Dexlansoprazole is an enantiomer of lansoprazole and a proton pump inhibitor (PPI) that suppresses gastric acid secretion by specific inhibition of the H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cell. The 60mg strength is a modified-release formulation designed for delayed and prolonged action, making it particularly effective for conditions like erosive esophagitis and non-erosive reflux disease (NERD). It is the first PPI with a Dual Delayed Release (DDR) technology, providing two distinct releases of the drug.
Adult: Healing of EE: 60mg once daily for up to 8 weeks. Maintenance of EE: 30mg once daily. Symptomatic GERD (without esophagitis): 30mg once daily for 4 weeks.
Note: Swallow the capsule whole with a glass of water. Do NOT crush, chew, or split the capsule. Can be taken without regard to food. For patients with swallowing difficulties, the capsule can be opened and the granules sprinkled on one tablespoon of applesauce, swallowed immediately without chewing, and followed with water. Do not store the mixture.
Dexlansoprazole is a prodrug that is activated in the acidic environment of the parietal cell canaliculus. It is a selective and irreversible inhibitor of the H+/K+ ATPase enzyme (the proton pump), the final common pathway for gastric acid secretion. Its inhibition leads to a profound and long-lasting reduction in both basal and stimulated gastric acid secretion.
Pregnancy: Category B: Animal reproduction studies have shown no risk, but no adequate and well-controlled studies in pregnant women. Use only if clearly needed. PPIs are generally considered low risk for use in pregnancy if indicated.
Driving: Dexlansoprazole is unlikely to affect the ability to drive and use machines. However, dizziness has been reported rarely.
| Atazanavir | Significantly reduces atazanavir plasma concentration, leading to loss of virologic response. | Major |
| Nelfinavir | Reduces nelfinavir plasma concentration. | Major |
| Rilpivirine | Markedly decreases rilpivirine plasma concentration, increasing risk of resistance. | Contraindicated |
| Clopidogrel | Dexlansoprazole may reduce the antiplatelet effect of clopidogrel (a prodrug activated by CYP2C19). The clinical significance is debated but caution is advised. | Moderate |
| Methotrexate | May increase methotrexate serum levels, potentially leading to toxicity, especially with high-dose methotrexate. | Moderate |
| Warfarin | Potential for increased INR and risk of bleeding due to possible interference with metabolism. Monitor INR closely. | Moderate |
| Ketoconazole, Itraconazole, Posaconazole | Reduced absorption of these drugs due to increased gastric pH, leading to decreased efficacy. | Moderate |
| Digoxin | Increased bioavailability of digoxin due to elevated gastric pH. Monitor digoxin levels. | Moderate |
| Tacrolimus | May increase tacrolimus exposure, especially in CYP2C19 poor metabolizers. Monitor levels. | Moderate |