In general, proton pump inhibitors like lansoprazole are used first because they are better than H2 blockers at reducing stomach acid. However, if you do not get on with a proton pump inhibitor for example, because of side effects , your doctor may prescribe an H2 blocker. You can buy famotidine and ranitidine without a prescription from pharmacies. You can take lansoprazole with an antacid, for example Gaviscon, if you need to but leave a gap of 2 hours between them. If you take lansoprazole for more than 3 months, the levels of magnesium in your blood may fall.
Low magnesium can make you feel tired, confused, dizzy and cause muscle twitches, shakiness and an irregular heartbeat. If you get any of these symptoms, tell your doctor. Taking lansoprazole for more than a year may increase your chances of certain side effects, including:. If you take lansoprazole for longer than 1 year your doctor will regularly check your health to see if you should carry on taking it.
It's not known if lansoprazole works less well the longer you take it. If you feel like lansoprazole isn't working any more, talk to your doctor. A Hong Kong study published in suggested that people taking proton pump inhibitors PPIs like lansoprazole for at least 3 years have a very small increased chance of developing stomach cancer.
For every 10, people taking a PPI long term, it was thought an extra 4 people get stomach cancer. However, the study didn't prove that PPIs were causing stomach cancer and the results may not apply in the UK. People who take PPIs regularly shouldn't be particularly concerned by this study. However, PPIs, like most medicines, have side effects, so it's best to take them for the shortest time possible.
Speak to your doctor or pharmacist if you are concerned. Usually, you can stop taking lansoprazole without reducing the dose first. If you've taken lansoprazole for a long time, speak to your doctor before you stop taking it.
Stopping the medicine suddenly could make your stomach produce a lot more acid, and make your symptoms return. Reducing the dose gradually before stopping completely will prevent this happening.
There's no clear evidence to suggest that taking lansoprazole will reduce fertility in either men or women. However, speak to a pharmacist or your doctor about it if you're trying to get pregnant. They may want to review your treatment. Lansoprazole doesn't affect any type of regular contraception including the combined pill. It may reduce the effectiveness of one type of emergency contraception called ellaOne ulipristal , so a different form of emergency contraceptive may be recommended instead.
Occasionally, lansoprazole can make you feel dizzy, sleepy, or get blurred vision. If this happens to you, do not drive, cycle or use machinery or tools until you feel better. Yes, you can drink alcohol with lansoprazole. However, drinking alcohol makes your stomach produce more acid than normal. This can irritate your stomach lining and make your symptoms worse.
It may be possible to ease symptoms caused by too much stomach acid by making a few changes to your diet and lifestyle.
Page last reviewed: 12 November Next review due: 12 November Lansoprazole On this page About lansoprazole Key facts Who can and cannot take lansoprazole How and when to take lansoprazole Side effects How to cope with side effects Pregnancy and breastfeeding Cautions with other medicines Common questions.
About lansoprazole Lansoprazole reduces the amount of acid your stomach makes. Help us improve our website Can you answer a quick question about your visit today?
It's usual to take lansoprazole once a day in the morning. For severe illness, you can take it twice a day — in the morning and in the evening. Common side effects include headache, diarrhoea and stomach pain. These tend to be mild and go away when you stop taking the medicine. Lansoprazole is called by the brand name Zoton FasTabs.
Lansoprazole isn't suitable for some people. To make sure lansoprazole is safe for you, tell your doctor if you: have had an allergic reaction to lansoprazole or any other medicines in the past have liver problems are due to have an endoscopy If you are having an endoscopy, ask your doctor if you should stop taking lansoprazole a few weeks before your procedure.
Dosage The usual dose to treat: indigestion is 15mg to 30mg a day acid reflux is 15mg to 30mg a day stomach ulcers is 15mg to 30mg a day Zollinger-Ellison syndrome is 60mg a day — this can increase to mg a day depending on how well it works for you Doses are usually lower for children, elderly people and people with liver problems.
Tablets and capsules Swallow tablets and capsules whole with a glass of water or juice. Liquid lansoprazole Liquid lansoprazole can be prescribed and made to order for children and people who cannot swallow capsules or tablets. Will my dose go up or down?
How long will I take it for? What if I forget to take it? If you usually take it: once a day, take the missed dose as soon as you remember, unless it is within 12 hours of your next dose in which case skip the missed dose twice a day, take the missed dose as soon as you remember, unless it is within 4 hours of your next dose in which case skip the missed dose Do not take a double dose to make up for a forgotten dose.
What if I take too much? However, you should check with your doctor if you have taken too much and have any of these symptoms: flushed skin feeling sweaty a fast heartbeat feeling sleepy blurred vision feeling confused or agitated.
Common side effects These common side effects may happen in more than 1 in people. Talk to your doctor or pharmacist if these side effects bother you or don't go away: headaches feeling sick diarrhoea or being sick vomiting stomach pain constipation wind itchy skin rashes feeling dizzy or tired dry mouth or throat Serious side effects Serious side effects are rare and happen in less than 1 in 1, people. Call a doctor straight away if you have: joint pain along with a red skin rash, especially in parts of your body exposed to the sun, such as your arms, cheeks and nose — these can be signs of a rare condition called subacute cutaneous lupus erythematosus.
This can happen even if you've been taking lansoprazole for a long time stomach pain that seems to be getting worse — this can be a sign of an inflamed liver or pancreas Serious allergic reaction In rare cases, it's possible to have a serious allergic reaction anaphylaxis to lansoprazole. Information: You can report any suspected side effect using the Yellow Card safety scheme.
Visit Yellow Card for further information. What to do about: headaches — make sure you rest and drink plenty of fluids. Do not drink too much alcohol.
Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking lansoprazole. These could be symptoms of a serious kidney problem called acute tubulointerstitial nephritis.
Taking this medicine for a long time may make it harder for your body to absorb vitamin B Tell your doctor if you have concerns about vitamin B12 deficiency. Check with your doctor right away if you have watery stool that does not go away, stomach pain, and fever while taking this medicine. Lansoprazole may increase your risk of having fractures of the hip, wrist, and spine. This is more likely if you have osteoporosis, if you are 50 years of age and older, if you receive high doses of this medicine, or if you use it for one year or more.
Cutaneous or systemic lupus erythematosus may occur or get worse in patients receiving a PPI. Call your doctor right away if you have joint pain or a skin rash on your cheeks or arms that gets worse when exposed to the sun. This medicine may cause hypomagnesemia low magnesium in the blood. Check with your doctor right away if you have convulsions seizures , fast, racing, or uneven heartbeat, muscle spasms tetany , tremors, or unusual tiredness or weakness.
This medicine may increase your risk for fundic gland polyps abnormal tissue growth in the upper part of your stomach. This is more likely if you are receiving this medicine for more than 1 year. Talk to your doctor if you have concerns.
Do not stop taking this medicine without first checking with your doctor, or unless told to do so by your doctor. Before you have any medical tests, tell the medical doctor in charge that you or your child are taking this medicine. The results of some tests may be affected by this medicine. Do not take other medicines unless they have been discussed with your doctor. John's wort or vitamin supplements.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.
Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:. Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission.
Mayo Clinic does not endorse any of the third party products and services advertised. Profound gastric acid suppression during PPI therapy leads to a drug-induced reflex hypergastrinemia and subsequent rebound acid hypersecretion. In this hypersecretory state, enterochromaffin-like cell hypertrophy also results in a temporal increase in serum chromogranin A CgA levels.
It is unclear, however, if this hypersecretory reflex results in clinically significant effects in patients on or attempting to discontinue PPI therapy. A clinically significant effect may lead to gastric acid-related symptoms upon PPI withdrawal and possible therapy dependence. Studies in healthy subjects H. Until more consistent study results shed light on this possible effect, it is prudent to follow current treatment guidelines employing the lowest effective dose, for the shortest duration of time in symptomatic patients.
For patients requiring maintenance therapy, consider on demand or intermittent PPI therapy, step down therapy to an H2 blocker, and regularly assess the need for continued gastric suppressive therapy.
Available data from published observational studies overall do not indicate an association of adverse pregnancy outcomes with lansoprazole treatment. Animal reproductive studies at doses up to 40 times the recommended human dose based on body surface area, revealed no evidence of impaired fertility or fetal harm. It is not known if lansoprazole crosses the human placenta; its low molecular weight suggests that it has the potential to do so.
Cases of inadvertent exposure and therapeutic use of lansoprazole in early gestation in humans suggest a low risk to the fetus. In a prospective study, outcomes from a group of 62 pregnant women administered median daily doses of 30 mg of lansoprazole were compared to a control group of pregnant women who did not take any PPIs.
In a retrospective cohort study covering all live births in Denmark from to , there was no significant increase in major birth defects during analysis of first trimester exposure to lansoprazole in live births. Animal studies indicate that lansoprazole is excreted into breast milk. No studies have been done to determine if lansoprazole is similarly excreted into human milk.
Alternative therapies for consideration include antacids and H2 blockers. Patients with phenylketonuria should be made aware that lansoprazole disintegrating tablets contain phenylalanine 2. The capsule and syrup formulations do not contain phenylalanine.
The safety and efficacy of lansoprazole has not been established in neonates or infants; however, the drug has been used off-label with caution in these populations. A multicenter, double-blind, placebo controlled study including infants 1 month to younger than 1 year of age with symptomatic GERD failed to show safety and efficacy. Limited data are available describing lansoprazole use in neonates.
In nonclinical studies in juvenile rats, heart valve thickening and bone changes delayed growth and impairment of weight gain were reported at doses at least 2. Patients one year of age and older do not appear to be at risk of heart valve injury.
Use with caution in patients with a history of systemic lupus erythematosus SLE as lansoprazole has been reported to activate or exacerbate SLE. Administration of lansoprazole may result in laboratory test interference, specifically serum chromogranin A CgA tests for neuroendocrine tumors, urine tests for tetrahydrocannabinol THC , secretin stimulation tests, and diagnostic tests for Helicobacter pylori.
Gastric acid suppression may increase serum CgA. Increased CgA concentrations may cause false positive results in diagnostic investigations for neuroendocrine tumors. To prevent this interference, temporarily stop lansoprazole at least 14 days before assessing CgA concentrations and consider repeating the test if initial concentrations are high.
If serial tests are performed, ensure the same commercial laboratory is used as reference ranges may vary. If a PPI-induced false positive urine screen is suspected, confirm the positive results using an alternative testing method. PPIs may also cause a hyper-response in gastrin secretion to the secretin stimulation test, falsely suggesting gastrinoma. Health care providers are advised to temporarily stop lansoprazole at least 28 days prior to performing a secretin stimulation test to allow gastrin concentrations to return to baseline.
Preparations that combine PPIs with antimicrobials and bismuth are known to suppress H. At a minimum, instruct the patient to avoid the use of lansoprazole in the 1 to 2 weeks prior to the test and the use of antimicrobials and bismuth preparations in the 4 weeks prior to the test.
Avoid use for more than 8 weeks except for high-risk patients e. If a PPI is used for longer than 12 weeks, the clinical rationale and documentation for continued use should support an underlying chronic disease e. Monitor for adverse events, including an increased risk of Clostridium difficile colitis. Acalabrutinib: Major Avoid the concomitant use of acalabrutinib and proton pump inhibitors PPI , such as lansoprazole; decreased acalabrutinib exposure may occur resulting in decreased acalabrutinib effectiveness.
Consider using an antacid or H2-blocker if acid suppression therapy is needed. Separate the administration of acalabrutinib and antacids by at least 2 hours; give acalabrutinib 2 hours before a H2-blocker. Acalabrutinib solubility decreases with increasing pH values. Alendronate: Moderate Proton pump inhibitors PPIs are widely used and are frequently coadministered in users of oral bisphosphonates. A national register-based, open cohort study of 38, elderly patients suggests that those who use proton pump inhibitors in conjunction with alendronate have a dose-dependent loss of protection against hip fracture.
While causality was not investigated, the dose-response relationship noted during the study suggested that PPIs may reduce oral alendronate efficacy, perhaps through an effect on absorption or other mechanism, and therefore PPIs may not be optimal agents to control gastrointestinal complaints. It is not yet clear if all bisphosphonates would exhibit a loss of efficacy when PPIs are coadministered, but the results suggest that the interaction may occur across the class.
Alendronate; Cholecalciferol: Moderate Proton pump inhibitors PPIs are widely used and are frequently coadministered in users of oral bisphosphonates. Hypomagnesemia occurs with thiazide diuretics chlorothiazide, hydrochlorothiazide, indapamide, and metolazone. Low serum magnesium may lead to serious adverse events such as muscle spasm, seizures, and arrhythmias. Therefore, clinicians should monitor serum magnesium concentrations periodically in patients taking a PPI and diuretics concomitantly.
Patients who develop hypomagnesemia may require PPI discontinuation in addition to magnesium replacement. Amobarbital: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary. The time to maximum concentration Tmax of amphetamines is decreased compared to when administered alone, thus increasing amphetamine concentrations and exposure, which may be of particular significance with extended-release dosage forms.
Monitor clinical response and adjust if needed. Some extended-release dosage forms of amphetamine or dextroamphetamine salts should not be given with PPIs. The concomitant use of PPIs with some extended-release dosage forms may result in amphetamine dose-dumping. Ampicillin: Major Proton pump inhibitors PPIs have long-lasting effects on the secretion of gastric acid.
For enteral ampicillin, whose bioavailability is influenced by gastric pH, the concomitant administration of PPIs can exert a significant effect on ampicillin absorption. Anticholinergics: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Apalutamide: Major Avoid coadministration of lansoprazole with apalutamide due to decreased lansoprazole exposure. Aprepitant, Fosaprepitant: Minor Use caution if lansoprazole and aprepitant, fosaprepitant are used concurrently and monitor for an increase in lansoprazole-related adverse effects for several days after administration of a multi-day aprepitant regimen.
Lansoprazole is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions. However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction.
Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1.
Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Aspirin, ASA; Butalbital; Caffeine: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary. Aspirin, ASA; Butalbital; Caffeine; Codeine: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary.
Atazanavir: Contraindicated Coadministration of proton pump inhibitors PPIs with atazanavir in treatment-experienced patients is contraindicated. PPIs can be used with atazanavir in treatment-naive patients under specific administration restrictions. While data are insufficient to recommend atazanavir dosing in children Atazanavir; Cobicistat: Contraindicated Coadministration of proton pump inhibitors PPIs with atazanavir in treatment-experienced patients is contraindicated.
While data are insufficient to recommend atazanavir dosing in children Atenolol; Chlorthalidone: Moderate Proton pump inhibitors have been associated with hypomagnesemia. Atropine: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Atropine; Difenoxin: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e. Atropine; Edrophonium: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Azilsartan; Chlorthalidone: Moderate Proton pump inhibitors have been associated with hypomagnesemia. Barbiturates: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary. Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary. Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Belladonna; Opium: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e. Concomitant use may result in decreased belumosudil exposure and reduced belumosudil efficacy. Bendroflumethiazide; Nadolol: Moderate Proton pump inhibitors have been associated with hypomagnesemia. Benztropine: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Bisacodyl: Minor The concomitant use of bisacodyl oral tablets with drugs that raise gastric pH like proton pump inhibitors can cause the enteric coating of the bisacodyl tablets to dissolve prematurely, leading to possible gastric irritation or dyspepsia. When taking bisacodyl tablets, it is advisable to avoid PPIs within 1 hour before or after the bisacodyl dosage. Boceprevir: Moderate Close clinical monitoring is advised when administering lansoprazole with boceprevir due to an increased potential for lansoprazole-related adverse events.
If lansoprazole dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Although this interaction has not been studied, predictions about the interaction can be made based on the metabolic pathway of lansoprazole. Coadministration may result in elevated lansoprazole plasma concentrations. Bosentan: Minor Monitor for decreased efficacy of lansoprazole if coadministration with bosentan is necessary. Bosentan is a moderate CYP3A4 inducer.
Drugs known to induce CYP3A4 may lead to decreased lansoprazole plasma concentrations. Bosutinib: Major Concomitant use of bosutinib and lansoprazole resulted in decreased plasma exposure of bosutinib. Consider using a short-acting antacid or H2 blocker if acid suppression therapy is needed; separate the administration of bosutinib and antacids or H2-blockers by more than 2 hours.
Bosutinib displays pH-dependent aqueous solubility. Budesonide: Minor Enteric-coated budesonide granules dissolve at a pH greater than 5. Concomitant use of budesonide oral capsules and drugs that increase gastric pH levels can cause the coating of the granules to dissolve prematurely, possibly affecting release properties and absorption of the drug in the duodenum.
Budesonide; Formoterol: Minor Enteric-coated budesonide granules dissolve at a pH greater than 5. Budesonide; Glycopyrrolate; Formoterol: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Minor Enteric-coated budesonide granules dissolve at a pH greater than 5. Bumetanide: Moderate Proton pump inhibitors have been associated with hypomagnesemia.
Hypomagnesemia occurs with loop diuretics furosemide, bumetanide, torsemide, and ethacrynic acid. Butabarbital: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary. Butalbital; Acetaminophen: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary.
Butalbital; Acetaminophen; Caffeine: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary. Butalbital; Acetaminophen; Caffeine; Codeine: Moderate Monitor for decreased efficacy of lansoprazole if concomitant use of lansoprazole and barbiturates is necessary.
Proton pump inhibitors inhibit secretion of gastric acid by proton pumps thereby increasing the gastric pH; for optimal absorption, rilpivirine requires an acidic environment. Co-administration of drugs that raise stomach pH increases risedronate bioavailability due to faster release of the drug from the enteric coated tablet.
This interaction does not apply to risedronate immediate-release tablets. PPIsare widely used and are frequently coadministered in users of oral bisphosphonates. A national register-based, open cohort study of 38, elderly patients suggests that those who use PPIs in conjunction with alendronate have a dose-dependent loss of protection against hip fracture.
Study results suggest that the interaction may occur across the class; however, other interactions have not been confirmed and data suggest that fracture protection is not diminished when risedronate is used with PPIs. A post hoc analysis of patients who took risedronate 5 mg daily during placebo-controlled clinical trials determined that risedronate significantly reduced the risk of new vertebral fractures compared to placebo, regardless of concomitant PPI use.
Capecitabine: Moderate Use caution if treatment with a proton pump inhibitor PPI is necessary in patients taking capecitabine, as progression-free survival PFS and overall survival OS may be adversely affected.
The mechanism of this potential interaction is unknown and data are conflicting. In a posthoc, retrospective, subgroup analysis of a phase 3 clinical trial in patients with advanced or metastatic gastroesophageal cancer, administration of a PPI was associated with a significant decrease in PFS and OS in patients treated with capecitabine plus oxaliplatin CapeOx vs.
Additionally, there was not a significant increase in concentration dependent toxicities e. These observations are in line with a previous retrospective study in which patients with colorectal cancer receiving PPI treatment and adjuvant capecitabine also experienced poorer relapse-free survival compared with patients not receiving a PPI. Coadministration with antacids increased exposure to capecitabine and its metabolites, but this was not clinically significant or clinically relevant.
Pharmacokinetic data on the impact of a PPI on capecitabine exposure are not available. Carbamazepine: Moderate Some manufacturers recommend avoiding the coadministration of hepatic cytochrome P enzyme inducers and proton pump inhibitors PPIs.
Carbamazepine induces hepatic cytochrome P enzymes, including those responsible for the metabolism of PPIs. If carbamazepine and PPIs must be used together, monitor the patient closely for signs and symptoms of GI bleeding or other signs and symptoms of reduced PPI efficacy.
Cefpodoxime: Moderate Cefpodoxime proxetil requires a low gastric pH for dissolution; therefore, concurrent administration with medications that increase gastric pH, such as proton pump inhibitors PPIs may decrease the bioavailability of cefpodoxime. The rate of absorption is not affected. Ceftibuten: Minor Coadministration of mg of ranitidine every 12 hours for 3 days increased the ceftibuten Cmax by 23 percent and ceftibuten AUC by 16 percent.
Based on this information, increased gastric pH caused by PPIs may possibly affect the kinetics of ceftibuten. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. Chlordiazepoxide; Clidinium: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Chlorothiazide: Moderate Proton pump inhibitors have been associated with hypomagnesemia. Chlorthalidone: Moderate Proton pump inhibitors have been associated with hypomagnesemia. Chlorthalidone; Clonidine: Moderate Proton pump inhibitors have been associated with hypomagnesemia. Because citalopram causes dose-dependent QT prolongation, the maximum daily dose should not exceed 20 mg per day in patients receiving CYP2C19 inhibitors.
Clobazam: Moderate A dosage reduction of clobazam may be necessary during co-administration of lansoprazole. Extrapolation from pharmacogenomic data indicates that concurrent use of clobazam with moderate or potent inhibitors of CYP2C19 may result in up to a 5-fold increase in exposure to N-desmethylclobazam. Adverse effects, such as sedation, lethargy, ataxia, or insomnia may be potentiated. Cobicistat: Minor Use caution when administering cobicistat and lansoprazole concurrently. Cobicistat is an inhibitor of CYP3A.
Coadministration of cobicistat with CYP3A substrates, such as lansoprazole, can increase lansoprazole exposure leading to increased or prolonged therapeutic effects and adverse events; however, the clinical impact of this has not yet been determined.
Cyanocobalamin, Vitamin B Moderate Proton pump inhibitors may cause a decrease in the oral absorption of cyanocobalamin, vitamin B Patients receiving long-term therapy with proton pump inhibitors should be monitored for signs of B12 deficiency. Drugs that increase the gastric pH may cause the premature release of cysteamine from delayed-release capsules, leading to an increase in WBC cystine concentration.
Concomitant administration of omeprazole 20 mg did not alter the pharmacokinetics of delayed-release cysteamine when administered with orange juice; however, the effect of omeprazole on the pharmacokinetics of delayed-release cysteamine when administered with water have not been studied.
Dacomitinib: Major Avoid coadministration of lansoprazole with dacomitinib due to decreased plasma concentrations of dacomitinib which may impact efficacy.
Darunavir; Cobicistat: Minor Use caution when administering cobicistat and lansoprazole concurrently. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Minor Use caution when administering cobicistat and lansoprazole concurrently. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Increased exposure to lansoprazole may occur during concurrent administration of ritonavir.
Although dosage adjustment of lansoprazole is not normally required, dosage reduction may be considered in patients receiving higher lansoprazole doses e. Ritonavir is a strong CYP3A4 inhibitor. Dasatinib: Major Do not administer proton pump inhibitors with dasatinib due to the potential for decreased dasatinib exposure and reduced efficacy.
Consider using an antacid if acid suppression therapy is needed. Administer the antacid at least 2 hours prior to or 2 hours after the dose of dasatinib. Delavirdine: Major Because proton pump inhibitors PPIs increase gastric pH, decreased delavirdine absorption may occur. However, since these agents affect gastric pH for an extended period, separation of doses may not eliminate the interaction.
Chronic use of PPIs with delavirdine is not recommended. Dexamethasone: Minor Monitor for decreased efficacy of lansoprazole if coadministration with dexamethasone is necessary. Dexamethasone is a moderate CYP3A4 inducer. Dicyclomine: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Digoxin: Moderate Lansoprazole or other proton pump inhibitors PPIs can affect digoxin absorption due to their long-lasting effect on gastric acid secretion. Additionally, PPIs may slightly increase digoxin bioavailability. Patients with digoxin serum levels at the upper end of the therapeutic range may need to be monitored for potential increases in serum digoxin levels when a PPI is coadministered with digoxin.
Finally, PPIs have been associated with hypomagnesemia. Becuase, low serum magnesium may lead to irregular heartbeat and increase the likelihood of serious cardiac arrhythmias, clinicians should monitor serum magnesium concentrations periodically in patients taking a PPI and digoxin concomitantly. Diphenoxylate; Atropine: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
Lansoprazole is a substrate for CYP3A4. The concomitant administration of dronedarone and CYP3A substrates may result in increased exposure of the substrate and should, therefore, be undertaken with caution. Elagolix: Minor Coadministration of elagolix with lansoprazole may theoretically increase plasma concentrations of lansoprazole. Monitor for lansoprazole-related adverse effects during coadministration with elagolix. Elagolix; Estradiol; Norethindrone acetate: Minor Coadministration of elagolix with lansoprazole may theoretically increase plasma concentrations of lansoprazole.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Minor Use caution when administering cobicistat and lansoprazole concurrently.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Minor Use caution when administering cobicistat and lansoprazole concurrently. Enzalutamide: Major Avoid coadministration of enzalutamide with lansoprazole due to decreased plasma concentrations of lansoprazole.
Erlotinib: Major Avoid coadministration of erlotinib with lansoprazole if possible due to decreases in erlotinib plasma concentrations. Erlotinib solubility is pH dependent and solubility decreases as pH increases. Coadministration of erlotinib with medications that increase the pH of the upper gastrointestinal tract may decrease the absorption of erlotinib. Separation of doses may not eliminate the interaction since proton pump inhibitors affect the pH of the upper GI tract for an extended period of time.
Increasing the dose of erlotinib is also not likely to compensate for the loss of exposure. If these drugs are used together, monitor for escitalopram-associated adverse reactions. It is unclear that the theoretical interaction would result in a net increase or decrease in PPI action.
Some manufacturers recommend avoiding the coadministration of hepatic cytochrome P enzyme inducers and PPIs. If eslicarbazepine and PPI must be used together, monitor the patient closely for signs and symptoms of GI bleeding or other signs and symptoms of reduced PPI efficacy, or for signs of PPI side effects.
Ethacrynic Acid: Moderate Proton pump inhibitors have been associated with hypomagnesemia. Concomitant use of fenofibric acid with CYP2C19 substrates, such as lansoprazole, has not been formally studied. Fenofibric acid may theoretically increase plasma concentrations of CYP2C19 substrates and could lead to toxicity for drugs that have a narrow therapeutic range. Monitor the therapeutic effect of lansoprazole during coadministration with fenofibric acid. Flavoxate: Moderate The American College of Gastroenterology states that the effectiveness of proton pump inhibitors PPIs may be theoretically decreased if given with other antisecretory agents e.
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