 5-fold, respectively.
Geriatric: Clearance is decreased with t½ increasing ~50% to 100%. Because mean t½ remains between 1.9 to 2.9 hours, repeated once daily dosing does not accumulate.
Capsule, delayed release (Lansoprazole Oral)
15 mg (per each): $4.72 - $5.90
30 mg (per each): $0.66 - $13.24
Capsule, delayed release (Prevacid Oral)
30 mg (per each): $16.60
Tablet Delayed Release Disintegrating (Lansoprazole Oral)
15 mg (per each): $15.77
30 mg (per each): $15.77
Tablet Delayed Release Disintegrating (Prevacid SoluTab Oral)
15 mg (per each): $16.60
30 mg (per each): $16.60
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