Drug Evaluation: Pulmonary-Allergy, Dermatological, Gastrointestinal & Arthritis: Lansoprazole: A new proton pump inhibitor for the treatment of peptic ulceration and reflux oesophagitis

Abstract

Lansoprazole is the second inhibitor of the gastric H+/K+-ATPase to be marketed for the treatment of peptic ulcer disease and reflux oesophagitis. Like omeprazole, lansoprazole is an acid-activated, non-competitive and highly specific inhibitor of the proton pump which causes profound and long-lasting inhibition of acid secretion. In controlled clinical trials, lansoprazole results in more rapid healing of duodenal and gastric ulcers than histamine H₂ receptor antagonists. The drug is extremely effective in treating oesophagitis, resistant ulcers and Zollinger-Ellison syndrome when compared with H₂ blockers and can be used in combination with amoxycillin or clarithromycin to achieve eradication of Helicobacter pylori. In a number of trials in which proton pump inhibitors (PPIs) have been directly compared, lansoprazole has produced slightly faster rates of healing and pain relief than omeprazole. These marginal advantages may reflect the improved bioavailability of lansoprazole and/or the fact that it has been launched at a higher recommended dose of 30 mg compared with 20 mg for omeprazole. The dominance of histamine H₂ antagonists in the prescription market is being eroded by H+/K+-ATPase inhibitors to the extent that proton pump inhibitors could well take over as the first choice antisecretory drugs in the prescription market over the next few years.

Key Words:

• antisecretory drugs
• proton pump inhibitors
• lansoprazole
• omeprazole
• pantoprazole
• rabeprazole
• histamine H₂ receptor antagonists
• cimetidine
• famotidine
• nizatidine
• ranitidine
• Helicobacter pylori
• antibiotics
• amoxycillin
• clarithromycin
• acid-peptic disorders
• gastric acid
• pepsin
• peptic ulcer
• duodenal ulcer
• gastric ulcer
• resistant ulcer
• reflux oesophagitis
• healing
• relapse
• Zollinger-Ellison
• carcinoids