Dexlansoprazole

Products

Dexlansoprazole was approved in many countries in 2014 in the form of modified-release capsules (Dexilant). Generic versions were registered in 2020.

Structure and properties

Dexlansoprazole (C₁₆H₁₄F₃N₃O₂S, M_r = 369.4 g/mol) is the pure -enantiomer of the racetmate lansoprazole (Agopton, both Takeda; generics). It exists as a white crystalline powder that is sparingly soluble in water.

Effects

Dexlansoprazole (ATC A02BC06) reduces gastric acid secretion by inhibiting the proton pump (H⁺/K⁺-ATPase) in the gastric vestibular cells irreversibly. It does not act locally in the lumen of the stomach but is absorbed biphasically in the intestine and reaches the gastric vestibular cells via systemic circulation. Dexlansoprazole is a prodrug and is only converted from acid to its active form in the canaliculi of the vestibular cells, where it binds covalently to the proton pump and thus inhibits it. What are the differences between this and lansoprazole?

• Different galenics with sustained (biphasic) release.
• Enantiomerically pure product
• Higher dosage
• Both enantiomers are active, but dexlansoprazole has a slightly longer residence time in the organism
• Different indications, lansoprazole can be used more broadly.
• Of dexlansoprazole at the time of introduction do not yet exist generics

Indications

• For the cure of erosive esophagitis.
• For maintenance therapy of healed erosive esophagitis and relief of stomach burning.

Dosage

According to the professional information. Capsules are taken once daily, regardless of meals. For lansoprazole, it is recommended to take it before meals.

Contraindications

Dexlansoprazole is contraindicated in the presence of hypersensitivity and concomitant administration of atazanavir. For complete precautions, see the drug label.

Interactions

Dexlansoprazole is a substrate of CYP2C19 and CYP3A4. Corresponding drug-drug interactions are possible. Other interactions have been described with antacids, sucralfate, atazanavir, ketoconazole, itraconazole, digoxin, CYP or P-gp substrates, tacrolimus, vitamin K antagonists, and methotrexate, among others.

Adverse effects

The most common potential adverse effects include diarrhea, abdominal pain, headache, nausea, flatulence, and constipation.