Lansoprazole

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Abstract
Lansoprazole is an inhibitor of gastric acid secretion and also exhibits antibacterial activity against Helicobacter pylori in vitro. Current therapy for peptic ulcer disease focuses on the eradication of H. pylori infection with maintenance therapy indicated in those patients who are not cured of H. pylori and those with ulcers resistant to healing. Lansoprazole 30mg combined with amoxicillin 1g, clarithromycin 250 or 500mg, or metronidazole 400mg twice daily was associated with eradication rates ranging from 71 to 94%, and ulcer healing rates were generally >80% in well designed studies. In addition, it was as effective as omeprazole- or rabeprazole-based regimens which included these antimicrobial agents. Maintenance therapy with lansoprazole 30 mg/day was significantly more effective than either placebo or ranitidine in preventing ulcer relapse. Importantly, preliminary data suggest that lansoprazole-based eradication therapy is effective in children and the elderly. In the short-term treatment of patients with gastro-oesophageal reflux disease (GORD), lansoprazole 15, 30 or 60 mg/day was significantly more effective than placebo, ranitidine 300 mg/day or cisapride 40 mg/day and similar in efficacy to pantoprazole 40 mg/day in terms of healing of oesophagitis. Lansoprazole 30 mg/day, omeprazole 20 mg/day and pantoprazole 40 mg/day all provided similar symptom relief in these patients. In patients with healed oesophagitis, 12-month maintenance therapy with lansoprazole 15 or 30 mg/day prevented recurrence and was similar to or more effective than omeprazole 10 or 20 mg/day. Available data in patients with NSAID-related disorders or acid-related dyspepsia suggest that lansoprazole is effective in these patients in terms of the prevention of NSAID-related gastrointestinal complications, ulcer healing and symptom relief. Meta-analytic data and postmarketing surveillance in >30 000 patients indicate that lansoprazole is well tolerated both as monotherapy and in combination with antimicrobial agents. After lansoprazole monotherapy commonly reported adverse events included dose-dependent diarrhoea, nausea/vomiting, headache and abdominal pain. After short-term treatment in patients with peptic ulcer, GORD, dyspepsia and gastritis the incidence of adverse events associated with lansoprazole was generally ≤5%. Similar adverse events were seen in long-term trials, although the incidence was generally higher (≤10%). When lansoprazole was administered in combination with amoxicillin, clarithromycin or metronidazole adverse events included diarrhoea, headache and taste disturbance. In conclusion, lansoprazole-based triple therapy is an effective treatment option for the eradication of H. pylori infection in patients with peptic ulcer disease. Preliminary data suggest it may have an important role in the management of this infection in children and the elderly. In the short-term management of GORD, lansoprazole monotherapy offers a more effective alternative to histamine H2-receptor antagonists and initial data indicate that it is an effective short-term treatment option in children and adolescents. In adults lansoprazole maintenance therapy is also an established treatment option for the long-term management of this chronic disease. Lansoprazole has a role in the treatment and prevention of NSAID-related ulcers and the treatment of acid-related dyspepsia; however, further studies are needed to confirm its place in these indications. Lansoprazole has emerged as a useful and well tolerated treatment option in the management of acid-related disorders. Lansoprazole inhibits gastric acid secretion via selective inhibition of the proton pump of the gastric parietal cell. Its active sulphenamide metabolites inactivate H+, K+-ATPase which catalyses the final step in the gastric acid secretion pathway. Data from healthy volunteers showed that lansoprazole 30mg provided faster control of intragastric acidity than pantoprazole 40mg, rabeprazole 20mg and omeprazole 20 and 40mg administered once daily. However, in terms of mean intragastric 24-hour pH, lansoprazole 30mg was equivalent to omeprazole 40mg and better than pantoprazole 40mg and omeprazole 20mg. The duration of increased intragastric pH above pH 3 or 4 was significantly longer for lansoprazole 30mg versus pantoprazole 40mg or omeprazole 20mg; lansoprazole 15 mg/day and omeprazole 20 mg/day were equivalent. Lansoprazole 30 mg/day significantly increased mean 24-hour gastric pH values compared with ranitidine 600 mg/day in a well designed crossover 5-day study. In addition, the percentage of time for which intragastric pH was maintained above 4 was significantly greater for lansoprazole than for ranitidine. In a well designed crossover study in patients with gastro-oesophageal reflux disease (GORD), lansoprazole 30 mg/day and omeprazole 20 mg/day increased median daytime and night-time intragastric pH to a similar extent. Although, on day 5 of treatment the total time spent with a mean oesophageal pH value of 87% were observed. A higher eradication rate was observed with a two-week triple lansoprazole-based regimen than a one-week regimen in a subgroup of 71 patients from a larger study but this difference was not significant. One-week triple therapy regimens with various combinations of lansoprazole 30mg or omeprazole 20mg plus amoxicillin 1g and/or clarithromycin 250 or 500mg and/or metronidazole 400mg administered twice daily generally show ulcer healing rates of >80%. Preliminary results obtained in a subgroup of patients indicate a greater incidence of ulcer healing was observed with a two-week lansoprazole-based triple therapy regimen although this was not significantly different compared with a one-week regimen. There are few available data on the efficacy of eradication regimens in elderly patients and in children. Lansoprazole-based triple therapy regimens...