Lansoprazole dosage: a complete prescribing and patient guide

The BNF provides specific dosing recommendations for lansoprazole based on the condition being treated.

Your prescriber will choose the appropriate dose and duration for your individual situation.

Gastro-oesophageal reflux disease (GORD):

• Mild symptoms: 15 mg once daily for 4 to 8 weeks
• Moderate to severe symptoms: 30 mg once daily for 4 to 8 weeks
• Maintenance therapy: 15 mg once daily (or 30 mg if symptoms recur at the lower dose)

Gastric ulcer:

• 30 mg once daily for 8 weeks
• Healing should be confirmed by endoscopy where appropriate

Duodenal ulcer:

• 30 mg once daily for 4 weeks
• Most duodenal ulcers heal within this timeframe

Helicobacter pylori eradication:

• 30 mg twice daily as part of a triple therapy regimen with two antibiotics (typically amoxicillin and clarithromycin or metronidazole) for 7 days

NSAID-associated ulcer:

• Treatment: 30 mg once daily for 4 to 8 weeks
• Prevention in patients who need to continue NSAIDs: 15 mg to 30 mg once daily

Zollinger-Ellison syndrome:

• Starting dose of 60 mg once daily, adjusted according to response
• Doses above 120 mg daily should be divided into two doses

Always follow your prescriber's instructions, as they may adjust these doses based on your medical history and response to treatment.

Taking lansoprazole correctly ensures that it works as effectively as possible.

Timing:

• Take lansoprazole 30 minutes before a meal, preferably in the morning before breakfast
• This timing is important because the proton pumps in your stomach are most active when stimulated by food. Taking the medication before eating ensures it is absorbed and ready to block acid production when the pumps are activated
• If you take it twice daily (for H. pylori treatment), take the second dose 30 minutes before your evening meal

How to swallow the capsules:

• Swallow the capsule whole with a glass of water
• Do not crush, chew, or open the capsule, as the granules inside have a special coating to protect them from stomach acid

If you have difficulty swallowing:

• Lansoprazole is available as orodispersible tablets (FasTab) that dissolve on the tongue
• Alternatively, capsules can be opened and the granules mixed with a small amount of water, orange juice, or apple juice. The granules should not be chewed
• For patients with nasogastric tubes, the granules can be dispersed in water and administered through the tube

Missed doses:

• If you forget a dose, take it as soon as you remember unless it is nearly time for your next dose
• Do not take a double dose to make up for a missed one
• If you regularly forget doses, set a daily reminder or link it to a routine activity like brushing your teeth

The appropriate duration of lansoprazole treatment depends on your condition and how well you respond.

NICE and the BNF both emphasise the importance of using the lowest effective dose for the shortest necessary duration.

Short-term use (2 to 8 weeks):

• Most conditions, including uncomplicated GORD, gastric ulcers, and duodenal ulcers, are treated with courses of 4 to 8 weeks
• H. pylori eradication requires only 7 days of lansoprazole as part of triple therapy
• After the course, your doctor should reassess whether continued treatment is needed

Longer-term use:

• Some patients with severe GORD, Barrett's oesophagus, or Zollinger-Ellison syndrome may need ongoing treatment
• NSAID prophylaxis may require continued use while the NSAID is being taken
• NICE recommends a step-down approach: reducing from 30 mg to 15 mg, and then trying to stop completely if symptoms allow

Regular review:

• The NHS recommends that all PPI prescriptions be reviewed at least annually
• Many patients continue taking lansoprazole beyond the recommended duration without reassessment
• Your GP or pharmacist should discuss whether you still need the medication at each review

Stopping lansoprazole:

• If you have been taking lansoprazole for more than 4 weeks, a gradual reduction is recommended to avoid rebound acid hypersecretion
• This involves reducing the dose over 2 to 4 weeks before stopping
• Some patients may benefit from switching to on-demand use, taking lansoprazole only when symptoms occur

Certain groups of patients may require dose adjustments when taking lansoprazole.

Older adults (over 65):

• No routine dose adjustment is required
• However, the BNF advises caution with long-term use due to the increased risk of bone fractures and magnesium deficiency in this age group
• Regular monitoring is recommended

Liver impairment:

• In moderate to severe liver disease, the dose should not exceed 15 mg daily
• Lansoprazole is metabolised by the liver, so impaired liver function can lead to higher drug levels
• Your doctor should monitor liver function during treatment

Kidney impairment:

• No dose adjustment is needed for kidney impairment
• However, long-term use has been rarely associated with interstitial nephritis, so kidney function should be monitored

Children:

• Lansoprazole is licensed for use in children aged 1 year and over for GORD
• Dosing is based on body weight: children weighing over 30 kg receive the adult dose; those under 30 kg typically receive 15 mg daily
• Use in children should be supervised by a specialist

Pregnancy and breastfeeding:

• Lansoprazole is not recommended in pregnancy unless the benefits outweigh the risks
• Limited data are available on its use during breastfeeding
• If acid suppression is needed in pregnancy, your doctor may prefer an antacid or ranitidine as a first-line option

Understanding the difference between the two available strengths helps clarify why your doctor has chosen a particular dose.

Lansoprazole 15 mg is typically used for:

• Mild acid reflux symptoms
• Maintenance therapy after a course of 30 mg has healed an ulcer or controlled severe reflux
• Prevention of NSAID-associated ulcers in lower-risk patients
• Step-down therapy when aiming to reduce and eventually stop treatment

Lansoprazole 30 mg is typically used for:

• Active gastric or duodenal ulcers
• Moderate to severe GORD symptoms
• H. pylori eradication (as part of triple therapy)
• NSAID-associated ulcer treatment
• Conditions requiring stronger acid suppression

Key points to remember:

• The 30 mg dose suppresses more acid but also carries a slightly higher risk of side effects
• NICE guidelines emphasise prescribing the lowest effective dose
• If your symptoms are well controlled on 30 mg, your doctor should consider stepping down to 15 mg
• Generic lansoprazole capsules in both strengths are widely available and inexpensive on the NHS
• If you are unsure which dose is right for you, discuss it with your GP at your next medication review