Dexlansoprazole

Dexlansoprazole, sold under the trade name Dexilant among others, is a medication which reduces stomach acid.[2] It is used to treat gastroesophageal reflux disease.[2] Effectiveness is similar to other proton pump inhibitors (PPIs).[3] It is taken by mouth.[2]

Dexlansoprazole
Clinical data
Trade namesKapidex, Dexilant, others
AHFS/Drugs.comMonograph
MedlinePlusa695020
License data
Pregnancy
category
  • US: B (No risk in non-human studies)
    Routes of
    administration    		By mouth
    Drug classProton pump inhibitor
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Excretion50% renal and 47% in the feces[1]
    Identifiers
    CAS Number
    PubChem CID
    IUPHAR/BPS
    ChemSpider
    UNII
    KEGG
    ChEMBL
    Chemical and physical data
    FormulaC16H14F3N3O2S
    Molar mass369.36 g·mol−1
    3D model (JSmol)
     NY (what is this?)  (verify)

    Common side effects include diarrhea, abdominal pain, and nausea.[2] Serious side effects may include osteoporosis, low blood magnesium, Clostridium difficile infection, anaphylaxis, and pneumonia.[2] Use in pregnancy and breastfeeding is of unclear safety.[4] It works by blocking H+/K+-ATPase in the parietal cells of the stomach.[2]

    Dexlansoprazole was approved for medical use in the United States in 2009.[2] In the United States the wholesale cost for a month is about US$270.[5] In Canada this amount costs about 71.50 CAD in 2016 making it the most expensive PPI available at the time.[3] In 2017, it was the 202nd most commonly prescribed medication in the United States, with more than two million prescriptions.[6][7]

    Medical use

    Dexlansoprazole is used to heal and maintain healing of erosive esophagitis and to treat heartburn associated with gastroesophageal reflux disease (GERD).[1] It lasts longer than lansoprazole, to which it is chemically related, and needs to be taken less often.[8] There is not good evidence that it works better than other PPIs.[3]

    Adverse effects

    The most significant adverse reactions (≥2%) reported in clinical trials were diarrhea, abdominal pain, bloating, nausea, upper respiratory tract infection, vomiting, and flatulence.[1]

    Mechanism of action

    Like lansoprazole, dexlansoprazole permanently binds to the proton pump and blocks it, preventing the formation of gastric acid.[8]

    Chemistry

    Dexlansoprazole is the (R)-(+)-enantiomer of lansoprazole, which is a racemic mixture of its (R)-(+) and (S)-(−)-enantiomers.[8] The Takeda drug has a dual release pharmaceutical formulation, with two types of granules of dexlansoprazole, each with a coating that dissolves at a different pH level.[8]

    Pharmacokinetics

    Dexlansoprazole ((R)-(+)-lansoprazole) has the same binding affinity to the proton pump as the (S)-enantiomer, but is associated with a three- to five-fold greater area under the plasma drug concentration time curve (AUC) compared with (S)-lansoprazole.[8] With its dual release pharmaceutical formulation, the first quick release produces a plasma peak concentration about one hour after application, with a second delayed release producing another peak about four hours later.[9][10] As of November 2009, clinical relevance of this form of release has yet to be shown.

    History

    Dexlansoprazole was approved by the U.S. Food and Drug Administration (FDA) in 2009, and was approved in Canada in 2010 and in Mexico in 2011.[8]

    Since Kapidex was approved in 2009, there have been reports of dispensing errors because of confusion with the drugs Casodex (bicalutamide) and Kadian (morphine), which have very different uses from Kapidex and from each other. In 2010, the FDA approved a name change for Kapidex to avoid confusion with the two other medications and Takeda began marketing it under the new name Dexilant.[11] It is also available in Bangladesh for the first time as Dexilend by Ziska Pharmaceuticals. It is also available in Bangladesh as Dexogut by Popular Pharmaceuticals and Delanix by Incepta Pharmaceuticals. It is also available in Bangladesh as Regler by Healthcare Pharmaceuticals Ltd.

    References
    1. Product Information: DEXILANT® delayed release oral capsules, dexlansoprazole delayed release oral capsules. Takeda Pharmaceuticals, Inc., Deerfield, IL, 2010. Revised: September 2012
    2. "Dexlansoprazole Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019.
    3. "[99] Comparative effectiveness of proton pump inhibitors | Therapeutics Initiative". 28 June 2016. Retrieved 14 July 2016.
    4. "Dexlansoprazole Use During Pregnancy". Drugs.com. Retrieved 3 March 2019.
    5. "NADAC as of 2019-02-27". Centers for Medicare and Medicaid Services. Retrieved 3 March 2019.
    6. "The Top 300 of 2020". ClinCalc. Retrieved 11 April 2020.
    7. "Dexlansoprazole - Drug Usage Statistics". ClinCalc. Retrieved 11 April 2020.
    8. Behm BW, Peura DA (August 2011). "Dexlansoprazole MR for the management of gastroesophageal reflux disease". Expert Review of Gastroenterology & Hepatology. 5 (4): 439–45. doi:10.1586/egh.11.37. PMID 21780890.
    9. FDA Approves KAPIDEX (dexlansoprazole) delayed release capsules for the Treatment of GERD
    10. Metz DC, Vakily M, Dixit T, Mulford D (May 2009). "Review article: dual delayed release formulation of dexlansoprazole MR, a novel approach to overcome the limitations of conventional single release proton pump inhibitor therapy". Alimentary Pharmacology & Therapeutics. 29 (9): 928–37. doi:10.1111/j.1365-2036.2009.03984.x. PMID 19298580.
    11. "KAPIDEX (dexlansoprazole) Renamed DEXILANT in U.S. to Avoid Name Confusion". Takeda. 4 March 2010.
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