Adults

The usual adult dose is 500 mg once daily, preferably in the morning before breakfast. Dosage may vary based on condition severity and physician's discretion. For severe conditions, higher doses or twice-daily regimens might be considered.

Elderly

No specific dose adjustment is generally required for elderly patients, but caution is advised due to potential age-related decrease in renal or hepatic function.

Renal_impairment

No dose adjustment is typically needed for patients with mild to moderate renal impairment. For severe renal impairment, consult a physician.

Onset

Onset of action within 1-2 hours, with maximal acid suppression achieved after several days of therapy.

Excretion

Primarily excreted in the urine (approximately 80%), with the remainder excreted in the feces.

Half life

Plasma elimination half-life is approximately 1-1.5 hours, but the duration of acid suppression is much longer due to irreversible binding to the proton pump.

Absorption

Rapidly absorbed after oral administration. Bioavailability increases with repeated dosing. Peak plasma concentrations are achieved within 1-2 hours.

Metabolism

Extensively metabolized in the liver primarily by the cytochrome P450 (CYP) enzyme system, specifically CYP2C19 and CYP3A4.

Digoxin

Increased gastric pH can increase the absorption and plasma levels of digoxin, potentially leading to digoxin toxicity. Monitor digoxin levels.

Warfarin

N-Proton may increase the International Normalized Ratio (INR) and prothrombin time in patients concomitantly receiving warfarin, increasing the risk of bleeding. Monitor INR carefully.

Clopidogrel

Concurrent use may reduce the antiplatelet effect of clopidogrel, especially in CYP2C19 poor metabolizers. Consider alternative antiplatelet therapy or a different PPI.

Methotrexate

N-Proton may elevate and prolong serum levels of methotrexate and/or its metabolite, particularly with high-dose methotrexate. Monitor for methotrexate toxicity.

Ketoconazole/Itraconazole/Atazanavir

Decreased gastric acidity may reduce the absorption of drugs that require an acidic gastric pH for absorption, such as ketoconazole, itraconazole, and atazanavir.