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Untitled Triple therapy: Lansoprazole 30 mg amoxicillin 1 g clarithromycin 500 mg PO q12hr for 10-14 days Dual therapy (clarithromycin resistant): Lansoprazole 30 mg amoxicillin 1 g PO q8hr for 14 days Penicillin allergy: Lansoprazole 30 mg clarithromycin 500 mg metronidazole 500 mg q12hr for 10-14 days Proton pump inhibitors (PPIs) are possibly associated with increased incidence of Clostridium difficile-associated diarrhea (CDAD); consider diagnosis of CDAD for patients taking PPIs who have diarrhea that does not improve Liver disease may require dosage reduction Cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE) reported with PPIs; avoid using for longer than mediy indicated; discontinue if sns or symptoms consistent with CLE or SLE are observed and refer patient to specialist Published observational studies suggest that PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist, or spine, particularly with prolonged (1 yr), hh-dose therapy Decreased gastric acidity increases serum chromogranin A (Cg A) levels and may cause false-positive diagnostic results for neuroendocrine tumors; temporarily discontinue PPIs before assessing Cg A levels Hypomagnesemia may occur with prolonged use (ie, 1 year); adverse effects may result and include tetany, arrhythmias, and seizures; in 25% of cases reviewed, magnesium supplementation alone did not improve low serum magnesium levels and the PPI had to be discontinued PPIs may decrease the efficacy of clopidogrel by reducing the formation of the active metabolite Relief of symptoms does not eliminate the possibility of a gastric malnancy Therapy increases risk of Salmonella, Campylobacter, and other infections Acute interstitial nephritis reported in patients taking proton pump inhibitors Daily long-term use (e.g., longer than 3 years) may lead to malabsorption or a deficiency of cyanocobalamin May elevate and/or prolong serum concentrations of methotrexate and/or its metabolite when administered oncomitantly with PPIs, possibly leading to toxicity; consider a temporary withdrawal of PPI therapy therapy with hh dose methotrexate administration Metabolized by hepatic CYP2C19; slow metabolizers are deficient in CYP2C19 enzyme and can have plasma concentration increase of 5-fold or hher Gastric parietal cells: Acidic p H converts lansoprazole to its active sulfenamide metabolites Active metabolites: Cyclic sulfenamide and disulfide metabolite Inactive metabolites: 5-hydroxy-lansoprazole, sulfide metabolite, omeprazole sulfone, sulfone metabolite, hydroxysulfide metabolite, hydroxysulfone metabolite Enzymes inhibited: CYP2C19 Administer before meals Contains enteric coated granules (acid labile); do not chew or crush; swallow capsule/tablet whole; do not chew, crush, or split Do not chew orally disintegrating tablets Powder for oral suspension: dissolve packet contents in 30 m L of water; do not use any other liquid; stir well and drink immediately Inject 5 m L sterile water for injection (SWI) into vial and gently dissolve to obtain a 6 mg/m L solution; can be stored at 77°F (25°C) for 1 hr Dilute in 50 m L NS, LR, or D5W; resulting solution can be stored at 77°F (25°C) for 24 hr (NS, LR) or 12 hr (D5W); refreration not necessary. Prevacid soltabs. information on compounding liquid prevacid. how to make liquid prevacid. prilosec or prevacid message board

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