Lansoprazole		GERD
Prevacid		Acid Reflux; Gastroesophageal Reflux; Gastroesophageal Reflux (GERD); Gastroesophageal Reflux Disease; Gastroesophageal ...

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DOSING For initial treatment of duodenal ulcers the recommended dose for adults is 15 mg daily for 4 weeks For the treatment of GERD the recommended initial treatment is 15 mg for up to 8

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Prevacid Lansoprazole 30 mg 30 caps Prevacid is a heartburn medication used to treat GERD

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all of the proton pump inhibitors that are available in capsule form can be opened and used as a solution of pellets that includes omeprazole lansoprazole and esomeprazole Nighttime reflux are we able to control it when we treat these patients Again the Gallup survey looked at the patients taking medicines Of those taking over the counter

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part of the stomach bulges into the chest cavity through an opening in the diaphragm hiatus The diaphragm is a sheet of muscle that separates the stomach cavity from the chest cavity What are the symptoms of GERD Heartburn is the most common symptom of

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food from the mouth to the stomach Reflux means to back up or flow backwards GERD is a condition in which acid bile and partially digested food in the stomach back up into the esophagus

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have unacceptable recurrence rates over 50 up to 80 similarly for cisapride It s only if we maintain these patients with omeprazole or lansoprazole that we can maintain healing of the EE Slide 19 Rabeprazole in Long Term Maintenance of Healed Erosive GERD We ve seen the introduction of 3 additional PPIs rabeprazole pantoprazole and esomeprazole There are similar data for

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is 3A4 some 2C19 Lansoprazole is 3A4 to get induction of 1A Rabeprazole is evenly distributed and pantoprazole with 2C19 but it s followed immediately by sulfate conjugation Slide CYP2C19 Metabolism Helicobacter pylori Eradication I wanted to talk to you about differences in metabolism of these enzymes The best example is CYP2C19 Mutations are quite

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very long And humans do make acid all the time It peaks when you eat a meal but we re making it all the time so you may get an effect for a very short period of time then it ll be gone Slide PPI Metabolism Briefly to talk about the metabolism Omeprazole s primarily 2C19 a little 3A4 Esomeprazole is 3A4 some 2C19 Lansoprazole is 3A4 to get induction of 1A

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secretion Omeprazole rabeprazole esomeprazole and lansoprazole bind to other cystine residues which don t contribute to acid inhibition and we don t know the significance of this binding Slide Pharmacodynamics of PPIs The important thing with the PPIs is that they only inhibit active pumps Although we have 100 of proton pumps within our stomach only about 70 to 80 of

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Slide Pharmacokinetic Characteristics of PPIs Food does affect bioavailability with omeprazole especially esomeprazole and lansoprazole So if the person forgets and takes the meal there

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Slide 33 Proton Pump Inhibitors 2001 What can we say about the individual PPIs I don t believe there are many major differences between omeprazole and lansoprazole Rabeprazole is a small

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more difficult Rabeprazole and lansoprazole have a more rapid onset of relief than omeprazole and pantoprazole in the first few days of therapy Esomeprazole is more rapid than omeprazole Slide 6 Satisfactory Heartburn Relief With Rabeprazole 20 mg Daily We can look at the Fass trial in which patients had EE and you can see this dramatic relief of symptoms in the first day

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Omeprazole pantoprazole and lansoprazole have high values while rabeprazole has a value near 1 Therefore it is not affected by the difference between extensive and poor metabolizers Slide 8 PPIs CYP2C19 Genotype and Gastric pH What is the consequence of that on gastric pH It is immediately evident that in contrast to lansoprazole which shows major differences between

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in a distant second by lansoprazole gave you a much better inhibition of gastric acid secretion on day 1 than did either pantoprazole or omeprazole or the omeprazole in the pellet suspension Slide Rabeprazole vs Omeprazole Rapidity of Symptom Relief We re starting to see some literature now that these agents that do have better day 1 efficacy and in particular rabeprazole does

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