Names and pronunciation
(dex-lan-so-prey′zole) Dexilant
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Drug reference
(dex-lan-so-prey′zole) Dexilant
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Func. class.: Antiulcer, proton pump inhibitor
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Chem. class.: Benzimidazole
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ACTION: Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump inhib- itor because it blocks final step of acid production
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USES: Gastroesophageal reflux dis- ease (GERD), severe erosive esophagitis, heartburn
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children, proton-pump hypersensitivity, gastric cancer, hepatic disease, vitamin B12 deficiency, colitis
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SIDE EFFECTS CNS: Headache, dizziness, confusion, agitation, amnesia, depression, anxiety, seizures, insomnia, migraine CV: Chest pain, angina, bradycardia, pal- pitations, CVA, hypertension, MI EENT: Tinnitus GI: Diarrhea, abdominal pain, vomit- ing, nausea, constipation, flatulence, colitis, dysgeusia, CDAD HEMA: Anemia, neutropenia, thrombocy- topenia, pernicious anemia, thrombosis INTEG: Rash, urticaria, pruritus META: Gout MS: Arthralgia, mylagia RESP: Upper respiratory infections, cough, epistaxis, dyspnea, pneumonia SYST: Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
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INTERACTIONS Increase: dexlansoprazole effect— CYP2C19, 3A4 inhibitors (fluvoxaMINE, voriconazole) Decrease: dexlansoprazole absorption— sucralfate Decrease: absorption of ketoconazole, itraconazole, iron, delavirdine, ampicil- lin, calcium carbonate Drug/Herb Decrease: dexlansoprazole effect—St. John’s wort Drug/Lab Test Increase: LFTs, bilirubin, creatinine, glu- cose, lipids Decrease: platelets, magnesium
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DOSAGE AND ROUTES Erosive esophagitis • Adult: PO 60 mg daily for up to 8 wk; maintenance: PO 30 mg daily for up to 6 mo GERD • Adult: PO 30 mg daily × 4 wk Hepatic disease • Adult: PO (Child-Pugh B): max 30 mg/ day; Child-Pugh C
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Available forms: Delayed-release cap- sules 30, 60 mg
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Administer: • Swallow capsules whole; do not crush, chew capsules; capsules may be opened, contents sprinkled on food, use immedi- ately; do not chew contents of capsule; give without regard to food
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Assess: • CDAD (rare): diarrhea, abdominal cramps, fever; report to prescriber promptly • Hepatotoxicity (rare): hepatitis, jaundice; monitor hepatic studies (AST, ALT, alkaline phosphatate) if hepatic ad- verse reactions occur • Hypomagnesemia: usually 3 mo to 1 yr after beginning therapy; monitor magne- sium level, assess for irregular heartbeats, muscle spasms; in children, fatigue, upset stomach, dizziness; magnesium supplement may be used • Anaphylaxis (rare), serious skin dis- D orders: require emergency intervention • Beers: avoid scheduled use >8 wk in older adults who are at high risk for erosive esophagitis, pathologic hyperse- cretory conditions • Pregnancy/breastfeeding: no well- controlled studies; use only if benefit out- weighs fetal risk; avoid breastfeeding, ex- cretion is unknown
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Evaluate: • Therapeutic response: absence of epi- gastric pain, swelling, fullness; healing of erosive esophagitis
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • CDAD: to report to prescriber at once abdominal cramps, bloody diarrhea, fever • That diabetic patient should know that hypoglycemia may occur • To avoid hazardous activities; dizzi- ness may occur • To avoid alcohol, salicylates, ibupro- fen; may cause GI irritation • To report allergic reactions, symp- toms of low magnesium levels • To notify prescriber if pregnancy is planned or suspected; not to breastfeed • To swallow capsule whole, not to chew, crush; to report all products being used to prescriber
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PHARMACOKINETICS Absorption 57%-64%; half-life 1-2 hr; protein binding 96.1%-98.8%; extensively metabolized in liver by CYP2C19/ CYP3A4; excreted in urine, feces; clear- ance decreased in geriatric patients, renal/hepatic impairment; peak 4 hr
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• Adult: PO 60 mg daily for up to 8 wk; maintenance: PO 30 mg daily for up to 6 mo GERD
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• Adult: PO 30 mg daily × 4 wk Hepatic disease
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• Adult: PO (Child-Pugh B): max 30 mg/ day; Child-Pugh C
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