dexlansoprazole

Absorption: Well absorbed following oral administration.

Distribution: Unknown.

Protein Binding: 96–99%.

Metabolism/Excretion: Extensively metabolized by the liver (CYP2C19 and CYP3A4 enzyme systems are involved); the CYP2C19 enzyme system exhibits genetic polymorphism (15–20% of Asian patients and 3–5% of Caucasian and Black patients may be poor metabolizers and may have significantly ↑ dexlansoprazole concentrations and an ↑ risk of adverse effects); no active metabolites. No renal elimination.

Half-life: 1–2 hr.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to dexlansoprazole or related drugs (benzimidazoles)
Severe hepatic impairment
Concurrent use of rilpivirine.

Use Cautiously in:

Moderate hepatic impairment (daily dose should not exceed 30 mg)
Patients using high doses for >1 yr (↑ risk of hip, wrist, or spine fractures and fundic gland polyps)
Patients using therapy for >3 yr (↑ risk of vitamin B₁₂ deficiency)
OB: Safety not established in pregnancy
Lactation: Safety not established in breastfeeding
Pedi: Children <12 yr (safety and effectiveness not established); ↑ risk of heart valve thickening in children <2 yr..

Adv. Reactions/Side Effects ⬆ ⬇

Derm: cutaneous lupus erythematosus.

F and E: hypomagnesemia (especially if treatment duration 3 mo).

GI: CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), abdominal pain, diarrhea, flatulence, fundic gland polyps, nausea, vomiting.

GU: acute tubulointerstitial nephritis.

Hemat: vitamin B₁₂ deficiency.

MS: bone fracture.

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS, ANGIOEDEMA, OR ACUTE TUBULOINTERSTITIAL NEPHRITIS), systemic lupus erythematosus.

Interactions ⬆ ⬇

Drug-Drug:

May ↓ absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavir, nelfinavir, rilpivirine, ampicillin esters, iron salts, erlotinib, and mycophenolate mofetil; concurrent use with rilpivirine contraindicated; avoid concurrent use with atazanavir and nelfinavir.
May ↑ levels of digoxin, methotrexate, and tacrolimus.
May ↑ effect of warfarin.
Hypomagnesemia ↑ risk of digoxin toxicity.

Route/Dosage ⬆ ⬇

PO (Adults and Children 12 yr): Healing of EE — 60 mg once daily for up to 8 wk; Maintenance of healed EE — 30 mg once daily for up to 6 mo (adults) and up to 16 wk (12–17 yr old); GERD — 30 mg once daily for 4 wk.

Hepatic Impairment

PO (Adults): Moderate hepatic impairment — daily dose should not exceed 30 mg.

Implementation ⬆ ⬇

Do not confuse Dexilant (dexlansoprazole) with duloxetine.
PO: May be administered without regard to food. DNC: Swallow capsules whole or may be opened and sprinkled on 1 tbsp of applesauce and swallowed immediately, without crushing or chewing, for patients with difficulty swallowing.
- Capsules may be opened and granules emptied into 20 mL water. Withdraw entire mixture into syringe; swirl gently to mix. Administer mixture into mouth or NG tube immediately; do not save for later. Rinse syringe with 10 mL of water twice to ensure all medication administered.
- Administer for shortest time possible to minimize risk of osteoporosis-related fractures and cutaneous or systemic lupus erythematosus.

US Brand Names ⬆ ⬇

Classifications ⬆ ⬇

Therapeutic Classification: antiulcer agents

Pharmacologic Classification: proton pump inhibitors

Availability ⬆ ⬇

(Generic available)

Delayed-release capsules: 30 mg; 60 mg;

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK*	DURATION
PO	unknown	1–2 hr (1st); 4–5 hr (2nd)	24 hr

*Reflects effects of delayed release capsule.

Assessment ⬆ ⬇

Assess patient routinely for epigastric or abdominal pain and for frank or occult blood in stool, emesis, or gastric aspirate.
Monitor bowel elimination. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD).
Monitor for signs and symptoms of decreased renal function (malaise, nausea, anorexia) periodically during therapy. If symptoms occur, discontinue dexlansoprazole and evaluate patient for acute tubulointerstitial nephritis.

Lab Test Considerations:

May cause abnormal liver function tests, including ↑ AST, ALT, and ↑ or ↓ serum bilirubin.
- May cause ↑ serum creatinine and BUN, ↑ blood glucose, and ↑ serum potassium, and ↓ serum magnesium levels.
- May cause ↓ platelet levels.
- May also cause ↑ gastrin and total protein levels.
- Monitor INR and prothrombin time in patients taking warfarin.

Pot. Nursing Diagnoses ⬆ ⬇

Acute pain (Indications).

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered but not if just before next scheduled dose; do not double doses.
Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
Advise patient to report onset of black, tarry stools; diarrhea; or abdominal pain to health care professional promptly, especially if accompanied by fever or bloody stools. Do not treat with antidiarrheals without consulting health care professional.
Advise patient to notify health care professional if signs and symptoms of hypomagnesemia (seizures, dizziness, abnormal or fast heartbeat, jitteriness, jerking movements or shaking [tremors], muscle weakness, spasms of the hands and feet, cramps or muscle aches, spasm of the voice box) occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in abdominal pain, heartburn, gastric irritation, and bleeding in patients with GERD; may require up to 4 wk of therapy.
Healing in patients with erosive esophagitis; may require up to 8 wk of therapy for healing and 6 mo of therapy for maintenance.

Code ⬆

NDC Code^*

50090- A-S Medication Solutions
50090-4374- Dexilant 50090-4374-0- 90 CAPSULE, DELAYED RELEASE in 1 BOTTLE (50090-4374-0)

55154- Cardinal Health
55154-5154- Dexilant 55154-5154-8- 1800 CAPSULE, DELAYED RELEASE in 1 BOTTLE (55154-5154-8)

64764- Takeda Pharmaceuticals America, Inc.
64764-171- Dexilant 64764-171-00- 7 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-171-00)

64764- Takeda Pharmaceuticals America, Inc.
64764-171- Dexilant 64764-171-01- 5 BLISTER PACK in 1 TRAY (64764-171-01) > 4 CAPSULE, DELAYED RELEASE in 1 BLISTER PACK

64764- Takeda Pharmaceuticals America, Inc.
64764-171- Dexilant 64764-171-03- 1 BOTTLE in 1 CARTON (64764-171-03) > 5 CAPSULE, DELAYED RELEASE in 1 BOTTLE

64764- Takeda Pharmaceuticals America, Inc.
64764-171- Dexilant 64764-171-11- 10 BLISTER PACK in 1 CARTON (64764-171-11) > 10 CAPSULE, DELAYED RELEASE in 1 BLISTER PACK

64764- Takeda Pharmaceuticals America, Inc.
64764-171- Dexilant 64764-171-19- 1000 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-171-19)

64764- Takeda Pharmaceuticals America, Inc.
64764-171- Dexilant 64764-171-30- 30 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-171-30)

64764- Takeda Pharmaceuticals America, Inc.
64764-171- Dexilant 64764-171-90- 90 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-171-90)

64764- Takeda Pharmaceuticals America, Inc.
64764-175- Dexilant 64764-175-00- 7 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-175-00)

64764- Takeda Pharmaceuticals America, Inc.
64764-175- Dexilant 64764-175-01- 5 BLISTER PACK in 1 TRAY (64764-175-01) > 4 CAPSULE, DELAYED RELEASE in 1 BLISTER PACK

64764- Takeda Pharmaceuticals America, Inc.
64764-175- Dexilant 64764-175-02- 30 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-175-02)

64764- Takeda Pharmaceuticals America, Inc.
64764-175- Dexilant 64764-175-11- 10 BLISTER PACK in 1 CARTON (64764-175-11) > 10 CAPSULE, DELAYED RELEASE in 1 BLISTER PACK

64764- Takeda Pharmaceuticals America, Inc.
64764-175- Dexilant 64764-175-19- 1000 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-175-19)

64764- Takeda Pharmaceuticals America, Inc.
64764-175- Dexilant 64764-175-30- 30 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-175-30)

64764- Takeda Pharmaceuticals America, Inc.
64764-175- Dexilant 64764-175-90- 90 CAPSULE, DELAYED RELEASE in 1 BOTTLE (64764-175-90)

section name header

Pronunciation ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇