What is the recommended dosage and use of Dexilant (dexlansoprazole) for treating gastroesophageal reflux disease (GERD) and erosive esophagitis?

Dexlansoprazole (Dexilant) Dosage and Use for GERD and Erosive Esophagitis

For treating gastroesophageal reflux disease (GERD) and erosive esophagitis, dexlansoprazole should be dosed at 60 mg once daily for healing erosive esophagitis for up to 8 weeks, followed by 30 mg once daily for maintenance therapy. 1

Recommended Dosing by Indication

Healing of Erosive Esophagitis

• Dosage: 60 mg once daily
• Duration: Up to 8 weeks
• Population: Patients 12 years of age and older

Maintenance of Healed Erosive Esophagitis

• Dosage: 30 mg once daily
• Duration: Up to 6 months in adults; up to 16 weeks in patients 12-17 years
• Efficacy: Significantly more effective than placebo in maintaining healing 2

Symptomatic Non-Erosive GERD

• Dosage: 30 mg once daily
• Duration: 4 weeks
• Efficacy: Effectively improves both heartburn and regurgitation symptoms 3

Administration Guidelines

• Can be taken without regard to food (unique advantage over some other PPIs)
• Swallow capsule whole; do not chew
• For patients with difficulty swallowing:
  • Can open capsule and sprinkle intact granules on applesauce
  • Can administer with water via oral syringe
  • Can administer via nasogastric tube (≥16 French)

Special Populations

Hepatic Impairment

• Moderate impairment (Child-Pugh Class B): Reduce dose to 30 mg once daily
• Severe impairment (Child-Pugh Class C): Not recommended 1

Clinical Efficacy

Dexlansoprazole demonstrates excellent efficacy in treating GERD:

• Healing rates: ≥92% of patients with all grades of erosive esophagitis achieved complete healing with dexlansoprazole 60 mg once daily 2, 4
• Symptom relief: Significantly greater improvements in both heartburn and regurgitation compared to placebo 3
• Maintenance therapy: Dexlansoprazole 30 mg once daily is significantly more effective than placebo in maintaining healing of erosive esophagitis 2
• On-demand therapy: Patients using dexlansoprazole experienced fewer days with reflux symptoms compared to esomeprazole in a 24-week study 5

Advantages of Dexlansoprazole

1. Modified release formulation: Dual delayed-release delivery system extends drug exposure and prolongs pH control 4
2. Dosing flexibility: Can be taken without regard to meals or time of day 6
3. Once-daily dosing: May replace twice-daily dosing of other agents 6
4. Effective for nocturnal GERD: Particularly helpful for patients with nighttime symptoms 6

Long-term Management Considerations

For patients requiring long-term PPI therapy:

• Titrate to lowest effective dose based on symptom control 7
• Consider on-demand therapy for non-erosive GERD patients 7
• Continuous daily therapy is recommended for patients with history of erosive esophagitis 7

Common Pitfalls and Caveats

1. Erosive vs. Non-erosive GERD: On-demand therapy is reasonable for non-erosive GERD but not recommended for patients with history of erosive esophagitis 7

2. Missed doses: If a dose is missed, take as soon as possible. If next scheduled dose is due, skip the missed dose and take the next dose on time. Do not take two doses at once 1

3. Monitoring: While long-term PPI therapy is generally well-tolerated, be aware that the main risk of reducing/discontinuing therapy is increased symptom burden 7

4. Extraesophageal symptoms: For patients with suspected extraesophageal reflux symptoms (laryngitis, asthma) with concomitant typical GERD symptoms, consider twice-daily PPI dosing for 8-12 weeks 7

Dexlansoprazole is generally well tolerated in clinical trials of up to 12 months' duration and can significantly improve quality of life in patients with GERD 2, 6.