Adults

For duodenal ulcer: 30 mg once daily for 4 weeks. For gastric ulcer and reflux esophagitis: 30 mg once daily for 8 weeks. For H. pylori eradication: 30 mg twice daily for 7-14 days with appropriate antibiotics. For Zollinger-Ellison syndrome: 60 mg once daily, adjusted as needed.

Elderly

No dose adjustment generally required, but caution in severely impaired hepatic function. Close monitoring is recommended.

Renal_impairment

No dose adjustment generally required. However, for severe impairment, monitoring is advised.

Onset

Acid suppression within 1-2 hours. Full therapeutic effect typically achieved within 2-3 days of daily dosing.

Excretion

Primarily excreted in urine (15-30%) and feces (60-80%) as inactive metabolites.

Half life

Approximately 1.3 to 1.7 hours (terminal half-life), but the duration of acid suppression is much longer due to irreversible binding.

Absorption

Rapidly absorbed after oral administration, bioavailability is about 80-90%. Food can delay absorption but does not significantly affect overall efficacy.

Metabolism

Extensively metabolized in the liver by cytochrome P450 enzymes (primarily CYP2C19 and CYP3A4).

Digoxin

Increased absorption of digoxin due to increased gastric pH, consider dose adjustment.

Warfarin

Potential for increased INR/bleeding risk, close monitoring recommended.

Tacrolimus

Increased tacrolimus plasma concentrations; monitor levels.

Clopidogrel

Possible reduction in antiplatelet effect of clopidogrel due to CYP2C19 inhibition.

Methotrexate

May increase methotrexate levels, especially with high-dose therapy; consider temporary PPI discontinuation.

Atazanavir, Nelfinavir

Reduced absorption and efficacy of these antiretrovirals due to increased gastric pH.

Iron Salts, Ketoconazole, Itraconazole

Reduced absorption of drugs requiring an acidic gastric pH for absorption.