Drug Guide
Dexlansoprazole
Classification
Therapeutic: Proton pump inhibitor (PPI)
Pharmacological: Proton pump inhibitor
FDA Approved Indications
- Erosive esophagitis associated with GERD
- Symptomatic GERD
- Maintenance of healing of erosive esophagitis
Mechanism of Action
Dexlansoprazole inhibits the H+/K+ ATPase enzyme system of the gastric parietal cells, leading to a decrease in gastric acid secretion.
Dosage and Administration
Adult: Typically 30 mg once daily before a meal; dose may be adjusted based on response and condition.
Pediatric: Not approved for pediatric use.
Geriatric: No specific initial dosage adjustment, but monitor for increased risk of side effects.
Renal Impairment: No dose adjustment required.
Hepatic Impairment: Use caution, no specific dosage adjustment recommended.
Pharmacokinetics
Absorption: Well absorbed, with a prompt and sustained release formulation.
Distribution: Extensively bound to plasma proteins.
Metabolism: Metabolized by hepatic CYP450 enzymes, primarily CYP2C19 and CYP3A4.
Excretion: Primarily via urine and feces.
Half Life: Approximately 1-2 hours; pharmacodynamic effect lasts longer.
Contraindications
- Hypersensitivity to dexlansoprazole or other PPIs.
Precautions
- Long-term use may increase risk of osteoporosis-related fractures, hypomagnesemia, and Clostridium difficile-associated diarrhea. Caution in patients with liver disease.
Adverse Reactions - Common
- Diarrhea (Common)
- Nausea (Common)
- Abdominal pain (Common)
Adverse Reactions - Serious
- Clostridium difficile-associated diarrhea (Serious but rare)
- Hypomagnesemia (Serious but rare)
- Severe allergic reactions (Rare)
Drug-Drug Interactions
- Clopidogrel (may reduce antiplatelet effect)
- Ketoconazole and itraconazole (may decrease absorption of PPIs)
- Methotrexate (may increase plasma levels)
Drug-Food Interactions
- No significant food interactions
Drug-Herb Interactions
- Potential interactions with St. John's Wort affecting metabolism.
Nursing Implications
Assessment: Monitor for relief of GERD symptoms, check magnesium levels in long-term therapy.
Diagnoses:
- Impaired gastrointestinal function related to acid suppression.
Implementation: Administer before meals, monitor for adverse effects.
Evaluation: Assess symptom improvement and adverse effects regularly.
Patient/Family Teaching
- Take medication exactly as prescribed, usually before meals.
- Report persistent diarrhea or signs of magnesium deficiency.
- Avoid crushing the capsule if not instructed, or take as directed.
Special Considerations
Black Box Warnings:
- Long-term use may increase risk of osteoporosis-related fractures.
- Risk of Clostridium difficile-associated diarrhea.
Genetic Factors: CYP2C19 polymorphisms can affect drug metabolism.
Lab Test Interference: Potential to interfere with urine steroidal metabolite testing.
Overdose Management
Signs/Symptoms: Nausea, vertigo, increased sweating, fatigue.
Treatment: Supportive care, activated charcoal if recent ingestion, and symptomatic management.
Storage and Handling
Storage: Store at room temperature, away from moisture and heat.
Stability: Stable for the duration of storage.