Dexend60 mg

Erosive Esophagitis (EE)

Dexend is an established, FDA-approved indication for healing of all grades of erosive esophagitis for up to 8 weeks in adults and adolescents 12 years of age and older. Dexend is also indicated for maintenance of healed erosive esophagitis and relief of heartburn for up to 6 months in adults (up to 16 weeks in patients 12 to 17 years of age).

Symptomatic Non-Erosive Gastroesophageal Reflux Disease (GERD)

Dexend is an established indication for treatment of heartburn associated with symptomatic non-erosive GERD for 4 weeks in adults and adolescents 12 years of age and older.

Each Dexlansoprazole delayed-release capsule contains Dexlansoprazole 30 mg or Dexlansoprazole 60 mg as the active ingredient.

Dexend is a proton pump inhibitor (PPI) medicine used to reduce the amount of acid produced in the stomach. Dexend is commonly prescribed to heal acid-related damage to the food pipe (erosive esophagitis) and to relieve persistent heartburn caused by acid reflux (GERD). Dexend uses a special dual delayed-release capsule technology that releases Dexend in two stages, allowing once-daily dosing to control stomach acid over a longer period. Dexend is taken by mouth, usually once a day, with or without food, and the dose and length of treatment with Dexend depend on the condition being treated. As with all proton pump inhibitors, Dexend should be used at the lowest effective dose for the shortest duration appropriate for the condition.

Proton Pump Inhibitor (PPI)

Dexlansoprazole is the R-enantiomer of lansoprazole and works by irreversibly inhibiting the hydrogen-potassium ATPase (proton pump) enzyme system at the secretory surface of gastric parietal cells, blocking the final step of acid production. Dexlansoprazole is formulated as a Dual Delayed-Release (DDR) capsule containing two types of enteric-coated granules with different pH-dependent release profiles, producing two separate plasma concentration peaks (approximately 1-2 hours and 4-5 hours after dosing) and extending the duration of acid suppression compared with conventional single-release PPIs. Dexlansoprazole is extensively metabolized in the liver, mainly via the CYP2C19 and CYP3A4 enzyme pathways, and has an elimination half-life of approximately 1-2 hours.

• Dexend capsules may be taken with or without food.
• Swallow the Dexend capsule whole; do not crush or chew it.
• If swallowing the capsule whole is difficult, the Dexend capsule may be opened and the granules sprinkled onto a tablespoon of applesauce, then swallowed immediately without chewing; the mixture should not be stored for later use.
• As directed by a healthcare professional, the granules from an opened Dexend capsule may also be mixed with water and given through an oral syringe or a nasogastric tube.
• If a dose of Dexend is missed, take it as soon as remembered; if it is almost time for the next dose, skip the missed dose and continue with the regular schedule. Do not take two doses of Dexend at one time.
• Take Dexend at the same time each day for the best effect.

• Clopidogrel: Dexend may modestly reduce formation of the active metabolite of clopidogrel through CYP2C19 inhibition; in clinical studies with Dexend this reduction was small (about 9%) and was not considered clinically important, but clinical judgment is advised when Dexend is combined with clopidogrel.
• Methotrexate (high-dose): Concomitant use of Dexend with high-dose methotrexate may elevate and/or prolong serum methotrexate levels, increasing the risk of methotrexate toxicity; a temporary interruption of Dexend may be considered by the prescriber.
• Warfarin: Concomitant use with Dexend may increase INR and prothrombin time, raising bleeding risk; INR/PT monitoring is recommended.
• Drugs dependent on gastric pH for absorption (e.g., certain antifungal and antiretroviral drugs such as ketoconazole, itraconazole, atazanavir): Because Dexend reduces stomach acidity, Dexend can lower the absorption and effectiveness of these drugs.
• Rilpivirine-containing products: Concurrent use with Dexend is contraindicated because Dexend significantly decreases rilpivirine plasma concentrations and can cause loss of antiviral effect.
• Tacrolimus: Dexend may increase tacrolimus blood concentrations, particularly in patients who are CYP2C19 intermediate or poor metabolizers; monitoring of tacrolimus levels is advised.
• Digoxin: Dexend may increase digoxin exposure; monitoring for digoxin toxicity is recommended.
• Strong CYP2C19/CYP3A4 inducers (e.g., rifampin, St. John's Wort): These may substantially decrease Dexend concentrations and reduce its effectiveness; concomitant use should generally be avoided.

Common Side Effects

Diarrhea, abdominal pain, nausea, upper respiratory tract infection, vomiting, and flatulence are the most commonly reported side effects of Dexend. In adolescents (12-17 years), headache, abdominal pain, diarrhea, nasopharyngitis, and oropharyngeal pain have also been reported with Dexend.

Serious Side Effects - Seek Medical Attention

• Signs of a severe allergic reaction (anaphylaxis) such as swelling of the face or throat, severe rash, or difficulty breathing.
• Severe skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis (blistering or peeling skin).
• Signs of kidney problems (acute tubulointerstitial nephritis), such as decreased urination, blood in urine, or swelling.
• Persistent, watery, or bloody diarrhea, which may indicate Clostridioides difficile-associated diarrhea (see Precautions and Warnings).
• Signs of liver problems, such as yellowing of the skin or eyes, dark urine, or severe abdominal pain.
• New or worsening joint pain with a rash on the cheeks or arms that worsens in sunlight (possible cutaneous or systemic lupus erythematosus).
• Signs of low magnesium, such as seizures, irregular heartbeat, tremors, or muscle spasms, particularly with long-term Dexend use (see Precautions and Warnings).
• A bone fracture, particularly of the hip, wrist, or spine, associated with long-term Dexend use (see Precautions and Warnings).

Pregnancy

There are no adequate, well-controlled studies of Dexend use in pregnant women. Animal reproduction studies with Dexend showed effects on fetal/offspring bone development (reduced femur weight, femur length, and growth plate thickness) at maternal exposures around 1.8 times the recommended human dose. Dexend should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, and pregnant women should discuss the use of Dexend with their healthcare provider.

Breastfeeding

It is not known whether Dexend passes into human breast milk; related lansoprazole metabolites have been detected in the milk of lactating rats. The decision to use Dexend while breastfeeding should weigh the benefits of breastfeeding and the mother's clinical need for Dexend against any potential risk to the infant, and should be made in consultation with a healthcare professional.

• Gastric malignancy: A symptomatic response to Dexend does not exclude the presence of gastric cancer; consider further evaluation, especially in older patients or those with alarm symptoms such as unexplained weight loss or persistent vomiting.
• Acute tubulointerstitial nephritis: This kidney condition may occur at any point during treatment with Dexend; discontinue promptly if it is suspected.
• Clostridioides difficile-associated diarrhea: Proton pump inhibitors such as Dexend may be associated with an increased risk of C. difficile infection, particularly in hospitalized patients; use Dexend at the lowest effective dose for the shortest duration needed.
• Bone fracture risk: Long-term use of Dexend, especially at high doses and for a year or longer, has been associated with an increased risk of osteoporosis-related fractures of the hip, wrist, or spine; at-risk patients should follow guidance on adequate calcium and vitamin D intake and use the lowest effective Dexend dose.
• Hypomagnesemia: Low blood magnesium has been reported with prolonged Dexend use, generally after 3 months or more and most often after a year; healthcare providers may consider checking magnesium levels before and periodically during long-term Dexend therapy.
• Vitamin B12 (cyanocobalamin) deficiency: Long-term use of Dexend, generally longer than 3 years, may reduce absorption of vitamin B12; monitor for signs of deficiency if long-term Dexend use is required.
• Cutaneous and systemic lupus erythematosus: New-onset or worsening lupus has been reported with PPI use, including Dexend; discontinue Dexend and refer to a specialist if manifestations occur.
• Fundic gland polyps: Long-term use of Dexend, especially beyond 1 year, is associated with an increased risk of benign fundic gland polyps; use the shortest duration of Dexend appropriate for the condition.
• Interference with diagnostic testing: Dexend can cause false-positive results in tests for neuroendocrine tumors (chromogranin A) and in secretin stimulation tests; Dexend should be temporarily stopped before these tests as advised by the prescriber.
• Methotrexate co-administration: See Drug Interactions; high-dose methotrexate combined with Dexend may require temporary interruption of Dexend.

There is limited experience with Dexend overdose, and no cases involving serious harm or death have been reported. If an overdose of Dexend is suspected, do not induce vomiting unless specifically directed to do so by a doctor or a poison control center. Seek immediate medical attention or contact an emergency or poison control service. Treatment of Dexend overdose is symptomatic and supportive; Dexend is not effectively removed by hemodialysis.

Store Dexend according to the instructions on the product label, and keep Dexend out of the reach of children.

Children

The safety and effectiveness of Dexend have been established only in patients 12 years of age and older. Dexend is not recommended in children younger than 2 years of age because of a potential risk of heart valve (mitral valve) thickening observed in animal studies, and Dexend has not been shown to be effective for symptomatic GERD in infants 1 month to less than 1 year of age. Use of Dexend in children below 12 years of age should only occur under specialist guidance.

Elderly

No overall differences in the safety or effectiveness of Dexend were observed between elderly and younger patients in clinical trials, although elimination of Dexend may be slower and drug exposure somewhat higher in older adults. No dose adjustment of Dexend is required based on age alone, but elderly patients using Dexend long-term should be monitored for bone, magnesium, and vitamin B12-related risks (see Precautions and Warnings).

Renal Impairment

No dosage adjustment of Dexend is required in patients with renal impairment, as Dexend is primarily eliminated through the liver rather than the kidneys.

Hepatic Impairment

No dose adjustment of Dexend is needed in mild hepatic impairment (Child-Pugh Class A). In moderate hepatic impairment (Child-Pugh Class B), the recommended dose of Dexend for healing erosive esophagitis is reduced to 30 mg once daily. Dexend is not recommended in patients with severe hepatic impairment (Child-Pugh Class C), as Dexend has not been studied in this population.

The duration of Dexend treatment depends on the indication: healing of erosive esophagitis is typically treated with Dexend for up to 8 weeks; maintenance therapy after healing, to keep the esophagitis healed and control heartburn, may continue with Dexend for up to 6 months in adults (up to 16 weeks in patients 12-17 years); and symptomatic non-erosive GERD is generally treated with Dexend for 4 weeks. Long-term or repeated courses of Dexend should be reviewed periodically by a healthcare professional, given the risks associated with prolonged PPI use (see Precautions and Warnings).

Proton Pump Inhibitor (PPI); Antisecretory / Antiulcer agent

Dexlansoprazole irreversibly binds to and inhibits the hydrogen-potassium ATPase (H+/K+-ATPase) enzyme, or proton pump, located on the surface of gastric parietal cells, thereby blocking the final step of gastric acid secretion regardless of the stimulus.

Dexend is approved for use only in patients 12 years of age and older for the labeled indications. The safety and effectiveness of Dexend have not been established in children below 12 years of age. Dexend is not recommended in children under 2 years of age because of a possible risk of heart valve thickening seen in animal studies, and studies have not shown Dexend (or its parent compound lansoprazole) to be effective for symptomatic GERD in infants aged 1 month to less than 1 year.