Lansoprazole An update of its place in the management of acid-related disorders

Lansoprazole is an inhibitor of gastric acid secretion and also exhibits an tibacterial activity against Helicobacter pylori in vitro. Current therapy for peptic ulcer disease focuses on the eradication of H. p ylori infection with maintenance therapy indicated in those patients who ar e not cured of H. pylori and those with ulcers resistant to healing. Lansop razole 30 mg combined with amoxicillin 1 g, clarithromycin 250 or 500 mg, o r metronidazole 400 mg twice daily was associated with eradication rates ra nging from 71 to 94%, and ulcer healing rates were generally > 80% in well designed studies. In addition, it was as effective as omeprazole- or rabepr azole-based regimens which included these antimicrobial agents. Maintenance therapy with lansoprazole 30 mg/day was significantly more effective than either placebo or ranitidine in preventing ulcer relapse. Importantly, prel iminary data suggest that lansoprazole-based eradication therapy is effecti ve in children and the elderly. In the short-term treatment of patients with gastro-oesophageal reflux dise ase (GORD), lansoprazole 15, 30 or 60 mg/day was significantly more effecti ve than placebo, ranitidine 300 mg/day or cisapride 40 mg/day and similar i n efficacy to pantoprazole 40 mg/day in terms of healing of oesophagitis. L ansoprazole 30 mg/day, omeprazole 20 mg/day and pantoprazole 40 mg/day all provided similar symptom relief in these patients. In patients with healed oesophagitis, 12-month maintenance therapy with lansoprazole 15 or 30 mg/da y prevented recurrence and was similar to or more effective than omeprazole 10 or 20 mg/day. Available data in patients with NSAID-related disorders or acid-related dys pepsia suggest that lansoprazole is effective in these patients in terms of the prevention of NSAID-related gastrointestinal complications, ulcer heal ing and symptom relief. Meta-analytic data and postmarketing surveillance in > 30 000 patients indi cate that lansoprazole is well tolerated both as monotherapy and in combina tion with antimicrobial agents. After lansoprazole monotherapy commonly rep orted adverse events included dose-dependent diarrhoea, nausea/vomiting, he adache and abdominal pain. After short-term treatment in patients with pept ic ulcer, CORD, dyspepsia and gastritis the incidence of adverse events ass ociated with lansoprazole was generally less than or equal to5%. Similar ad verse events were seen in long-term trials, although the incidence was gene rally higher (less than or equal to 10%). When lansoprazole was administere d in combination with amoxicillin, clarithromycin or metronidazole adverse events included diarrhoea, headache and taste disturbance. In conclusion, lansoprazole-based triple therapy is an effective treatment option for the eradication of H. pylori infection in patients with peptic u lcer disease. Preliminary data suggest it may have an important role in the management of this infection in children and the elderly. In the short-ter m management of GORD, lansoprazole monotherapy offers a more effective alte rnative to histamine H-2-receptor antagonists and initial data indicate tha t it is an effective short-term treatment option in children and adolescent s. In adults lansoprazole maintenance therapy is also an established treatm ent option for the long-term management of this chronic disease. Lansoprazo le has a role in the treatment and prevention of NSAID-related ulcers and t he treatment of acid-related dyspepsia; however, further studies are needed to confirm its place in these indications. Lansoprazole has emerged as a u seful and well tolerated treatment option in the management of acid-related disorders.