dexlansoprazole
Brand: Dexilant
Prototype: omeprazole
Drug Class: proton pump inhibitor
Drug Family: GI agent
Subclass: R-enantiomer PPI with dual delayed-release
Organ Systems: gastrointestinal
Mechanism of Action
R-enantiomer of lansoprazole that irreversibly inhibits gastric H+/K+-ATPase. Unique dual-release formulation produces two plasma concentration peaks, extending acid suppression.
H+/K+-ATPase (proton pump)
Indications
- GERD
- erosive esophagitis (healing and maintenance)
- non-erosive GERD
Contraindications
- hypersensitivity to PPIs
- concurrent rilpivirine use
Adverse Effects
Common
- diarrhea
- abdominal pain
- nausea
- flatulence
Serious
- Clostridium difficile-associated diarrhea
- hypomagnesemia
- acute interstitial nephritis
- bone fractures (long-term)
Pharmacokinetics (ADME)
| Absorption | dual delayed-release capsule yields two Tmax peaks (~1–2 h and 4–5 h); can be taken without regard to food |
| Distribution | 96–99% protein bound |
| Metabolism | hepatic via CYP2C19 (primary) and CYP3A4 |
| Excretion | renal and fecal |
| Half-life | 1–2 hours |
| Onset | 1–2 hours |
| Peak | dual peak at 1–2 h and 4–5 h |
| Duration | 24 hours |
| Protein Binding | 96–99% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| atazanavir | reduced absorption at increased gastric pH | major |
| methotrexate | PPI class effect on renal methotrexate clearance | major |
| clopidogrel | CYP2C19 inhibition reduces active metabolite of clopidogrel | moderate |
Nursing Considerations
- Unique advantage: capsule may be taken without regard to meals, improving patient adherence.
- Capsules may be opened and granules sprinkled on applesauce for patients unable to swallow whole; do not crush granules.
- Monitor serum magnesium in patients on long-term therapy or those also taking digoxin or diuretics.
- Educate patient that this formulation has two release phases to provide longer acid control throughout the day.
Clinical Pearls
- The dual delayed-release technology delivers two separate absorption peaks, maintaining elevated gastric pH for a longer duration than standard PPIs.
- Can be taken without regard to food, which is a practical advantage over other PPIs that require pre-meal dosing.
Safety Profile
Pregnancy generally-safe
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
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