From the Guidelines
Dexlansoprazole should be used with caution in patients with a history of severe erosive esophagitis or GERD-related complications, and its use should be weighed against the potential benefits and harms, as recommended by the 2022 AGA clinical practice update on de-prescribing of proton pump inhibitors 1. When considering the use of dexlansoprazole, it is essential to evaluate the patient's individual risk factors and medical history. For patients with a known history of more severe erosive esophagitis (Los Angeles Classification grade C/D) or those with GERD-related complications, dexlansoprazole should generally not be considered for discontinuation unless the benefits and harms have been weighed and discussed with the patient. Some key points to consider when using dexlansoprazole include:
- The typical dosage is 30 mg once daily for up to 4 weeks for symptomatic non-erosive GERD, and 60 mg once daily for up to 8 weeks for healing erosive esophagitis, with a maintenance dose of 30 mg once daily for up to 6 months.
- Dexlansoprazole works by reducing stomach acid production by blocking the hydrogen-potassium adenosine triphosphatase enzyme system in the gastric parietal cells.
- Common side effects include diarrhea, abdominal pain, nausea, and headache.
- Long-term use may increase risks of vitamin B12 deficiency, bone fractures, and Clostridium difficile infections. It is also important to note that dexlansoprazole, like other PPIs, may interact with other medications, such as clopidogrel, and affect their efficacy, as reported in the 2009 ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction 1. However, the most recent and highest quality study on this topic is the 2022 AGA clinical practice update on de-prescribing of proton pump inhibitors 1, which provides the most up-to-date guidance on the use of dexlansoprazole.
From the FDA Drug Label
DEXLANSOPRAZOLE delayed-release capsules, for oral use Initial U. S. Approval: 1995 (lansoprazole) INDICATIONS AND USAGE Dexlansoprazole is a proton pump inhibitor (PPI) indicated in patients 12 years of age and older for: Healing of all grades of erosive esophagitis (EE). (1. 1) Maintenance of healed EE and relief of heartburn. (1.2) Treatment of symptomatic non-erosive gastroesophageal reflux disease (GERD). (1. 3)
The indications for Dexlansoprazole are:
- Healing of erosive esophagitis (EE)
- Maintenance of healed EE and relief of heartburn
- Treatment of symptomatic non-erosive gastroesophageal reflux disease (GERD) 2
From the Research
Overview of Dexlansoprazole
- Dexlansoprazole is a proton pump inhibitor (PPI) used for the treatment of gastroesophageal reflux disease (GERD) and erosive esophagitis (EE) 3, 4, 5, 6, 7.
- It has a unique dual delayed-release formulation, which releases the drug at two points in time, providing prolonged inhibition of gastric acid secretion 5, 6, 7.
Efficacy of Dexlansoprazole
- Studies have shown that dexlansoprazole is effective in healing EE and maintaining healed EE, with healing rates of 88-95% 3, 4, 5.
- Dexlansoprazole has also been shown to be effective in relieving symptoms of GERD, including heartburn, with symptom relief rates comparable to other PPIs 3, 6, 7.
- A study comparing dexlansoprazole to esomeprazole found that dexlansoprazole had fewer days with reflux symptoms and better persistent improvement in GERDQ score during the on-demand period 3.
Safety of Dexlansoprazole
- Dexlansoprazole has been shown to be safe and well-tolerated, with common adverse effects including diarrhea, abdominal pain, nausea, upper respiratory infection, vomiting, and flatulence 4, 6.
- A study in adolescents found that dexlansoprazole was safe and efficacious for healing EE and maintaining healed EE, with a similar safety profile to adults 4.
Comparison to Other PPIs
- Dexlansoprazole has been compared to lansoprazole and esomeprazole in several studies, with results showing that dexlansoprazole is at least as effective as these other PPIs in healing EE and relieving symptoms of GERD 3, 5, 6.
- Dexlansoprazole has a unique dual delayed-release formulation, which may provide advantages over other PPIs in terms of prolonged inhibition of gastric acid secretion 5, 6, 7.