Lansoprazole Dosing in Pediatric Patients
Weight-Based Dosing for Children 1-11 Years
For children aged 1-11 years with GERD, lansoprazole should be dosed at 15 mg once daily for those weighing ≤30 kg and 30 mg once daily for those weighing >30 kg. 1
- This weight-based approach demonstrated a 76% symptom improvement rate and 100% healing of erosive esophagitis by 12 weeks in clinical trials 1, 2
- The dose may be increased up to 30 mg twice daily (maximum 60 mg/day) after 2 or more weeks if symptoms persist 1, 3
- Treatment duration is typically 8-12 weeks 1, 2
Adolescent Dosing (12-17 Years)
For adolescents aged 12-17 years, use 15 mg once daily for non-erosive GERD or 30 mg once daily for erosive esophagitis. 1
- This regimen achieved 95.5% healing rates for erosive esophagitis at 8 weeks 1, 2
- Symptom frequency and severity were reduced by 63% and 69%, respectively 1, 2
Infants and Neonates (<1 Year)
Lansoprazole is NOT recommended for infants under 1 year of age, as it was not shown to be effective in this population. 1
- A placebo-controlled trial in 162 infants (1 month to <12 months) showed no difference between lansoprazole and placebo (54% response rate in both groups) 1
- If used off-label in neonates ≤10 weeks: 0.5-1.0 mg/kg/day 1, 4
- If used off-label in infants >10 weeks: 1.0-1.5 mg/kg/day 1, 4
Important caveat: Infants ≤10 weeks have 2-5 times higher drug exposure than older infants, requiring lower doses to avoid excessive plasma concentrations 4
Administration Guidelines
Lansoprazole should be administered 30 minutes before meals for optimal acid suppression. 5
- For children unable to swallow capsules, the delayed-release capsule can be opened and pellets mixed with applesauce 6
- Do not crush or chew the enteric-coated pellets, as lansoprazole is acid-labile 1
Comparative Context with Other PPIs
While the question specifically asks about lansoprazole, it's worth noting that omeprazole is dosed at 10 mg once daily for children 10-<20 kg and 20 mg once daily for children ≥20 kg 6, and lansoprazole 30 mg once daily is equivalent to omeprazole 20 mg once daily 7. Both PPIs demonstrate superior efficacy compared to H2-receptor antagonists for pediatric GERD 6, 5.
Safety Considerations
Lansoprazole is generally well-tolerated in children, with the most common adverse effects being constipation (5%) and headache (3%). 1, 2, 3
- Median fasting serum gastrin levels increased 89% from baseline but remained within normal range (25-111 pg/mL) 1, 3
- Do not exceed recommended doses and duration in pediatric patients, as juvenile animal studies showed heart valve thickening and bone changes at high doses 1
- Long-term use (>2.5 years) may be associated with enterochromaffin cell hyperplasia in up to 50% of children 6
Treatment Duration Limits
Treatment should not exceed 8-12 weeks without reassessment, as safety and effectiveness beyond this duration have not been established in pediatric patients. 1