Proton pump inhibitor (PPI)
ATC code: A02BC03 (Lansoprazole)
A benzimidazole. In the acidic secretory canaliculi of parietal cells, it converts to active sulfenamide that covalently binds the H+/K+-ATPase (proton pump). Suppresses basal and stimulated acid secretion by 80–95% over 24 hours. Compared with omeprazole, faster onset and higher bioavailability (80–90%). CYP2C19- and CYP3A4-metabolized. Half-life 1.5 hours, but the effect lasts over 24 hours via irreversible pump binding.
First line
First-line for gastroesophageal reflux disease per 2022 and Spanish AEG 2024 alongside other PPIs. Standard dose 30 mg once daily for 4–8 weeks. In erosive esophagitis, extend to 8 weeks with possible step-down to maintenance 15 mg. The 2019 Cochrane meta-analysis showed comparable efficacy across PPIs; differences are in cost and individual tolerability.
First line
First-line for gastric and duodenal ulcer per 2017. Dose 30 mg once daily for 4–8 weeks within H. pylori eradication (with amoxicillin, clarithromycin, or metronidazole for 10–14 days) or as monotherapy in HP-negative ulcer.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Lansoprazole is used prophylactically in low-risk NSAID-gastropathy patients and for unevaluated heartburn. 2022 limits PPIs to patients with confirmed risk factors. In low-risk populations the benefit-risk balance is unfavorable, with long-term use linked to fractures ( DSC 2011), hypomagnesemia (FDA DSC 2011), B12 deficiency and CDI (FDA DSC 2012).
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FDA category B. Pregnancy use is acceptable when indicated. Large data set without described teratogenic effects.
Compatible with breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Lansoprazole is evaluated for the following indications with varying evidence strength: Peptic ulcer disease (evidence tier A), Gastroesophageal reflux disease (evidence tier A), PPI for NSAID gastric prophylaxis in low-risk patients (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Lansoprazole (≥ 1 in 100): Headache, Diarrhea or constipation, Nausea, Abdominal pain, Flatulence, Skin rash. See the Safety section for uncommon and serious reactions.
FDA category B. FDA category B. Pregnancy use is acceptable when indicated. Large data set without described teratogenic effects.
Compatible with breastfeeding.
Lansoprazole is contraindicated in: Lansoprazole or other PPI hypersensitivity; Concomitant rilpivirine (antiretroviral); Severe hepatic impairment – dose adjustment needed. Full list in the Safety section.