Lansoprazole

Odorless

White to brownish-white crystalline powder

0.97

Freely soluble in dimethylformamide; soluble in ethyl acetate, dichloromethane and acetonitrile; very slightly soluble in ether, and practically insoluble in hexane and water.

>55.4 [ug/mL] (The mean of the results at pH 7.4)

178-182 °C

178 to 182 °C (decomposes)

MP: approx 166 °C with decomposition. Stable when exposed to light for up to two months. The compound degrades in aqueous solution, the rate of degradation increasing with decreasing pH. At 25 °C the half-lives are approx 0.5 and 18 hrs at pH 5.0 and pH 7.0, respectively.

178 - 182 °C

Solid

pKa1 = 1.1; pKa2 = 6.9; pKa3 = 12 /Estimated/

185.8 Ų [M+H]+ [CCS Type: TW; Method: calibrated with polyalanine and drug standards]

165.37 Ų [M+H-H2O]+ [CCS Type: TW; Method: calibrated with polyalanine and drug standards]；177.38 Ų [M+H]+ [CCS Type: TW; Method: calibrated with polyalanine and drug standards]；187.78 Ų [M+Na]+ [CCS Type: TW; Method: calibrated with polyalanine and drug standards]

This chemical does not meet GHS hazard criteria for 0.7% (1 of 136) of reports.

Warning

H315 (96.3%): Causes skin irritation [Warning Skin corrosion/irritation]；H319 (96.3%): Causes serious eye irritation [Warning Serious eye damage/eye irritation]；H335 (95.6%): May cause respiratory irritation [Warning Specific target organ toxicity, single exposure; Respiratory tract irritation]

P261, P264, P264+P265, P271, P280, P302+P352, P304+P340, P305+P351+P338, P319, P321, P332+P317, P337+P317, P362+P364, P403+P233, P405, and P501 (click each P-code to see the statement)

Aggregated GHS information provided per 136 reports by companies from 17 notifications to the ECHA C&L Inventory. Each notification may be associated with multiple companies.；Reported as not meeting GHS hazard criteria per 1 of 136 reports by companies.；There are 16 notifications provided by 135 of 136 reports by companies with hazard statement code(s).；Information may vary between notifications depending on impurities, additives, and other factors. The percentage value in parenthesis indicates the notified classification ratio from companies that provide hazard codes. Only hazard codes with percentage values above 10% are shown. For more detailed information, please visit ECHA C&L website.

Lansoprazole: Does not have an individual approval but may be used under an appropriate group standard

The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription drug products, incl lansoprazole, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act.

Skin Irrit. 2 (96.3%)；Eye Irrit. 2 (96.3%)；STOT SE 3 (95.6%)

Skin Irrit. 2 (100%)；Eye Irrit. 2 (100%)；STOT SE 3 (100%)

SRP: The most favorable course of action is to use an alternative chemical product with less inherent propensity for occupational exposure or environmental contamination. Recycle any unused portion of the material for its approved use or return it to the manufacturer or supplier. Ultimate disposal of the chemical must consider: the material's impact on air quality; potential migration in soil or water; effects on animal, aquatic, and plant life; and conformance with environmental and public health regulations.

Possible interactions of lansoprazole with medications known to be metabolized by the hepatic cytochrome p450 enzyme system should be considered.

... Lansoprazole, by increasing gastric pH, as the potential to affect the bioavailability of any medication whose absorption is pH-dependent. Also, lansoprazole may prevent the degradation of acid-labile drugs.

Lansoprazole causes prolonged inhibition of gastric acid secretion, and thereby my interfere with the absorption of these medications /ampicillin ester, digoxin, iron salts, ketoconazole/and other for which bioavailability is determined by gastric pH.

Lansoprazole appears to produce a dose-dependent decrease in the absorption of cyanocobalamin; this my be due to lansoprazole-induced hypochlorhydria or achlorhydria.

For more Interactions (Complete) data for LANSOPRAZOLE (9 total), please visit the HSDB record page.

Despite its wide use, lansoprazole has only rarely been associated with hepatic injury. In large scale, long term trials of lansoprazole, serum ALT elevations have occurred in less than 1% of patients and at rates similar to those that occur with placebo or comparator drugs. Only a small number of cases of clinically apparent liver disease due to lansoprazole or dexlansoprazole have been published and most have been anicteric and mild. In most instances, the time to onset was within 2 to 4 weeks and the pattern of enzyme elevations was hepatocellular or mixed. Hypersensitivity reactions with fever, rash and eosinophilia have been described due to dexlansoprazole and lansoprazole, and these reactions may be accompanied by minor serum enzyme elevations and thus qualify for DRESS syndrome (drug-rash with eosinophilia and systemic symptoms). Autoantibody formation is rare. Recovery is usually rapid (within a month) and complete upon stopping lansoprazole. Recurrence on reexposures has been reported.；Likelihood score: C (probable rare cause of clinically apparent liver injury).

It is not known whether lansoprazole is distributed into breast milk. However, lansoprazole or its metabolites are distributed into the milk of rats.

/HUMAN EXPOSURE STUDIES/ In one reported case of overdose, the patient consumed 600 mg of lansoprazole with no adverse reaction.

Drug Induced Liver Injury Rank (DILIrank 2.0)

Lansoprazole

vLess-DILI-concern

3

Adverse reactions

DOI:10.1016/j.drudis.2016.02.015

/LABORATORY ANIMALS: Chronic Exposure or Carcinogenicity/ Duodenogastric reflux is known to cause an increased frequency of cancer in the glandular portion of the stomach in rats. Furthermore, it is debated whether inhibition of gastric acid secretion may promote gastric carcinogenesis. In the present study we examined the combined effect of gastroduodenal reflux and acid inhibition with respect to the development of gastric carcinoma in the rat. Following the construction of a gastrojejunostomy in male Wistar rats, half of them were given the proton pump inhibitor lanzoprazole for 1 year. The rats were then killed and the pH in the stomach and gastrin in blood were measured. The stomach was examined macroscopically as well as histologically. Gastrin levels at autopsy were significantly increased in treated rats compared to the control group, confirming an effect of lanzoprazole on gastric acid secretion. Body weight was significantly reduced in the treated rats. Thirty of 79 rats developed gastric cancer, and they were all adenocarcinomas of the Lauren intestinal type. Gastric cancers occurred significantly more often in lanzoprazole-treated rats (50%) compared with controls (27%). Lanzoprazole given orally enhances the carcinogenic effect of duodenogastric reflux in rats.

/LABORATORY ANIMALS: Chronic Exposure or Carcinogenicity/ Leydig cell tumors (LCTs) are frequently observed during rodent carcinogenicity studies, however, the significance of this effect to humans remains a matter of debate. Many chemicals that produce LCTs also induce hepatic cytochromes P450 (CYPs), but it is unknown whether these two phenomena are causally related. Our aim was to investigate the existence of a liver-testis axis wherein microsomal enzyme inducers enhance testosterone metabolic clearance, resulting in a drop in circulating hormone levels and a consequent hypertrophic response from the hypothalamic-pituitary-testis axis. Lansoprazole was selected as the model compound as it induces hepatic CYPs and produces LCTs in rats. Male Sprague-Dawley rats were dosed with lansoprazole (150 mg/kg/day) or vehicle for 14 days. Lansoprazole treatment produced effects on the liver consistent with an enhanced metabolic capacity, including significant increases in relative liver weights, total microsomal CYP content, individual CYP protein levels, and enhanced CYP-dependent testosterone metabolism in vitro. Following intravenous administration of 14(C)testosterone, lansoprazole-treated rats exhibited a significantly smaller area under the curve and significantly higher plasma clearance. Significant reductions in plasma and testicular testosterone levels were observed, confirming the ability of this compound to perturb androgen homeostasis. No significant changes in plasma LH, FSH, or prolactin levels were detected under our experimental conditions. Lansoprazole treatment exerted no marked effects on testicular testosterone metabolism.

/LABORATORY ANIMALS: Chronic Exposure or Carcinogenicity/ In 2 year studies in rats receiving up to 40 times the recommended human dose, lansoprazole produced dose-related gastric enterochromaffin-life (ECL) cell hyperplasia and ECL cell carcinoids in both male and female rats. Lansoprazole also increased the incidence of intestinal metaplasia of the gastric epithelium, and produced dose-related increases in the incidence of testicular interstitial adenomas. In a 1 year toxicity study in rats receiving 13 times the recommended human dose, testicular interstitial cell adenoma also occurred in 1 of 30 rats. In a 2 year study in mice receiving up to 80 times the recommended human dose, lansoprazole produced an increased incidence of liver tumors (Hepatocellular adenomas and carcinomas), a dose-related increase in the incidence of gastric ECL cell hyperplasia, and adenomas of the rete restis in males.

/LABORATORY ANIMALS: Developmental or Reproductive Toxicity/ Lansoprazole at oral doses up to 150 mg/kg/day was found to have no effect on fertility and reproductive performance of male and female rats.

For more Non-Human Toxicity Excerpts (Complete) data for LANSOPRAZOLE (6 total), please visit the HSDB record page.

◉ Summary of Use during Lactation；No information is available on the use of lansoprazole during breastfeeding. However, lansoprazole has been used safely in newborn infants, so it is unlikely that the amount in breastmilk would be harmful.；◉ Effects in Breastfed Infants；Relevant published information was not found as of the revision date.；◉ Effects on Lactation and Breastmilk；The Spanish pharmacovigilance system found 3 cases of gynecomastia associated with lansoprazole reported during the time period of 1982 to 2006. A retrospective claims database study in the United States found that users of proton pump inhibitors had an increased risk of gynecomastia.；A review article reported that a search of database from the European Pharmacovigilance Centre found 45 cases of gynecomastia, 11 cases of galactorrhea, 3 cases of breast pain and 5 cases of breast enlargement associated with lansoprazole. A search of the WHO global pharmacovigilance database found 123 cases of gynecomastia, 30 cases of galactorrhea, 36 cases of breast pain and 18 cases of breast enlargement associated with lansoprazole.；In a retrospective study, out of total of 127 cases of gynecomastia in of 175 male patients, 11 patients were treated had been treated with lansoprazole.；One case of elevated serum prolactin and galactorrhea was reported in a 21-year-old man. When omeprazole was substituted for lansoprazole, the serum prolactin decreased to the normal range and galactorrhea ceased. Although this case occurred in Spain, it was not included in the report above.；A 13-year-old girl with a recent history of bilateral galactorrhea and hyperprolactinemia from omeprazole and domperidone on separate occasions was given lansoprazole to prevent gastrointestinal irritation following intravenous diclofenac for a severe headache. After 3 days of lansoprazole therapy, she again developed galactorrhea and an elevated serum prolactin that returned to normal a week after discontinuing lansoprazole.；A 17-year-old woman using a progestin-containing IUD for 1 year began lansoprazole 15 mg daily and presented after 1 week with bilateral galactorrhea and hyperprolactinemia of 92 mcg/L. Seventy-two hours after discontinuation of lansoprazole, galactorrhea ceased. Four months later, serum prolactin was normal at 24.1 mcg/L with no recurrence of galactorrhea. The authors judged the adverse reaction likely to be caused by lansoprazole.；The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Lansoprazole: Does not have an individual approval but may be used under an appropriate group standard

The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription drug products, incl lansoprazole, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act.

A02BC03

A - Alimentary tract and metabolism；A02 - Drugs for acid related disorders；A02B - Drugs for peptic ulcer and gastro-oesophageal reflux disease (gord)；A02BC - Proton pump inhibitors；A02BC03 - Lansoprazole

QA - Alimentary tract and metabolism；QA02 - Drugs for acid related disorders；QA02B - Drugs for peptic ulcer and gastro-oesophageal reflux disease (gord)；QA02BC - Proton pump inhibitors；QA02BC03 - Lansoprazole

97% of lansoprazole is plasma protein bound.

Lansoprazole decreases gastric acid secretion by targeting H+,K+-ATPase, which is the enzyme that catalyzes the final step in the acid secretion pathway in parietal cells. Conveniently, lansoprazole administered any time of day is able to inhibit both daytime and nocturnal acid secretion. The result is that lansoprazole is effective at healing duodenal ulcers, reduces ulcer-related pain, and offers relief from symptoms of heartburn Lansoprazole also reduces pepsin secretion, making it a useful treatment option for hypersecretory conditions such as Zollinger-Ellison syndrome.

As a PPI, lansoprazole is a prodrug and requires protonation via an acidic environment to become activated. Once protonated, lansoprazole is able to react with cysteine residues, specifically Cys813 and Cys321, on parietal H+,K+-ATPase resulting in stable disulfides. PPI's in general are able to provide prolonged inhibition of acid secretion due to their ability to bind covalently to their targets.

Lansoprazole is a selective and irreversible proton pump inhibitor. In the acidic environment of the gastric parietal cell, lansoprazole is converted to active sulphenamide derivatives that bind to the sulfhydryl group of (H+, K+)-adenosine triphosphatase ((H+,K+)-ATPase), also known as the proton pump (H+,K+)-ATPase catalyzes the final step in the gastric acid secretion pathway. Lansoprazole's inhibition of (H+,K+)-ATPase results in inhibition of both centrally and peripherally mediated gastric acid secretion. The inhibitory effect is dose-related. Lansoprazole inhibits both basal and stimulated gastric acid secretion regardless of the stimulus.

One source reports the half life of lansoprazole to be 0.9 - 1.6 hours, while another source cites 0.9 - 2.1 hours. The general consensus is that lansoprazole has a short half life and is approximately 2 hours or less. These numbers may be misleading since it suggests that lansoprazole has a short duration of action when in practice, lansoprazole can effectively inhibit acid secretion for ~24 hours due to it's mechanism of action.

Elimination: Normal renal function: Approximately 1.5 hours. Renal function impairment: Shortened elimination half-life. Elderly patients: 1.9 to 2.9 hours. Hepatic function impairment: 3.2 to 7.2 hours.

Lansoprazole is predominantly metabolized in the liver by CYP3A4 and CYP2C19. The resulting major metabolites are 5-hydroxy lansoprazole and the sulfone derivative of lansoprazole.

Lansoprazole is extensively metabolized in the liver to two main excretory metabolites that are inactive. In the acidic environment of the gastric parietal cell, lansoprazole is converted to two active compounds that inhibit acid secretion by (H+,K+)-ATPase within the parietal cell canaliculus, but that are not present in the systemic circulation.

0K5C5T2QPG

LANSOPRAZOLE

Established Pharmacologic Class [EPC] - Proton Pump Inhibitor

Mechanisms of Action [MoA] - Proton Pump Inhibitors

Physiologic Effects [PE] - Inhibition Gastric Acid Secretion

Lansoprazole is a Proton Pump Inhibitor. The mechanism of action of lansoprazole is as a Proton Pump Inhibitor. The physiologic effect of lansoprazole is by means of Inhibition Gastric Acid Secretion.

Various agents with different action mechanisms used to treat or ameliorate PEPTIC ULCER or irritation of the gastrointestinal tract. This has included ANTIBIOTICS to treat HELICOBACTER INFECTIONS; HISTAMINE H2 ANTAGONISTS to reduce GASTRIC ACID secretion; and ANTACIDS for symptomatic relief.

Compounds that inhibit H(+)-K(+)-EXCHANGING ATPASE. They are used as ANTI-ULCER AGENTS and sometimes in place of HISTAMINE H2 ANTAGONISTS for GASTROESOPHAGEAL REFLUX.

The oral bioavailability of lansoprazole is reported to be 80-90% and the peak plasma concentration(Cmax) is achieved about 1.7 hours after oral dosing. Food reduces the absorption of lansoprazole (both Cmax and AUC are reduced by 50-70%); therefore, patients should be instructed to take lansoprazole before meals.

A reported 14-23% of a lansoprazole is eliminated in the urine with this percentage range including both conjugated and unconjugated hydroxylated metabolites.

The apparent volume of distribution of lansoprazole is 0.4 L/kg.

The reported clearance of lansoprazole is 400-650 mL/min.

Very high (around 97%) /protein binding/; protein binding remains constant over the concentration range of 0.05 to 5 ug/mL. In patient with renal function impairment, protein binding may be decreased by 1 to 1.5%.

Distributed in tissue, particularly gastric parietal cells. Apparent oral volume of distribution following administration of 30 mg of lansoprazole is about 0.5 L/kg.

Liver

Membrane

Lansoprazole Action Pathway；Lansoprazole Metabolism Pathway

Antiulcerative

Medication

Use (kg; approx.) in Germany (2009): >750；Use (kg) in USA (2002): 17100；Consumption (g per capita; approx.) in Germany (2009): 0.00916；Consumption (g per capita) in the USA (2002): 0.0606；Calculated removal (%): 17.8

Trade names: Agopton, Lansox, Lanzor, Limpidex, Ogast, Prevacid, Takepron, Zoton

Preparation: A. Nohara, Y. Maki, EP 174726; US 4628098 (both 1986 to Takeda)