What are the recommended adult and pediatric dosing regimens of lansoprazole for heartburn, gastro‑oesophageal reflux disease, ulcer disease, erosive oesophagitis, Helicobacter pylori eradication, and Zollinger‑Ellison syndrome?

Lansoprazole Dosing Recommendations

For adults, lansoprazole 30 mg once daily is the standard dose for most acid-related disorders including duodenal ulcer, gastric ulcer, GERD, and erosive esophagitis, while pediatric dosing is weight-based at 15 mg daily for children ≤30 kg and 30 mg daily for those >30 kg. 1

Adult Dosing by Indication

Duodenal and Gastric Ulcers

• Active duodenal ulcer: 15 mg once daily for 4 weeks 1
• Active benign gastric ulcer: 30 mg once daily for up to 8 weeks 1
• Maintenance of healed duodenal ulcer: 15 mg once daily for up to 12 months 1
• NSAID-associated gastric ulcer (healing): 30 mg once daily for 8 weeks 1
• NSAID-associated gastric ulcer (risk reduction): 15 mg once daily for up to 12 weeks in patients with documented ulcer history 1

Gastroesophageal Reflux Disease

• Symptomatic GERD (adults): 15 mg once daily for up to 8 weeks 1
• Erosive esophagitis (healing): 30 mg once daily for up to 8 weeks; if not healed, may extend for additional 8 weeks 1
• Maintenance of healed erosive esophagitis: 15 mg once daily for up to 12 months 1

Helicobacter pylori Eradication

Triple therapy (lansoprazole/amoxicillin/clarithromycin):

• Lansoprazole 30 mg twice daily + amoxicillin 1000 mg twice daily + clarithromycin 500 mg twice daily for 14 days 2, 1

Dual therapy (lansoprazole/amoxicillin):

• Lansoprazole 30 mg three times daily + amoxicillin 1000 mg three times daily for 14 days 1
• This regimen is reserved for patients allergic to or intolerant of clarithromycin, or when clarithromycin resistance is known or suspected 1

Zollinger-Ellison Syndrome and Hypersecretory Conditions

• Initial dose: 60 mg once daily 1
• Dose adjustment: Titrate based on individual patient needs; doses up to 90 mg twice daily (180 mg/day total) have been used 1, 3
• Duration: Long-term treatment as needed to control basal acid output 1

Pediatric Dosing

Ages 12-17 Years

• Symptomatic GERD: 15 mg once daily for up to 8 weeks 1
• Erosive esophagitis: 30 mg once daily for up to 8 weeks 1

Ages 1-11 Years

• Weight ≤30 kg: 15 mg once daily for up to 12 weeks 1
• Weight >30 kg: 30 mg once daily for up to 12 weeks 1
• These doses apply to both symptomatic GERD and erosive esophagitis 1

Infants <1 Year of Age

Lansoprazole should NOT be used routinely in infants under 1 year with GERD. 4 A multicenter, double-blind, placebo-controlled trial of 162 infants aged 1-12 months demonstrated no difference in efficacy between lansoprazole and placebo for symptom improvement, while serious adverse events—particularly lower respiratory tract infections—occurred significantly more frequently with lansoprazole (OR 6.56; 95% CI 1.18-26.25) 4, 1

First-line management for infant GERD includes: 4

• Smaller, more frequent feedings to reduce gastric distension
• Thickening formula (if formula-fed; avoid in preterm infants due to necrotizing enterocolitis risk)
• Maternal elimination diet (exclude milk and egg for 2-4 weeks if breastfeeding)
• Trial of extensively hydrolyzed or amino acid-based formula if formula-fed
• Upright positioning when awake and supervised

Critical Dosing Considerations

Timing of Administration

• Administer 30 minutes before meals for optimal acid suppression 5
• For patients unable to swallow capsules, pellets can be mixed with applesauce 6, 5

Duration Limits

• Do not exceed recommended treatment duration in pediatric patients 1
• Controlled studies in adults for maintenance therapy do not extend beyond 12 months 1
• In pediatric patients (1-11 years), lansoprazole was not administered beyond 12 weeks in clinical studies 1

Comparative Efficacy

• Lansoprazole 30 mg daily produces higher healing rates than H2-receptor antagonists (ranitidine, famotidine) for duodenal ulcers, gastric ulcers, and reflux esophagitis 7, 8, 3
• Lansoprazole 30 mg daily provides faster epigastric pain relief than omeprazole 20 mg daily after 1 week, though healing rates at 4 and 8 weeks are equivalent 7, 8
• For H. pylori eradication, lansoprazole-based triple therapy produces similar eradication rates to omeprazole-based regimens 7, 8

Common Pitfalls to Avoid

Do not prescribe PPIs for uncomplicated infant reflux or "fussiness" without clear GERD symptoms. This represents overuse without proven benefit and exposes infants to unnecessary infection risk (6.56-fold increased odds of lower respiratory tract infections) 4

Do not continue PPI therapy beyond 4-8 weeks in infants without specialist consultation and re-evaluation of diagnosis. 4

Do not use sequential or hybrid non-bismuth quadruple therapy for H. pylori eradication as first-line treatment. Concomitant therapy (all four drugs simultaneously for 14 days) is the preferred non-bismuth quadruple regimen 2

Avoid re-using clarithromycin or levofloxacin after treatment failure. Antibiotic resistance is common after exposure to these agents 2

Do not extrapolate adult or term infant dosing to premature infants. Immature renal function increases risk of drug accumulation 6

Special Populations

Stress Ulcer Prophylaxis in Critically Ill Adults

• Low-dose PPI therapy is defined as ≤30 mg lansoprazole daily 2
• Discontinue stress ulcer prophylaxis when critical illness resolves or risk factors are no longer present 2

Long-Term Safety Monitoring

• Long-term use (>2.5 years) may cause enterochromaffin cell hyperplasia in up to 50% of pediatric patients 6, 5
• Common adverse effects include headache, diarrhea, dizziness, and nausea 3, 9
• Acid suppression in infants is associated with increased risk of lower respiratory tract infections 6