What is the maximum dose of Proton Pump Inhibitor (PPI) Prevacid (Lansoprazole) for a 75-year-old lady on single daily Prevacid 30mg and Xarelto (Rivaroxaban) for a history of Factor V Leiden?

From the Guidelines

The maximum recommended dose of Prevacid (lansoprazole) for a 75-year-old lady taking Xarelto (rivaroxaban) with Factor V Leiden history is 30 mg once daily, which she is already taking, and no dose increase is recommended for this patient.

Key Considerations

• For elderly patients (>65 years), no dosage adjustment is typically needed for lansoprazole, but caution is warranted due to potential age-related decreases in hepatic, renal, or cardiac function 1.
• The standard maximum dose of 30 mg daily is appropriate for most indications including gastroesophageal reflux disease (GERD), erosive esophagitis, and duodenal ulcers.
• While higher doses (up to 60 mg daily) may occasionally be used for certain conditions like Zollinger-Ellison syndrome, this would be uncommon and require specialist supervision.
• The concurrent use of Xarelto does not necessitate lansoprazole dose adjustment, though monitoring for potential decreased absorption of rivaroxaban is prudent as PPIs can slightly reduce its bioavailability.

Important Interactions and Precautions

• According to the provided evidence, the dose equivalence among proton pump inhibitors is outlined in Table 5, which suggests that lansoprazole 30 mg once daily is equivalent to omeprazole 20 mg once daily 1.
• For this patient with Factor V Leiden, maintaining effective anticoagulation is critical, so any medication changes should be approached cautiously with appropriate follow-up.
• It is also important to note that the solubility of certain medications can decrease as pH increases, which may affect their concentrations when co-administered with PPIs like lansoprazole, although this specific interaction is not detailed for rivaroxaban in the provided evidence.

From the Research

Maximum PPI Dose for a 75-year-old Lady

• The maximum dose of Proton Pump Inhibitor (PPI) Prevacid (Lansoprazole) is not explicitly stated in the provided studies for a 75-year-old lady on single daily Prevacid 30mg and Xarelto (Rivaroxaban) for a history of Factor V Leiden.
• However, according to the study 2, Lansoprazole is approved for various treatments, including the short-term treatment of erosive reflux oesophagitis, active gastric ulcer, and active duodenal ulcer, with a daily dose of 30 mg.
• The study 3 evaluated the use of pantoprazole 40 mg daily in patients receiving rivaroxaban and/or aspirin, but it does not provide information on the maximum dose of lansoprazole.
• The study 4 reviewed the risk of gastrointestinal bleeding associated with direct oral anticoagulants (DOACs), including rivaroxaban, but it does not provide information on the maximum dose of PPIs.
• The study 5 assessed the pharmacokinetic and pharmacodynamic profile of rivaroxaban, but it does not provide information on the maximum dose of PPIs.
• The study 6 examined the relationship between Factor V Leiden mutation and inflammatory bowel disease, but it does not provide information on the maximum dose of PPIs.

Considerations for PPI Dosing

• The dosing of PPIs, such as lansoprazole, should be individualized based on the patient's specific condition and response to treatment 2.
• The use of PPIs in patients receiving anticoagulants, such as rivaroxaban, should be carefully considered, as it may increase the risk of gastrointestinal bleeding 3, 4.
• The patient's age, medical history, and concomitant medications should be taken into account when determining the optimal dose of PPIs.

PPI Dosing in Patients with Factor V Leiden

• There is limited information available on the specific dosing of PPIs in patients with Factor V Leiden 6.
• However, the study 6 suggests that patients with Factor V Leiden may be at increased risk of thromboembolism, and the use of anticoagulants, such as rivaroxaban, may be necessary to reduce this risk.