Usage
- Domperidone + Lansoprazole is prescribed for the treatment of gastroesophageal reflux disease (GERD), peptic ulcers, gastritis, and Zollinger-Ellison syndrome. It also helps alleviate symptoms like nausea, vomiting, heartburn, acid reflux, stomach fullness, bloating, belching, and gas associated with these conditions. It can also address symptoms related to delayed gastric emptying.
- Pharmacological Classification: This combination drug falls into two categories:
- Domperidone: Dopamine antagonist and prokinetic agent.
- Lansoprazole: Proton pump inhibitor (PPI).
- Mechanism of Action: Domperidone blocks dopamine receptors, increasing the movement of food through the stomach and intestines. Lansoprazole inhibits the proton pump in the stomach, reducing acid production.
Alternate Names
- No widely recognized alternate names exist for the combination itself.
- Brand Names: Lansec, Lans DX, and other regional variations.
How It Works
- Pharmacodynamics: Domperidone acts as an antiemetic by blocking peripheral dopamine D2 receptors in the chemoreceptor trigger zone. It also enhances gastric motility by stimulating acetylcholine release. Lansoprazole irreversibly inhibits H+/K+-ATPase (proton pump) in gastric parietal cells, reducing gastric acid secretion.
- Pharmacokinetics:
- Domperidone is rapidly absorbed orally, but bioavailability is low due to first-pass metabolism. It is metabolized primarily by CYP3A4.
- Lansoprazole is also absorbed orally and converted to its active form in the acidic environment of parietal cells. It is extensively metabolized by CYP2C19 and CYP3A4.
- Receptor Binding/Enzyme Inhibition: Domperidone binds to dopamine D2 receptors. Lansoprazole inhibits the H+/K+-ATPase enzyme.
- Elimination Pathways: Both drugs are primarily metabolized in the liver and excreted through renal and fecal routes.
Dosage
Standard Dosage
Adults: One capsule containing 30mg lansoprazole and 10mg domperidone, once daily, taken before a meal. The duration is determined by the treating physician based on the patient’s condition.
Children: Not generally recommended for children under 12 years of age, as safety and efficacy have not been established.
Special Cases:
- Elderly Patients: Use with caution due to increased risk of adverse effects like dizziness and drowsiness. No specific dosage adjustments are mentioned.
- Patients with Renal Impairment: Dosage adjustments may be needed depending on the degree of impairment. Monitor closely.
- Patients with Hepatic Dysfunction: Use with caution, as dosage adjustments may be necessary.
- Patients with Comorbid Conditions: Use with caution in patients with heart conditions and electrolyte imbalances.
Clinical Use Cases
The provided sources do not offer dosage information for specific clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Dosing in such instances should be at the discretion of the attending physician based on individual patient needs.
Dosage Adjustments
- Modifications may be necessary based on renal/hepatic function and other medical conditions.
- Consider genetic polymorphisms affecting CYP2C19 and CYP3A4, which may impact the metabolism of lansoprazole.
Side Effects
Common Side Effects:
Diarrhea, nausea, vomiting, headache, dizziness, stomach pain, dry mouth, and constipation.
Rare but Serious Side Effects:
Heart-related issues (arrhythmias, QT prolongation), hypomagnesemia (with prolonged use), vitamin B12 deficiency (with prolonged use), bone fractures (with prolonged use), gut infections (with prolonged use).
Long-Term Effects:
Prolonged use (over a year) may lead to increased risk of hypomagnesemia, vitamin B12 deficiency, bone fractures, and gut infections.
Adverse Drug Reactions (ADR):
Any severe or unusual reactions, including allergic reactions, cardiac events, or persistent gastrointestinal issues, require immediate medical attention.
Contraindications
- Hypersensitivity to domperidone, lansoprazole, or any components.
- Gastrointestinal bleeding, mechanical obstruction.
- Severe liver disease, pheochromocytoma, cardiac disorders (QT prolongation, ventricular arrhythmia).
- Patients with conditions such as stomach tumors, osteoporosis, lupus, or low magnesium levels.
- Concomitant use with drugs that prolong the QT interval (e.g., certain antipsychotics, antibiotics).
Drug Interactions
- Ketoconazole, itraconazole, methotrexate, digoxin, warfarin, atazanavir, ritonavir, erythromycin.
- St. John’s wort, alcohol.
- Antihypertensive drugs, benzodiazepines, carbamazepine, clarithromycin, fluoxetine, itraconazole, lorazepam, paroxetine, quinidine, and rifampin.
- CYP450 interactions, particularly with inhibitors (ketoconazole, itraconazole) and inducers (rifampin) of CYP2C19 and CYP3A4.
Pregnancy and Breastfeeding
- Pregnancy Category B: Use only if benefits outweigh risks. Fetal risks are not well-established.
- Consult a doctor before use during breastfeeding, as domperidone and lansoprazole may be excreted in breast milk. The safety profile in infants is not comprehensively established.
Drug Profile Summary
- Mechanism of Action: Domperidone enhances gastric motility; lansoprazole reduces gastric acid secretion.
- Side Effects: Diarrhea, nausea, headache, dizziness, stomach pain, and potential long-term effects like hypomagnesemia and bone fractures.
- Contraindications: Hypersensitivity, GI bleeding, severe liver disease, certain cardiac conditions, concomitant use with QT prolonging drugs.
- Drug Interactions: Ketoconazole, itraconazole, digoxin, warfarin, St. John’s wort, alcohol.
- Pregnancy & Breastfeeding: Use with caution; consult a physician.
- Dosage: Adults: one capsule (30mg lansoprazole + 10mg domperidone) once daily before a meal.
- Monitoring Parameters: Electrolytes (magnesium, potassium), cardiac function (ECG for QT interval), and signs of GI bleeding.
Popular Combinations
None specifically mentioned. Combination therapy is generally determined by the physician based on individual patient needs and conditions.
Precautions
- Screen for allergies, metabolic disorders, organ dysfunction.
- Pregnant Women: Assess potential risks vs. benefits with the physician.
- Breastfeeding Mothers: Assess potential risks to the neonate.
- Children & Elderly: Use cautiously, considering age-related physiological changes.
- Lifestyle Considerations: Avoid alcohol, as it can worsen symptoms. Caution with driving if drowsiness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Domperidone + Lansoprazole?
A: The standard adult dose is one capsule (30mg lansoprazole and 10mg domperidone) once daily before meals. Dosage adjustments might be necessary based on the specific condition, age, other medical conditions, and concomitant medications.
Q2: Can this combination be used in children?
A: It is generally not recommended for children under 12, as safety and efficacy have not been well-established in this population.
Q3: What are the common side effects patients should be aware of?
A: Common side effects include diarrhea, nausea, headache, dizziness, stomach pain, dry mouth, and constipation.
Q4: Are there any serious side effects?
A: While rare, serious side effects can include heart-related issues, hypomagnesemia, vitamin B12 deficiency, bone fractures (with long-term use), and gut infections.
Q5: What are the contraindications for this medication?
A: Contraindications include hypersensitivity, gastrointestinal bleeding, mechanical obstruction, severe liver disease, certain cardiac conditions, and concomitant use with QT prolonging drugs.
Q6: Can this medication be taken during pregnancy or breastfeeding?
A: It should be used cautiously during pregnancy and breastfeeding. Consult a physician to assess potential risks versus benefits.
Q7: Does this combination interact with other medications?
A: Yes, it can interact with various medications, including antifungals (ketoconazole, itraconazole), certain antibiotics, digoxin, warfarin, and St. John’s wort. It is crucial to inform your doctor about all concomitant medications.
Q8: What should patients do if they experience any side effects?
A: Patients should report any side effects, especially severe or unusual ones, to their physician immediately.
Q9: How long does it take for this medication to work?
A: Patients may experience symptom relief within a few days, but it can take up to 4 weeks for full effectiveness.
Q10: Can this medication cause weight gain?
A: Weight gain is not a typically reported side effect.
