Nursing2024 Drug Handbook

lansoprazole 847

• Prolonged treatment (2 years or more) may cause vitamin B 12 malabsorption caused by hypochlorhydria or achlorhydria. Observe for clinical signs and symptoms consistent with vitamin B 12 deficiency. • Use oral solution cautiously in patients with phenylketonuria. • Prolonged PPI use beyond 1 year may in- crease risk of fundic gland polyps. Use the shortest duration of PPI therapy appropriate to the condition being treated. • Dialyzable drug: No. PREGNANCY-LACTATION-REPRODUCTION • There are no adequate studies during preg- nancy. Use during pregnancy only if clearly needed. • It isn’t known if drug appears in human milk. Evaluate risks and benefits of discon- tinuing breastfeeding or discontinuing drug. NURSING CONSIDERATIONS Alert: Monitor patient for signs and symp- toms of low magnesium level, such as ab- normal HR or rhythm, palpitations, mus- cle spasms, tremor, or seizures. In children, abnormal HR may present as fatigue, upset stomach, dizziness, and light-headedness. • New onset and exacerbation of existing cu- taneous lupus erythematosus and SLE have been reported in patients taking PPIs, includ- ing lansoprazole. Avoid administering PPIs for longer than medically indicated. Discon- tinue drug and refer patient to appropriate specialist for evaluation if indicated. Alert: May increase risk of CDAD. Evalu- ate for CDAD in patients who develop diar- rhea that doesn’t improve. • Patients with severe liver disease may need dosage adjustment, but don’t adjust dosage for older adults or patients with renal insufficiency. • Just because symptoms respond to therapy, gastric malignancy shouldn’t be ruled out. • Monitor patient for hypersensitivity reac- tions, including SCARs (SJS, TEN, DRESS syndrome, acute generalized exanthematous pustulosis). • Look alike–sound alike: Don’t confuse Pre- vacid with Pepcid, Prilosec, or Prevpac. PATIENT TEACHING • Teach patient safe drug administration. • Inform patient with phenylketonuria that ODTs contain 2.5 mg phenylalanine/15-mg tablet and 5.1 mg phenylalanine/30-mg tablet.

are intermediate or poor metabolizers of CYP2C19. Monitor tacrolimus level. Theophylline: May increase theophylline clearance. Adjust theophylline dosage when lansoprazole is started or stopped. Use to- gether cautiously. Warfarin: May increase bleeding time. Moni- tor INR and PT. Drug-herb. St. John’s wort: May increase risk of sun sensitivity. Advise patient to avoid excessive sunlight exposure. Drug-food. Any food: May decrease rate and extent of GI absorption. Advise patient to take before meals. EFFECTS ON LAB TEST RESULTS • May increase LFT values and creatinine, BUN, potassium, lipid, serum urea, gastrin, globulin, and LDH levels. • May increase or decrease cholesterol or electrolyte levels. • May decrease Hb level. • May increase or decrease WBC and platelet counts. • May cause abnormal RBC count. • May increase urinary albumin and glucose levels. • May cause urine crystals. • May cause positive fecal occult blood re- sult. • May cause false-positive results in diagnos- tic investigations for neuroendocrine tumors, urine screening tests for tetrahydrocannabi- nol, and gastrin secretion in response to se- cretin stimulation test. CONTRAINDICATIONS & CAUTIONS • Contraindicated in patients hypersensitive to drug or its components. Reactions may in- clude anaphylaxis, angioedema, acute inter- stitial nephritis, and urticaria. Alert: Prolonged use of PPIs or use with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuret- ics) may require magnesium supplementation and possible discontinuation of drug. Monitor magnesium levels before starting treatment and periodically thereafter. Alert: Drug may increase risk of hip, wrist, and spine fractures with long-term and multi- ple daily dose use. • Acute interstitial nephritis has been ob- served in patients taking PPIs and may occur at any point during therapy. Discontinue drug if condition develops.

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Canada

OTC Off-label use

Do not crush *Liquid contains alcohol

Genetic