What is the recommended dose of Lansoprazole (Proton Pump Inhibitor) for a patient, considering factors such as age, medical history, and current medications?

Lansoprazole Dosing Recommendations

For adults, lansoprazole 30 mg once daily is the standard dose for most acid-related disorders, while pediatric dosing is weight-based: 15 mg daily for children ≤30 kg and 30 mg daily for children >30 kg, both administered 30 minutes before meals. 1

Adult Dosing

Standard Indications

• Duodenal ulcer: 15 mg once daily is as effective as 30 mg or 60 mg, with 4-week healing rates of 89.4%, 91.7%, and 89.9% respectively 2
• Gastroesophageal reflux disease (GERD): 30 mg once daily is the typical dose, superior to ranitidine for symptom relief and healing 3
• Erosive esophagitis: 30 mg once daily, with maintenance therapy at the same dose 3
• Helicobacter pylori eradication: 30 mg twice daily as part of combination therapy 4, 3

High-Dose Scenarios

• Zollinger-Ellison syndrome: 60-180 mg daily, with effective control maintained for ≥4 years 3
• Dosages may be reduced once healing and symptom relief are achieved 3

PPI Selection Considerations

When choosing between PPIs, higher-potency agents are preferred, particularly with amoxicillin-containing regimens 4:

• Lansoprazole 30 mg is equivalent to omeprazole 20 mg 5
• Esomeprazole 20-40 mg twice daily or rabeprazole 20-40 mg twice daily are recommended over other PPIs when cost is equivalent 4
• Pantoprazole should be avoided due to lower relative potency 4

Pediatric Dosing

Age 1-11 Years

• ≤30 kg: 15 mg once daily 1
• >30 kg: 30 mg once daily 1
• Dose may be increased up to 30 mg twice daily if symptoms persist after ≥2 weeks 1
• Treatment duration: 8-12 weeks for symptomatic GERD and erosive esophagitis 1
• Do not exceed recommended dose and duration 1

Age 12-17 Years

• Non-erosive GERD: 15 mg once daily for 8 weeks 1
• Erosive esophagitis: 30 mg once daily for 8-12 weeks 1

Infants <1 Year

• Lansoprazole is NOT effective and NOT recommended in infants 1 month to <12 months of age 1
• A controlled trial showed no difference between lansoprazole and placebo (54% response in both groups) 1
• Neonates have 2-fold higher drug exposure than adults, but efficacy remains unproven 1

Administration Guidelines

Timing and Method

• Administer 30 minutes before meals for optimal acid suppression 5, 1
• For children unable to swallow capsules, open the delayed-release capsule and mix pellets with applesauce 5

Special Populations

• Elderly (≥65 years): No dose adjustment required based on age alone 3
• Renal impairment: No specific dose adjustment needed 1
• Hepatic impairment: Consider dose reduction in severe cases (not explicitly detailed in provided evidence)

Safety Considerations

Short-Term Use

• Most common adverse effects: headache (3%), constipation (5%), diarrhea, dizziness, nausea 1, 3
• Well tolerated across all age groups 3, 6

Long-Term Use

• Pediatric concern: Long-term use >2.5 years may cause enterochromaffin cell hyperplasia in up to 50% of children 5
• Adult data: Well tolerated for ≤4 years in Zollinger-Ellison syndrome and reflux disease 3
• Increases in serum gastrin levels (89% increase from baseline) are expected and similar to adult responses 1

Critical Pitfall

Never use lansoprazole in infants <1 year of age for symptomatic GERD—it has been proven ineffective in controlled trials and only increases unnecessary drug exposure 1

Clinical Context for NSAID Users

When lansoprazole is used for gastroprotection in patients on chronic NSAIDs 4:

• Age <65, no GI history, not on aspirin/steroids/warfarin: PPI use is inappropriate 4
• Age <65, on aspirin or with prior GI event: NSAID + PPI is appropriate 4
• Age ≥65 with complicated GI event: NSAID + PPI is appropriate regardless of aspirin use 4