Lansoprazole (Prevacid): Indications and Dosing
Lansoprazole is FDA-approved for treating gastroesophageal reflux disease (GERD) and acid-related disorders, with pediatric dosing of 0.7-3 mg/kg/day for children ≥1 year and 15-30 mg daily for adults, administered once daily before eating in the morning. 1
Adult Dosing
GERD and Erosive Esophagitis
- Standard dose: 30 mg once daily is the optimal dose for reflux esophagitis, producing 81.3% healing at 4 weeks and 95.4% at 8 weeks 2
- Mild GERD: 15 mg once daily is effective for frequent heartburn, providing 61.3% nighttime heartburn-free nights over 14 days 3
- Refractory cases: 30 mg twice daily produces significantly greater acid suppression (mean 24-hour pH 5.07) compared to once-daily dosing (pH 4.47) 4
Over-the-Counter Use
- 15 mg once daily for 14 days for frequent heartburn (≥2 days/week) 1
- Take before eating in the morning
- May repeat 14-day course every 4 months if needed
- Full effect may take 1-4 days
Chronic Cough Due to GERD
- 30 mg twice daily for at least 12 weeks when GERD is suspected as the cause of chronic cough 5
NSAID-Associated Ulcer Prevention
- 15 mg once daily is effective for secondary prevention in patients requiring long-term low-dose aspirin, reducing ulcer recurrence to 3.7% at 1 year versus 31.7% with gefarnate 6
Pediatric Dosing
Children ≥1 Year
FDA-approved dosing: 0.7-3 mg/kg/day once daily 7
- Studies demonstrate effective range of 0.7-3.0 mg/kg/day for GERD symptoms and erosive esophagitis healing 7
- Multiple formulations available:
- Capsule contents sprinkled on soft foods or juices
- Strawberry-flavored orally disintegrating tablets
- Administration via nasogastric tube (≥8 French) 7
Infants <1 Year
Use with extreme caution; PPIs not superior to placebo for irritability in infants 7
- If used: 1.0-2.0 mg/kg/day based on pharmacodynamic studies 8
- Critical caveat: Placebo-controlled trials show no superiority over placebo for reducing irritability in infants 7
- Increased risk of lower respiratory tract infections, gastroenteritis, candidemia, and necrotizing enterocolitis in preterm infants 7
- Consider twice-daily dosing (approximately 7.5 mg BID) for faster symptom response compared to 15 mg once daily 9
Key Clinical Considerations
Advantages Over H2-Receptor Antagonists
- PPIs are superior to H2RAs for symptom relief and healing erosive esophagitis 7
- H2RAs develop tachyphylaxis within 6 weeks, limiting long-term use 7
Safety Profile
- Generally well tolerated with adverse events <5% in short-term use (diarrhea, headache, nausea, abdominal pain) 10
- Long-term use (>2.5 years) associated with enterochromaffin cell hyperplasia in up to 50% of children 7
- Acid suppression increases risk of community-acquired pneumonia and gastroenteritis 7
Administration Pearls
- Swallow capsules whole; do not crush or chew 1
- For those unable to swallow: sprinkle granules on soft foods (applesauce) or mix with fruit juice—no effect on bioavailability 11
- Take before first meal of the day for optimal effect
Common Pitfall
Avoid overprescribing in infants with uncomplicated reflux. The dramatic increase in PPI prescriptions for infants is concerning given lack of efficacy for irritability and increased infection risk 7. Reserve for documented erosive esophagitis or severe GERD refractory to conservative measures.