Updates on Pseudoephedrine concern its use, contraindications and chemical compounds usually associated with medicinal formulations.

 Laccourreye O, Werner A, Giroud JP, Couloigner V, Bonfils P, Bondon-Guitton E. Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(1):31–34. doi:10.1016/j.anorl.2014.11.001

Abstract. Due to their vasoconstrictive action on the nasal mucosa, ephedrine and pseudoephedrine are highly efficient amines for relief of nasal congestion. As with any vasoconstrictor and as underscored by the French Society of Otorhinolaryngology in its 2011 guideline, these molecules should not be used in patients under the age of 15. Furthermore, due to unpredictable severe cardiovascular and neurological adverse events that may occur even at low dose and in the absence of any pre-existing pathology, they should not be prescribed for the common cold, and ENT physicians must carefully weigh the risk/benefit ratio in patients with allergic rhinitis. Distribution should be regulated and over-the-counter sales banned. Copyright © 2014 Elsevier Masson SAS.

Głowacka K, Wiela-Hojeńska A. Pseudoephedrine-Benefits and Risks. Int J Mol Sci. 2021 May 13;22(10):5146. doi: 10.3390/ijms22105146. 

Abstract. Pseudoephedrine (PSE) is a drug with a long history of medical use; it is helpful in treating symptoms of the common cold and flu, sinusitis, asthma, and bronchitis. Due to its central nervous system (CNS) stimulant properties and structural similarity to amphetamine, it is also used for non-medical purposes. The substance is taken as an appetite reducer, an agent which eliminates drowsiness and fatigue, to improve concentration and as a doping agent. Due to its easier availability, it is sometimes used as a substitute for amphetamine or methamphetamine. Pseudoephedrine is also a substrate (precursor) used in the production of these drugs. Time will tell whether legal restrictions on the sale of this drug will reduce the scale of the problem associated with its misuse.

Munafò A, Frara S, Perico N, Di Mauro R, Cortinovis M, Burgaletto C, Cantarella G, Remuzzi G, Giustina A, Bernardini R. In search of an ideal drug for safer treatment of obesity: The false promise of pseudoephedrine. Rev Endocr Metab Disord. 2021 Dec;22(4):1013-1025. doi: 10.1007/s11154-021-09658-w. 

Abstract. Obesity is a major public health problem worldwide. Only relatively few treatment options are, at present, available for the management of obese patients. Furthermore, treatment of obesity is affected by the widespread misuse of drugs and food supplements. Ephedra sinica is an old medicinal herb, commonly used in the treatment of respiratory tract diseases. Ephedra species contain several alkaloids, including pseudoephedrine, notably endowed with indirect sympathomimetic pharmacodynamic properties. The anorexigenic effect of pseudoephedrine is attributable primarily to the inhibition of neurons located in the hypothalamic paraventricular nucleus (PVN), mediating satiety stimuli. Pseudoephedrine influences lipolysis and thermogenesis through interaction with β3 adrenergic receptors and reduces fat accumulation through down-regulation of transcription factors related to lipogenesis. However, its use is associated with adverse events that involve to a large extent the cardiovascular and the central nervous system. Adverse events of pseudoephedrine also affect the eye, the intestine, and the skin, and, of relevance, sudden cardiovascular death related to dietary supplements containing Ephedra alkaloids has also been reported. In light of the limited availability of clinical data on pseudoephedrine in obesity, along with its significantly unbalanced risk/benefit profile, as well as of the psychophysical susceptibility of obese patients, it appears reasonable to preclude the prescription of pseudoephedrine in obese patients of any order and degree. © 2021. The Author(s).

Nakamori S, Takahashi J, Hyuga S, Yang J, Takemoto H, Maruyama T, Oshima N, Uchiyama N, Amakura Y, Hyuga M, Hakamatsuka T, Goda Y, Odaguchi H, Hanawa T, Kobayashi Y. Analgesic Effects of Ephedra Herb Extract, Ephedrine Alkaloids-Free Ephedra Herb Extract, Ephedrine, and Pseudoephedrine on Formalin-Induced Pain. Biol Pharm Bull. 2019;42(9):1538-1544. doi: 10.1248/bpb.b19-00260.

Abstract.  The analgesic effect of Ephedra Herb (EH) is believed to be derived from the anti-inflammatory action of pseudoephedrine (Pse). We recently reported that ephedrine alkaloids-free EH extract (EFE) attenuates formalin-induced pain to the same level as that achieved by EH extract (EHE), which suggests that the analgesic effect of EH may not be due to ephedrine alkaloids (EAs). To examine the contribution of EAs to the analgesic effect of EH, mice were injected with formalin to induce a biphasic pain reaction (first phase, 0-5 min; second phase, 10-45 min) at various time points after oral administration of the following test drugs: ephedrine (Eph), Pse, "authentic" EHE from Tsumura & Co. (EHE-Ts), EFE, and EHE that was used as the source of EFE (EHE-To). Biphasic pain was suppressed at 30 min after administration of Eph, EHE-Ts, and EHE-To. At 6 h after administration of EFE, EHE-To, and Pse-and at 4 to 6 h after administration of EHE-Ts-only second-phase pain was suppressed; however, the effect of Pse at 6 h was not significant. These results suggested that EHE has a biphasic analgesic effect against biphasic formalin-induced pain: in the first phase of analgesia (30 min after administration), biphasic pain is suppressed by Eph; in the second phase of analgesia (4-6 h after administration), second-phase pain is alleviated by constituents other than EAs, although Pse may partially contribute to the relief of second-phase pain.

Tuncer I, Unsal U. Acute effect of pseudoephedrine on macular microcirculation in healthy subjects: an optical coherence tomography angiography study. Jpn J Ophthalmol. 2022 Jan;66(1):94-100. doi: 10.1007/s10384-021-00859-z.

Abstract. Purpose: To quantitatively evaluate the acute effects of pseudoephedrine on the macular microvasculature using optical coherence tomography angiography (OCTA)....Conclusion: Oral pseudoephedrine intake causes a significant decrease in superficial macular blood flow and SFCT. Impairmant of macular microcirculation can be detected noninvasively and quantitavitely by OCTA. © 2021. Japanese Ophthalmological Society.

Spencer BG, Baskin J, Giarola BF, Craig JE. Single Dose of Pseudoephedrine Induces Simultaneous Bilateral Acute Angle Closure Crisis. Case Rep Ophthalmol. 2019;10(3):365–368. Published 2019 Oct 24. doi:10.1159/000503854

Abstract. Simultaneous bilateral acute angle closure crisis (AACC) is a sight-threatening ocular emergency. Many "cold and flu" preparations contain compounds with sympathomimetic or anticholinergic qualities that confer a risk of inducing AACC. We present a review of cold and flu preparation-induced AACC, and present a case of simultaneous bilateral AACC triggered by a single oral dose of pseudoephedrine. The challenges facing the clinician in recognizing simultaneous bilateral AACC in the context of an upper respiratory tract infection are addressed. An awareness of this uncommon clinical entity, its pertinent clinical features, risk factors, and the drug classes that may precipitate an attack is critical for the timely diagnosis and management of this ocular emergency. Notably, clinicians must be aware that even a single dose of an implicated medication may trigger an attack of AACC. Copyright © 2019 by S. Karger AG, Basel

Pseudoephedrine hydrochloride is the chlorine salt  form of pseudoephedrine, a biointegrated monoamine alkaloid that acts as a central nervous system stimulant and is a diastereoisomer of ephedrine.

The name describes the structure of the molecule:

• Pseudoephedrine - It's an alkaloid found in some plants of the Ephedra genus. Its chemical structure is similar to that of ephedrine but with some differences, hence the "pseudo-" prefix in the name.
• hydrochloride indicates that the pseudoephedrine molecule is combined with hydrochloric acid, forming a salt. This salt is often used in medications because it's more stable and soluble than the base pseudoephedrine.

Description of the raw materials used in its production:

• Pseudoephedrine is the main raw material for the production of pseudoephedrine hydrochloride. It is a synthetic chemical compound that can be obtained through chemical synthesis processes from appropriate precursors.
• Hydrochloric acid is used for the formation of pseudoephedrine hydrochloride. It is a corrosive chemical substance that reacts with pseudoephedrine to form its hydrochloride salt.

Industrial chemical synthesis step-by-step:

• Pseudoephedrine Preparation - Pseudoephedrine is prepared through chemical synthesis processes from appropriate precursors, following the proprietary methodologies of the manufacturing companies.
• Reaction with Hydrochloric Acid - Pseudoephedrine is reacted with hydrochloric acid, usually in the form of an aqueous solution, to form pseudoephedrine hydrochloride. During this reaction, hydrochloric acid reacts with the amino group of pseudoephedrine to form the hydrochloride salt.
• Purification - The reaction product is purified to remove any impurities or residual reagents. This can be done through processes such as crystallization, filtration, or washing.
• Drying - The purified pseudoephedrine hydrochloride is dried to remove any solvent or moisture residues.
• Quality Control - Pseudoephedrine hydrochloride undergoes quality control checks to ensure its purity, concentration, and compliance with the required standards.

What it is for and where

Medical

Take only under medical supervision

Pharmaceutical Use. Pseudoephedrine hydrochloride is used as an active ingredient in various decongestant pharmaceutical products, such as tablets, syrups, or nasal sprays.

Both pseudoephedrine and ephedrine, that belong to the amphetamine family, have a long history as nasal decongestants.

Ephedrine was synthesized in 1920 in Japan and subsequently marketed by Merck, while pseudoephedrine appeared on the market shortly afterwards. Ephedrine is administered nasally and a prescription is required for its use while pseudoephedrine is taken orally and is an over-the-counter medicine.

Pseudoephedrine is usually used in combination with other chemical compounds such as acetylsalicylic acid (1) or paracetamol (2) for the symptomatic treatment of nasal congestion.

Treatments with Pseudoephedrine hydrochloride administered twice a day significantly reduced rhinitis and asthma symptoms and improved overall asthma quality of life in patients with seasonal allergic rhinitis and concomitant mild-to-moderate asthma (3).

This study considers that acute administration of pseudoephedrine, even at high doses, has no psychostimulant effects and may be relatively safe for the treatment of non-chronic nasal congestion (4).

With regard to contraindications of this drug, a percentage of somnolence, insomnia and nervousness has been found in children (5).

The combination of two over-the-counter drugs such as ibuprofen and pseudoephedrine has been shown to be effective in rhinogenic headache (6).

Pseudoephedrine is currently banned in the world of sport because its stimulating activity can improve performance. However, its effect is marginal and probably less than that of caffeine (7).

Some studies have warned of unpredictable serious cardiovascular and neurological adverse events that could occur, advising treating physicians to carefully assess the risks when prescribing this substance for the common cold (8).

Like all drugs it can cause side effects. Always ask the physician.

Pseudoephedrine updates

• Molecular Formula: C₁₀H₁₆ClNO
• Linear Formula:  C₆H₅CH[CH(NHCH₃)CH₃]OH·HCl 
• Molecular Weight: 201.69 g/mol
• CAS: 345-78-8
• EC Number: 206-462-1
• UNII  6V9V2RYJ8N
• MDL number MFCD00058088
• PubChem Substance ID  329823450
• Beilstein/REAXYS Number 3915112

Synonyms: 

• Pseudoephedrine Hcl
• Sudafed hydrochloride
• Tussaphed
• CoAdvil
• Novafed
• Dorcol
• Sudomyl

References____________________________________________________________________

(1) Loose I, Winkel M. Clinical, double-blind, placebo-controlled study investigating the combination of acetylsalicylic acid and pseudoephedrine for the symptomatic treatment of nasal congestion associated with common cold. Arzneimittelforschung. 2004;54(9):513–521. doi:10.1055/s-0031-1297006

(2) Furcha R, Monnet J. An open-label, in-use study assessing the warming sensation accompanying IFF Flavour 316282 and the acceptability and local tolerability of a syrup containing paracetamol and pseudoephedrine for the short-term treatment of symptoms of an upper respiratory tract infection. SAGE Open Med. 2015;3:2050312115575937. Published 2015 Mar 19. doi:10.1177/2050312115575937

(3) Nathan RA, Finn AF Jr, LaForce C, et al. Comparison of cetirizine-pseudoephedrine and placebo in patients with seasonal allergic rhinitis and concomitant mild-to-moderate asthma: randomized, double-blind study. Ann Allergy Asthma Immunol. 2006;97(3):389–396. doi:10.1016/S1081-1206(10)60806-X

(4) Sa-Ih N, Reakkamnuan C, Samerphob N, Cheaha D, Niyomdecha S, Kumarnsit E. Local field potential power spectra and locomotor activity following treatment with pseudoephedrine in mice. Acta Neurobiol Exp (Wars). 2020;80(1):19–31.

(5) Gelotte CK, Albrecht HH, Hynson J, Gallagher V. A Multicenter, Randomized, Placebo-Controlled Study of Pseudoephedrine for the Temporary Relief of Nasal Congestion in Children With the Common Cold. J Clin Pharmacol. 2019;59(12):1573–1583. doi:10.1002/jcph.1472

(6) Chiarugi A, Camaioni A. Update on the pathophysiology and treatment of rhinogenic headache: focus on the ibuprofen/pseudoephedrine combination. Acta Otorhinolaryngol Ital. 2019;39(1):22–27. doi:10.14639/0392-100X-1882

(7) Gheorghiev MD, Hosseini F, Moran J, Cooper CE. Effects of pseudoephedrine on parameters affecting exercise performance: a meta-analysis. Sports Med Open. 2018;4(1):44. Published 2018 Oct 5. doi:10.1186/s40798-018-0159-7

(8) Laccourreye O, Werner A, Giroud JP, Couloigner V, Bonfils P, Bondon-Guitton E. Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants. Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Feb;132(1):31-4. doi: 10.1016/j.anorl.2014.11.001. 

Most paracetamol studies focus on dosage and contraindications. The analgesic and antipyretic effects are confirmed.

May F, Peytavin G, Fourati S, et al. Paracetamol absorption test to detect poor enteric absorption of oseltamivir in intensive care unit patients with severe influenza: a pilot study. Intensive Care Med. 2019;45(10):1484–1486. doi:10.1007/s00134-019-05693-z

Zhang AJX, Zhu H, Chen Y, et al. Prostaglandin E2-Mediated Impairment of Innate Immune Response to A(H1N1)pdm09 Infection in Diet-Induced Obese Mice Could Be Restored by Paracetamol. J Infect Dis. 2019;219(5):795–807. doi:10.1093/infdis/jiy527

Shiffman S, Battista DR, Kelly JP, Malone MK, Weinstein RB, Kaufman DW. Prevalence of exceeding maximum daily dose of paracetamol, and seasonal variations in cold-flu season. Br J Clin Pharmacol. 2018;84(6):1250–1257. doi:10.1111/bcp.13551

Walter EB, Hornik CP, Grohskopf L, et al. The effect of antipyretics on immune response and fever following receipt of inactivated influenza vaccine in young children. Vaccine. 2017;35(48 Pt B):6664–6671. doi:10.1016/j.vaccine.2017.10.020

Lee HJ, Suh YJ, Kim AJ, Han SB, Durey A. Hemodynamic changes in patients with influenza A after propacetamol infusion in the emergency department. Am J Emerg Med. 2018;36(1):1–4. doi:10.1016/j.ajem.2017.06.037

Falup-Pecurariu O, Man SC, Neamtu ML, et al. Effects of prophylactic ibuprofen and paracetamol administration on the immunogenicity and reactogenicity of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugated vaccine (PHiD-CV) co-administered with DTPa-combined vaccines in children: An open-label, randomized, controlled, non-inferiority trial. Hum Vaccin Immunother. 2017;13(3):649–660. doi:10.1080/21645515.2016.1223001

Atkinson HC, Stanescu I, Salem II, Potts AL, Anderson BJ. Increased bioavailability of phenylephrine by co-administration of acetaminophen: results of four open-label, crossover pharmacokinetic trials in healthy volunteers [published correction appears in Eur J Clin Pharmacol. 2015 Jun;71(6):771-2]. Eur J Clin Pharmacol. 2015;71(2):151–158. doi:10.1007/s00228-014-1788-5

Diener HC. Paracetamol bei Rückenschmerzen wirkungslos [Paracetamol is ineffective in back pain]. MMW Fortschr Med. 2015;157(14):32. doi:10.1007/s15006-015-3407-5

Karakaya G, Kalyoncu AF. Paracetamol and asthma. Expert Opin Pharmacother. 2003;4(1):13–21. doi:10.1517/14656566.4.1.13

Whitehouse MW, Butters DE. Paracetamol (acetaminophen): a blessing or a hidden curse?. Inflammopharmacology. 2014;22(1):63–65. doi:10.1007/s10787-013-0189-1

Graham GG, Scott KF, Day RO. Tolerability of paracetamol. Drug Saf. 2005;28(3):227–240. doi:10.2165/00002018-200528030-00004

Toussaint K, Yang XC, Zielinski MA, et al. What do we (not) know about how paracetamol (acetaminophen) works?. J Clin Pharm Ther. 2010;35(6):617–638. doi:10.1111/j.1365-2710.2009.01143.x

Mattia C, Coluzzi F. What anesthesiologists should know about paracetamol (acetaminophen). Minerva Anestesiol. 2009;75(11):644–653.

van de Straat R, Bijloo GJ, Vermeulen NP. Paracetamol, 3-monoalkyl- and 3,5-dialkyl-substituted derivatives. Antioxidant activity and relationship between lipid peroxidation and cytotoxicity. Biochem Pharmacol. 1988;37(18):3473–3476. doi:10.1016/0006-2952(88)90699-5

Paracetamol, N-(4-Hydroxyphenyl)acetamide or Acetaminophen, first marketed in the United States in 1950 and in U.K. in 1956, is an active ingredient,analgesic and antipyretic, used for the treatment of influenza and colds, present in the hundreds of drugs that can be sold without a prescription.

Take only under medical supervision

Paracetamol has antipyretic properties similar to aspirin, but unlike aspirin, it has no anti-inflammatory activity. The antipyretic properties of both paracetamol and aspirin are based on the inhibition of prostglandins and other substances by arachidonic acid (1).

The maximum daily dose for adults is 4 grams per day (12). It is usually considered safe even if, in overdose, it is associated with liver injury. Avoid using alcohol, smoking, or other drugs while taking this medicine.

It's also a drug for patients who suffer from pain associated with osteoarthritis.

This study found that paracetamol is effective in reducing fever and symptoms and reflects current recommendations that only treat symptoms and not routine prophylaxis (3).

In particular, in elderly people it is important to strictly follow the advice on maximum doses that should not be exceeded (4).

In infants undergoing major surgery, morphine is used as standard postoperative analgesic therapy. To reduce the amount of morphine, paracetamol has been successfully used (5). 

In children the use of aspirin has almost disappeared and paracetamol has become the primary treatment for analgesia and antipyresis (6).

Contraindications

After ingestion, 90% of paracetamol is metabolized in the liver in combination with glucuronic acid, sulfuric acid and cystine (7).

Paracetamol overdose is the main causative factor of acute liver failure (8) (9) but some natural products have demonstrated hepatoprotective effects against paracetamol-induced hepatotoxicity (10).

Taking paracetamol on an occasional basis does not pose any problems, but taking it regularly and continuously for a few days can increase the risk of cardiovascular disease (11).

Like all drugs it can cause side effects. Always ask the physician.

More about paracetamol

Typical optimal characteristics of the commercial product Paracetamol

Appearance	Powder fine white
Boiling Point	387.8±25.0 °C at 760 mmHg
Melting Point	168.0°C to 172.0°C
Density	1.2930g/mL
Flash Point	188.4±23.2 °C
PSA	49.33000
LogP	0.34
Index of Refraction	1.619
Vapour Pressure	0.0±0.9 mmHg at 25°C
Safety

• Molecular Formula: C₈H₉NO₂
• Linear Formula:  CH₃CONHC₆H₄OH 
• Molecular  Weight: 151.16 g/mol
• CAS: 103-90-2
• EC Number: 203-157-5
• UNII 362O9ITL9D
• InChI=1S/C8H9NO2/c1-6(10)9-7-2-4-8(11)5-3-7/h2-5,11H,1H3,(H,9,10) 
• InChl Key      RZVAJINKPMORJF-UHFFFAOYSA-N
• SMILES    CC(=O)NC1=CC=C(C=C1)O
• IUPAC   N-(4-hydroxyphenyl)acetamide
• ChEBI   46195
• DSSTox Substance ID: DTXSID2020006
• MDL number MFCD00002328
• PubChem Substance  ID 329820028
• NACRES NA.24
• Beilstein/REAXYS Number 2208089

Synonyms: 

• N-(4-hydroxyphenyl)acetamide
• Panadol
• N-Acetyl-p-aminophenol
• Algotropyl
• p-Acetamidophenol
• Hydroxyacetanilide
• p-Hydroxyacetanilide

References__________________________________________________________________

(1) Meredith TJ, Goulding R. Paracetamol. Postgrad Med J. 1980;56(657):459–473. doi:10.1136/pgmj.56.657.459

(2) Food and Drug Administration, HHS.  Organ-specific warnings; internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use; final monograph. Final rule.  Fed Regist. 2009 Apr 29;74(81):19385-409.

(3) Rose MA, Juergens C, Schmoele-Thoma B, Gruber WC, Baker S, Zielen S. An open-label randomized clinical trial of prophylactic paracetamol coadministered with 7-valent pneumococcal conjugate vaccine and hexavalent diphtheria toxoid, tetanus toxoid, 3-component acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b vaccine. BMC Pediatr. 2013;13:98. Published 2013 Jun 21. doi:10.1186/1471-2431-13-98

(4) What dose of paracetamol for older people?. Drug Ther Bull. 2018;56(6):69–72. doi:10.1136/dtb.2018.6.0636

(5) Krekels EH, van Ham S, Allegaert K, et al. Developmental changes rather than repeated administration drive paracetamol glucuronidation in neonates and infants. Eur J Clin Pharmacol. 2015;71(9):1075–1082. doi:10.1007/s00228-015-1887-y

(6) Cranswick N, Coghlan D. Paracetamol efficacy and safety in children: the first 40 years. Am J Ther. 2000;7(2):135–141. doi:10.1097/00045391-200007020-00010

(7) Jóźwiak-Bebenista M, Nowak JZ. Paracetamol: mechanism of action, applications and safety concern. Acta Pol Pharm. 2014;71(1):11–23.

(8) Bretherick AD, Craig DG, Masterton G, et al. Acute liver failure in Scotland between 1992 and 2009; incidence, aetiology and outcome. QJM. 2011;104(11):945–956. doi:10.1093/qjmed/hcr098

(9) Minsart C, Liefferinckx C, Lemmers A, et al. New insights in acetaminophen toxicity: HMGB1 contributes by itself to amplify hepatocyte necrosis in vitro through the TLR4-TRIF-RIPK3 axis. Sci Rep. 2020;10(1):5557. Published 2020 Mar 27. (z) doi:10.1038/s41598-020-61270-1

(10) Chang L, Xu D, Zhu J, Ge G, Kong X, Zhou Y. Herbal Therapy for the Treatment of Acetaminophen-Associated Liver Injury: Recent Advances and Future Perspectives. Front Pharmacol. 2020;11:313. Published 2020 Mar 11. doi:10.3389/fphar.2020.00313

(11) Perrin G, Arnoux A, Berdot S, Katsahian S, Danchin N, Sabatier B. Association Between Exposure to Effervescent Paracetamol and Hospitalization for Acute Heart Failure: A Case-Crossover Study. J Clin Pharmacol. 2022 Jan 16. doi: 10.1002/jcph.2027.

Comparison of the gastric acid inhibition function among lansoprazole, pantoprazole, and their respective stereoisomers in healthy Chinese subjects.
Yu L, Sun LN, Zhang XH, Xu YH, Zhang HW, Shen YW, Xie LJ, Wang MF, Jiao HW, Li YQ, Wang YQ, Liu Y.
Int J Clin Pharmacol Ther. 2019 Nov;57(11):552-560. doi: 10.5414/CP203514.

Pharmacokinetic/Pharmacodynamic Evaluation of Dexlansoprazole Infusion Injection Compared with Lansoprazole in Healthy Chinese Adults.
Wu L, Liu J, Zheng Y, Zhai Y, Lin M, Wu G, Lv D, Shentu J.
Clin Drug Investig. 2019 Oct;39(10):953-965. doi: 10.1007/s40261-019-00824-2.

Vonoprazan versus Lansoprazole for the Initial Treatment of Reflux Esophagitis: A Cost-effectiveness Analysis in Japan.
Habu Y.
Intern Med. 2019 Sep 1;58(17):2427-2433. doi: 10.2169/internalmedicine.2535-18.

Diagnosis and treatment of laryngopharyngeal reflux: Use of empirical lansoprazole.
Batioglu-Karaaltin A, Develioglu O, Akiner U, Kulekci M.
Ear Nose Throat J. 2018 Dec;97(12):E1-E6.

Maintenance for healed erosive esophagitis: Phase III comparison of vonoprazan with lansoprazole.
Ashida K, Iwakiri K, Hiramatsu N, Sakurai Y, Hori T, Kudou K, Nishimura A, Umegaki E.
World J Gastroenterol. 2018 Apr 14;24(14):1550-1561. doi: 10.3748/wjg.v24.i14.1550.

Comparison of oral and intravenous lansoprazole for the prevention of bleeding from artificial ulcers after endoscopic submucosal dissection for gastric tumors: a prospective randomized phase II study (KDOG 0802).
Ishido K, Tanabe S, Azuma M, Katada C, Wada T, Yano T, Koizumi W.
Surg Endosc. 2018 Jun;32(6):2939-2947. doi: 10.1007/s00464-017-6008-9.

Lansoprazole-sulfide, pharmacokinetics of this promising anti-tuberculous agent.
Mdanda S, Baijnath S, Shobo A, Singh SD, Maguire GEM, Kruger HG, Arvidsson PI, Naicker T, Govender T.
Biomed Chromatogr. 2017 Dec;31(12). doi: 10.1002/bmc.4035.

Ingestibility and Formulation Quality of Lansoprazole Orally Disintegrating Tablets.
Chono S, Matsui M, Nakamura K, Kasai R.
J Pharm (Cairo). 2016;2016:6131608. doi: 10.1155/2016/6131608.

Safety

Lansoprazole as an uncommon cause of anaphylaxis: What to give next?
Aydin AA, Bilge S, Duzenli T, Aslan H, Aydin G.
North Clin Istanb. 2018 Aug 8;6(3):315-316. doi: 10.14744/nci.2018.36539.

Population Scale Retrospective Analysis Reveals Potential Risk of Cholestasis in Pregnant Women Taking Omeprazole, Lansoprazole, and Amoxicillin.
Zhang Y, Shi D, Abagyan R, Dai W, Dong M.
Interdiscip Sci. 2019 Jun;11(2):273-281. doi: 10.1007/s12539-019-00335-w.

Lansoprazole is a chemical compound, a benzimidazole sulphoxide derivative is a member of the pyridines and benzimidazoles.

It occurs as a fine, white powder.

What it is used for and where

Take only under medical supervision

It is one of the proton pump inhibitors (omeprazole, pantoprazole, esomeprazole, rabeprazole and ilaprazole) as a potent inhibitor of gastric acid secretion and is widely used for the treatment of gastroesophageal reflux, dyspepsia and peptic ulcer (1).

It's one of the well tolerated drugs and since it has a certain sensitivity to acids, it is normally administered in the form of capsules containing granules coated with enteric substances to prevent gastric decomposition and to increase bioavailability.

Due to its anti-inflammatory properties, it inhibits the induction of various inflammatory mediators, thus preventing acute liver damage (2).

Lansoprazole supplementation (50 mg/kgBW) for 4 weeks produced significant decreases in the renal cyst  and an improvement in renal function through the reduction of plasma creatinine and blood urea nitrogen (3).

Like all drugs it can cause side effects. Always consult your doctor.

Lansoprazole studies

Typical commercial product characteristics Lansoprazole 

Appearance	White powder
Boiling Point	555.8±60.0 °C at 760 mmHg
Melting Point	178-182°C dec.
Flash Point	289.9±32.9°C
Density	1.5±0.1 g/cm3
Loss on drying	≤2.0%
Heavy metals	≤10 ppm
Water	≤1.0%
Sulphated ash	≤0.5%/g
Residue on ignition	≤0.1%
Safety

• Molecular Formula  C₁₆H₁₄F₃N₃O₂S
• Molecular Weight  369.4 g/mol
• Exact Mass   369.075867
• CAS: 103577-45-3   138530-94-6
• UNII    0K5C5T2QPG
• EC Number   2017-001-1
• DSSTox Substance ID  DTXSID4023200
• IUPAC  2-[[3-methyl-4-(2,2,2-trifluoroethoxy)pyridin-2-yl]methylsulfinyl]-1H-benzimidazole
• InChI=1S/C16H14F3N3O2S/c1-10-13(20-7-6-14(10)24-9-16(17,18)19)8-25(23)15-21-11-4-2-3-5-12(11)22-15/h2-7H,8-9H2,1H3,(H,21,22)  
• InChl Key      MJIHNNLFOKEZEW-UHFFFAOYSA-N
• SMILES   CC1=C(C=CN=C1CS(=O)C2=NC3=CC=CC=C3N2)OCC(F)(F)F
• NSC    758710    758638
• MDL number MFCD00866873
• PubChem Substance ID 329750232

Synonyms:

• Prevacid
• Lanzopral
• Blason
• Takepron
• Ketian
• Zoton
• Lancid
• Lansoprazolum
• Lanston
• Lanproton
• Prezal
• Lansopep
• Ulpax
• Lasoprol
• Lanz
• Mesactol
• Bamalite
• Pro Ulco
• Monolitum
• Lanzol
• Lansoprazol
• Lanzul
• Agopton
• PrevOnco
• Limpidex
• Lanzo
• Ogastro
• Biuret Gr
• Lanzor
• 2-(((3-Methyl-4-(2,2,2-trifluoroethoxy)-2-pyridinyl)methyl)sulfinyl)-1H-benzimidazole
• 2-(((3-Methyl-4-(2,2,2-trifluoroethoxy)-2-pyridyl)methyl)sulfinyl)benzimidazole
• 2-[[3-methyl-4-(2,2,2-trifluoroethoxy)pyridin-2-yl]methylsulfinyl]-1H-benzimidazole
• 1H-Benzimidazole, 2-[[[3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridinyl]methyl]sulfinyl]-
• 2-[[3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridyl]methylsulfinyl]-1H-benzimidazole
• 2-(((3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridyl)methyl)sulfinyl)-1H-benzimidazole
• 2-[[[3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridinyl]methyl]sulfinyl]-1H-benzimidazole
• 2-(((3-methyl-4-(2,2,2-trifluoroethoxy)pyridin-2-yl)methyl)sulfinyl)-1H-benzo[d]imidazole
• 1H-Benzimidazole, 2-(((3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridinyl)methyl)sulfinyl)-
• 2-[[[3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridyl]methyl]sulfinyl]-1H-benzimidazole
• 2-[[[3-Methyl-4-(2,2,2-trifluoroethoxy)-2-pyridyl]methyl]sulfinyl]benzimidazole
• 2-{[3-methyl-4-(2,2,2-trifluoroethoxy)pyridin-2-yl]methylsulfinyl}-1H-benzimidazole
• 2-[[3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridinyl]methylsulfinyl]-1H-benzimidazole
• 2-[({3-methyl-4-[(2,2,2-trifluoroethyl)oxy]pyridin-2-yl}methyl)sulfinyl]-1H-benzimidazole
• 2-[[3-methyl-4-[2,2,2-tris(fluoranyl)ethoxy]pyridin-2-yl]methylsulfinyl]-1H-benzimidazole
• 2-[[[3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridyl] methyl] sulfinyl] benzimidazole
• 2-{[3-methyl-4-(2,2,2-trifluoroethoxy)pyridin-2-yl]methanesulfinyl}-1H-1,3-benzodiazole
• 2-({[3-methyl-4-(2,2,2-trifluoroethoxy)pyridin-2-yl]methyl}sulfinyl)-1H-benzimidazole
• 2-({3-Methyl-4-(2,2,2-trifluoroethoxy)-2-pyridyl)methyl} sulphinylbenzimidazole;2-({3-Methyl-4-(2,2,2-trifluoroethoxy)-2-pyridyl)methyl} sulphinylbenzimidazole

References________________________________________

(1) Pharmacological and clinical profile of lansoprazole (Takepron IV injection 30 mg)]. Inatomi N, Nitta K, Sakurai Y. Nihon Yakurigaku Zasshi. 2008 Feb;131(2):149-56.

(2) The Proton Pump Inhibitor Lansoprazole Has Hepatoprotective Effects in In Vitro and In Vivo Rat Models of Acute Liver Injury. Nakatake R, Hishikawa H, Kotsuka M, Ishizaki M, Matsui K, Nishizawa M, Yoshizawa K, Kaibori M, Okumura T. Dig Dis Sci. 2019 Oct;64(10):2854-2866. doi: 10.1007/s10620-019-05622-6.

(3)  Lansoprazole reduces renal cyst in polycystic kidney disease via inhibition of cell proliferation and fluid secretion.  Nantavishit J, Chatsudthipong V, Soodvilai S.  Biochem Pharmacol. 2018 Aug;154:175-182. doi: 10.1016/j.bcp.2018.05.005.

Pantoprazole pretreatment elevates sensitivity to vincristine in drug-resistant oral epidermoid carcinoma in vitro and in vivo.
Lu ZN, Shi ZY, Dang YF, Cheng YN, Guan YH, Hao ZJ, Tian B, He HW, Guo XL.
Biomed Pharmacother. 2019 Sep 27;120:109478. doi: 10.1016/j.biopha.2019.109478.

The Safety of Long-term Daily Usage of a Proton Pump Inhibitor: A Literature Review.  Abbas MK, Zaidi ARZ, Robert CA, Thiha S, Malik BH.  Cureus. 2019 Sep 4;11(9):e5563. doi: 10.7759/cureus.5563.

Outcomes of Prophylactic Pantoprazole in Adult Intensive Care Unit Patients Receiving Dialysis: Results of a Randomized Trial.  Schefold JC, Krag M, Marker S, Perner A, Wetterslev J, Wise MP, Borthwick M, Bendel S, Keus F, Guttormsen AB, Lange T, Møller MH; the SUP-ICU investigators.  Am J Nephrol. 2019;50(4):312-319. doi: 10.1159/000502732.

Subcutaneous pantoprazole in an elderly, palliative care patient.  Michelon H, Souchu H, Chauvron-Defilippi B, Lecoeur A, Villart M, Denis M.  BMJ Support Palliat Care. 2019 Aug 28. pii: bmjspcare-2019-001916. doi: 10.1136/bmjspcare-2019-001916.

Comparison of the gastric acid inhibition function among lansoprazole, pantoprazole, and their respective stereoisomers in healthy Chinese subjects.  Yu L, Sun LN, Zhang XH, Xu YH, Zhang HW, Shen YW, Xie LJ, Wang MF, Jiao HW, Li YQ, Wang YQ, Liu Y.  Int J Clin Pharmacol Ther. 2019 Nov;57(11):552-560. doi: 10.5414/CP203514.

Pantoprazole in ICU patients at risk for gastrointestinal bleeding-1-year mortality in the SUP-ICU trial.  Marker S, Krag M, Perner A, Wetterslev J, Lange T, Wise MP, Borthwick M, Bendel S, Keus F, Guttormsen AB, Schefold JC, Rasmussen BS, Elkmann T, Bestle M, Arenkiel B, Laake JH, Kamper MK, Lång M, Pawlowicz-Dworzanska MB, Karlsson S, Liisanantti J, Dey N, Knudsen H, Granholm A, Møller MH; SUP-ICU trial investigators.  Acta Anaesthesiol Scand. 2019 Oct;63(9):1184-1190. doi: 10.1111/aas.13436.

Effects of Somatostatin Combined with Pantoprazole on Serum C-Reactive Protein and Intercellular Adhesion Molecule-1 in Severe Acute Pancreatitis.  Liu J, Wang G, Liu Y, Huang L, Xu X, Wang J.  J Coll Physicians Surg Pak. 2019 Jul;29(7):683-684. doi: 10.29271/jcpsp.2019.07.683.

Intragastric pH effect of 20mg of levo-pantoprazole versus 40mg of racemic pantoprazole the first seven days of treatment in patients with gastroesophageal reflux disease.  Remes-Troche JM, García García FD, Rojas-Loureiro G, Rivera-Gutiérrez X, Reyes-Huerta J, Amieva-Balmori M.  Rev Gastroenterol Mex. 2019 May 16. pii: S0375-0906(19)30052-7. doi: 10.1016/j.rgmx.2019.02.006.

Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial.  Moayyedi P, Eikelboom JW, Bosch J, Connolly SJ, Dyal L, Shestakovska O, Leong D, Anand SS, Störk S, Branch KRH, Bhatt DL, Verhamme PB, O'Donnell M, Maggioni AP, Lonn EM, Piegas LS, Ertl G, Keltai M, Cook Bruns N, Muehlhofer E, Dagenais GR, Kim JH, Hori M, Steg PG, Hart RG, Diaz R, Alings M, Widimsky P, Avezum A, Probstfield J, Zhu J, Liang Y, Lopez-Jaramillo P, Kakkar A, Parkhomenko AN, Ryden L, Pogosova N, Dans A, Lanas F, Commerford PJ, Torp-Pedersen C, Guzik T, Vinereanu D, Tonkin AM, Lewis BS, Felix C, Yusoff K, Metsarinne K, Fox KAA, Yusuf S; COMPASS Investigators.  Gastroenterology. 2019 Aug;157(2):403-412.e5. doi: 10.1053/j.gastro.2019.04.041

Continuous Infusion versus Intermittent Dosing with Pantoprazole for Gastric Endoscopic Submucosal Dissection.  Lee BE, Kim GH, Song GA, Seo JH, Jeon HK, Baek DH, Kim DU.  Gut Liver. 2019 Jan 15;13(1):40-47. doi: 10.5009/gnl18222. 

Inhibition of STAT3 in gastric cancer: role of pantoprazole as SHP-1 inducer.  Koh JS, Joo MK, Park JJ, Yoo HS, Choi BI, Lee BJ, Chun HJ, Lee SW.  Cell Biosci. 2018 Sep 6;8:50. doi: 10.1186/s13578-018-0248-9.

Meta-analysis of the efficacy and safety of pantoprazole in the treatment and symptom relief of patients with gastroesophageal reflux disease - PAN-STAR.  Dabrowski A, Štabuc B, Lazebnik L.  Prz Gastroenterol. 2018;13(1):6-15. doi: 10.5114/pg.2018.74556.

Safety

Anaphylactic reactions due to pantoprazole: case report of two cases.  Gupta PP, Bhandari R, Mishra DR, Agrawal KK, Bhandari R, Jirel S, Malla G.  Int Med Case Rep J. 2018 May 23;11:125-127. doi: 10.2147/IMCRJ.S153099.

Acute generalized exanthematous pustulosis caused by pantoprazole.  Schmitz B, Sorrells T, Glass JS.  Cutis. 2018 May;101(5):E22-E23

Anaphylaxis as a Rare Side Effect of Pantoprazole; a Case Report.  Faridaalaee G, Ahmadian Heris J.  Emerg (Tehran). 2018;6(1):e34