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Patients taking the commonly used stomach-acid–suppressing drugs lansoprazole and dexlansoprazole should be aware that they have clinically important interactions with many other prescription medications. Both drugs belong to the family of medications known as proton pump inhibitors, all of which Public Citizen’s Health Research Group has designated as Limited Use.
Lansoprazole is available as a single-active-ingredient drug by prescription under the brand name PREVACID and...
Patients taking the commonly used stomach-acid–suppressing drugs lansoprazole and dexlansoprazole should be aware that they have clinically important interactions with many other prescription medications. Both drugs belong to the family of medications known as proton pump inhibitors, all of which Public Citizen’s Health Research Group has designated as Limited Use.
Lansoprazole is available as a single-active-ingredient drug by prescription under the brand name PREVACID and over-the-counter (OTC) under the brand name PREVACID 24 HR, as well as in multiple prescription and OTC generic versions. The prescription versions are approved by the Food and Drug Administration (FDA) to treat several stomach-acid–related disorders, including ulcers in the stomach and duodenum (the first part of the small intestine) and gastroesophageal reflux disease.[1] Over-the-counter lansoprazole is FDA-approved only for treatment of frequent heartburn (occurring two or more days a week).[2] The drug is not intended for immediate relief of heartburn because it takes one to four days of treatment for full effect in reducing stomach acid.
Lansoprazole also is a component of a three-drug prescription medication kit containing the antibiotics amoxicillin and clarithromycin (available in a generic version only) that is approved to treat patients with Helicobacter pylori bacterial infection, frequently the cause of ulcers in the duodenum.[3]
Dexlansoprazole is available by prescription only, under the brand name DEXILANT and in a generic version. It is approved by the FDA only for treatment of various types of gastroesophageal reflux disease.[4]
Like many drugs, lansoprazole is a mixture of two forms that have identical chemical makeup but are “mirror images” of each other, known scientifically as optical isomers.[5] Dexlansoprazole contains only one of the two isomers that make up lansoprazole. Therefore, unsurprisingly, both drugs interact with the same medications.
Interacting drugs[6],[7],[8]
The Table below provides examples of other prescription oral drugs that have clinically important interactions with both lansoprazole and dexlansoprazole. The following are some particularly notable examples of these drug interactions.
Antiviral drugs
Lansoprazole and dexlansoprazole can interact with several antiviral drugs used to treat HIV infection. For most of these interacting antiviral drugs — including atazanavir (EVOTAZ, REYATAZ) and rilpivirine (COMPLERA, EDURANT, JULUCA, ODEFSEY) — concomitant use with lansoprazole or dexlansoprazole decreases blood levels of the antiviral drug, which may reduce the effectiveness of the antiviral drug and promote the development of HIV antiviral drug resistance. In the case of rilpivirine, the product labeling for lansoprazole and dexlansoprazole warns that neither drug should be used concomitantly with rilpivirine because the interaction is so significant.
For the antiviral drug saquinavir (INVIRASE), concomitant use with lansoprazole or dexlansoprazole has the opposite effect: It can lead to increased blood levels of saquinavir and saquinavir-related toxicity.
Cancer drugs
Lansoprazole and dexlansoprazole can interact with several oral cancer drugs, including erlotinib (TARCEVA) and neratinib (NERLYNX). Concomitant use of either proton pump inhibitor with these cancer drugs may result in decreased blood levels of the cancer drugs, potentially decreasing their effectiveness in treating cancer.
Digoxin
Concomitant use of lansoprazole or dexlansoprazole with digoxin (LANOXIN) — which is used to treat heart failure and to control heart rate in patients with atrial fibrillation (a common abnormal heart rhythm characterized by an irregular and often rapid heartbeat) — can result in increased and potentially highly toxic blood levels of digoxin. Common symptoms of digoxin toxicity are loss of appetite, nausea, vomiting and fatigue. Digoxin toxicity also can lead to abnormal heart rhythms. If concomitant use of lansoprazole or dexlansoprazole with digoxin is unavoidable, more frequent monitoring of blood digoxin levels should occur, especially during initiation and discontinuation of these proton pump inhibitors.
Methotrexate
Concomitant use of proton pump inhibitors like lansoprazole and dexlansoprazole with methotrexate (OTREXUP, RASUVO, TREXALL, XATMEP) — which is used to treat the autoimmune diseases rheumatoid arthritis, psoriasis and several types of cancer — may increase methotrexate in the blood to toxic levels. This interaction is most likely to occur when methotrexate is administered in high doses.
Methotrexate toxicity can cause a wide range of serious and life-threatening adverse effects, including:
- anemia (low red blood cell levels);
- low white blood cell levels, which can lead to serious infections;
- low blood platelet levels, which can lead to bleeding;
- liver damage; and
- kidney failure.[9]
Symptoms of methotrexate toxicity may include fatigue, chills, fever, dizziness, mouth sores, nausea, vomiting, diarrhea, easy bruising and hair loss.
Warfarin
Concomitant use of lansoprazole or dexlansoprazole with the anticoagulant (blood thinner) warfarin (COUMADIN, JANTOVEN) can increase blood levels of warfarin, increasing the risk of bleeding complications. Patients who take warfarin should undergo more frequent monitoring of warfarin levels during therapy with lansoprazole or dexlansoprazole and, initially, after discontinuing these proton pump inhibitors.
Examples of Oral Drugs That Have Clinically Important Interactions With Lansoprazole and Dexlansoprazole
| Generic Name | Brand Name(s) | Drug Class |
|---|---|---|
| atazanavir | EVOTAZ,† REYATAZ | Antiviral drug for HIV infection |
| digoxin | LANOXIN | Heart failure/atrial fibrillation drug |
| erlotinib | TARCEVA | Cancer drug |
| ketoconazole* | generic only for oral use | Antifungal drug |
| levothyroxine | EUTHYROX, LEVO-T, LEVOXYL, SYNTHROID, THYQUIDITY, THYRO-TABS, TIROSINT, UNITHROID | Drug for hypothyroidism |
| methotrexate** | OTREXUP, RASUVO, TREXALL, XATMEP | Immunosuppressant/cancer drug |
| mycophenolate mofetil | CELLCEPT | Immunosuppressant/organ transplant drug |
| nelfinavir | VIRACEPT | Antiviral drug for HIV infection |
| neratinib | NERLYNX | Cancer drug |
| pazopanib | VOTRIENT | Cancer drug |
| rifampin | RIFADIN, RIMACTANE | Antibiotic |
| rilpivirine | COMPLERA,† EDURANT, JULUCA,† ODEFSEY† | Antiviral drug for HIV infection |
| saquinavir | INVIRASE | Antiviral drug for HIV infection |
| sunitinib | SUTENT | Cancer drug |
| tacrolimus | ASTRAGRAF XL, ENVARSUS XR, PROGRAF | Immunosuppressant/organ transplant drug |
| voriconazole | VFEND | Antifungal drug |
| warfarin | COUMADIN, JANTOVEN | Anticoagulant (blood thinner) |
†Combination drug product that contains one or more other active ingredients
*Designated as Do Not Use by Worst Pills, Best Pills News
**Designated as Limited Use by Worst Pills, Best Pills News
What You Can Do
If you need treatment with either lansoprazole or dexlansoprazole, review all your other medications with your doctor to assess your risk of potentially significant drug interactions. If you are taking certain medications that interact with lansoprazole or dexlansoprazole, you may need to adjust the dosage of the interacting drug or undergo more frequent monitoring of the blood levels of the interacting drug, or your doctor may advise you to take a different drug for your stomach-acid condition. Be aware that other drugs not listed in this article also may have dangerous interactions with lansoprazole and dexlansoprazole.
References
[1] Takeda Pharmaceuticals America, Inc. Label: lansoprazole (PREVACID). November 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020406s092,021428s039lbl.pdf. Accessed August 12, 2021.
[2] GSK Consumer Healthcare. Label: lansoprazole (PREVACID 24 HR). April 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/022327Orig1s027lbl.pdf. Accessed August 12, 2021.
[3] Sandoz. Label: lansoprazole, amoxicillin and clarithromycin. June 2018. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=62f096ec-8684-4c8c-a4c5-eb7c22f559c1&type=display. Accessed August 21, 2021.
[4] Takeda Pharmaceuticals America, Inc. Label: dexlansoprazole (DEXILANT). November 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/022287s034lbl.pdf. Accessed August 12, 2021.
[5] Dexlansoprazole (KAPIDEX, DEXILANT): The sixth proton pump inhibitor for heartburn. Worst Pills, Best Pills News. July 2010. https://www.worstpills.org/newsletters/view/698. Accessed August 12, 2021.
[6] Takeda Pharmaceuticals America, Inc. Label: lansoprazole (PREVACID). November 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020406s092,021428s039lbl.pdf. Accessed August 12, 2021.
[7] Takeda Pharmaceuticals America, Inc. Label: dexlansoprazole (DEXILANT). November 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/022287s034lbl.pdf. Accessed August 12, 2021.
[8] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search terms: “lansoprazole” and “dexlansoprazole.” Accessed July 19, 2021.
[9] Sun Pharmaceutical Industries, Inc. Label: methotrexate tablets. July 2020. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=8f1260de-b60c-4f0e-8af6-0e957b0a281b&type=display. Accessed July 20, 2021.
