Drug Cocktails

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Alcohol

Booze, ethyl or ethanol, adult beverage, brew, brewski, liquor, drink, shot, sauce, rot gut, hooch, giggle juice, moonshine, jello shots, wobbly pop

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Interaction

No significant changes were seen in the pharmacokinetics of alcohol or blood alcohol levels in a study where participants were given alcohol (0.6 g/kg) before and after taking lansoprazole 30 mg daily for 3 days.

Mechanism

First-pass metabolism of alcohol is not expected to be affected by proton pump inhibitors as they do not affect alcohol dehydrogenase activity.

Significance

Concurrent use of alcohol and lansoprazole does not appear to be a concern in regard to drug-drug interactions.

However, some conditions for which proton pump inhibitors are used may be worsened by alcohol (e.g. gastroesophageal reflux, peptic ulcer disease, etc), thus there may still be a drug-disease interaction.

Think First

Mixing lansoprazole with alcohol doesn't seem to change the risk of drinking alcohol. This means, your usual dose of lansoprazole and 1 or 2 drinks.

Remember, 1 drink = 1 beer, 1 glass of wine or 1 shot of liquor.

Think First

Alcohol can irritate the stomach lining. This could work against the helpful effects of lansoprazole.

Tobacco

smokes, butts, cigs, cigars, darts, stogies, cancer sticks, chew, dip

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Interaction
Duodenal ulcers treated with a similar class of medication (H2-blockers) heal slower in smokers and are more likely to recur when treatment is over if smoking continues.

Smoking can worsen gastroesophageal reflux disease.

Significance
There is no information regarding drug-drug interactions between smoking and lansoprazole. However, it is possible that a drug-disease interaction could occur.

Think First

Smoking may cause heartburn or slow down the healing of an ulcer. If you are taking lansoprazole for either of these problems, smoking could work against the helpful effects of lansoprazole.

Caffeine

coffee, java, joe, soda, pop, tea, energy drinks (Red Bull®, Monster®, Rock Star®, Amp®, NOS®, Full Throttle®, 5-hour Energy Drink®, Beaver Buzz®), chocolate, cocoa

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Interaction
a) A study investigated the ability of CYP2C19-metabolized proton pump inhibitors to induce CYP1A2 (of which caffeine is a substrate). 14 subjects (12 extensive metabolizers and 2 poor metabolizers) were administered lansoprazole 30 mg daily for 7 days. The pharmacokinetics of lansoprazole was investigated on days 1 and 7. Potential changes in CYP1A2 activity were examined using changes in the rate of caffeine metabolism (the rate was measured during pre-treatment and again on days 1 and 7) using the caffeine breath test and the urinary caffeine metabolite ratio. Caffeine (3 mg/kg PO) was given on days 1 and 7 two hours after lansoprazole administration. The mean AUC of lansoprazole in the poor metabolizers (PM) was approximately 5-fold higher compared to the extensive metabolizers (EM). The half-life of lansoprazole was 3.5-fold higher in the PMs. The results of this study indicated that CYP1A2 activity was not induced by lansoprazole when given at recommended therapeutic doses; this was seen in both the PMs and the EMs.

b) A second study found that concomitant use of lansoprazole and caffeine resulted in a 10% increase in caffeine clearance.

Significance
Lansoprazole may increase the clearance of caffeine by about 10%, but this is not believed to be clinically significant.

Think First

Lansoprazole doesn't seem to affect the way your body handles caffeine.

Think First

Caffeine can cause or worsen heartburn. Caffeine could work against the helpful effects of lansoprazole if you take it to treat heartburn.

Cannabis/ Hash

Marijuana, mary jane, BC bud, blunt, chronic, J, jay, joint, hemp, pot, grass, herb, 420, dope, THC, weed, reefer, ganja, gangster, skunk, hydro, hash oil, weed oil, hash brownies, grease, boom, honey oil, K2, spice, poppers, shatter, budder

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Interaction
Cannabis may inhibit the metabolism of lansoprazole.

Mechanism
Cannabidiol (CBD) may inhibit CYP2C19 and CYP3A4, although this has not been shown at doses used in human studies. Lansoprazole is metabolized by CYP2C19 and CYP3A4.

Significance
The significance of this interaction is unknown.

Think First

Cannabis use could slow down the removal of lansoprazole from your body. This could increase your risk of side effects from lansoprazole.

Cocaine/ Crack

coke, snow, flake, nose candy, blow, lady white, stardust, rock, crystal, bazooka, moon rock, tar

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Opioids

codeine, Tylenol #3®, cody, meperidine, Demerol®, DXM, dextromethorphan, robo, skittles, morphine, morph, monkey, methadone, bupe, sub, or dollies, oxycodone, Oxycontin®, hillbilly heroin, OxyNeo®, OC, oxy, roxy, percs, fentanyl, Sublimaze®, Duragesic®, china white, hydrocodone, Hycodan®, Vicodin®, suboxone®, buprenorphine, vike, heroin, H, horse, junk, smack, brown sugar, black tar, down, china white, purple drank, W18, carfentanil, elephant tranquilizer, loperamide, lope, lean

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Interaction
One study found in vitro data that lansoprazole inhibits the metabolism of oxycodone and methadone.

Mechanism
This appears to be due to CYP2D6 and possibly CYP3A4 inhibition by lansoprazole.

Significance
The significance of this data is unclear and the authors suggest more research should be done in the area.

Theoretically, lansoprazole could result in increase adverse effects from oxycodone or methadone, or other opioids metabolized by these enzymes.

Serious Risk for Harm

It is possible that lansoprazole could slow down the removal of some opioids from your body. This would be like taking too much opioid, and could cause dangerously slow breathing.

Amphetamines/ Stimulants

uppers, ecstasy, E, X, Molly, mesc, XTC, love drug, MDA, MDE, Eve, MDMA, adam, disco biscuit, bennies, black beauties, Dexedrine®, Adderall®, dexies, Ritalin®, speed, crystal, meth, ice, glass, crank, tweak, cat, qat, kat, khat, bath salts, Ivory Wave, Vanilla Sky, Cloud 9

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Interaction
AMPHETAMINES: The absorption of oral amphetamines may be increased by lansoprazole.

DEXMETHYLPHENIDATE (Focalin XR® brand): There is the potential for an interaction between lansoprazole and Focalin XR® dexmethylphenidate extended-release capsules (brand-specific interaction).

METHYLPHENIDATE (Ritalin LA® brand): There is the potential for an interaction between lansoprazole and Ritalin LA® methylphenidate extended-release capsules (brand-specific interaction).

Mechanism
AMPHETAMINES: GI alkalinizing agents may increase the absorption of amphetamines.

DEXMETHYLPHENIDATE (Focalin XR® brand):The release of dexmethylphenidate from Focalin XR® capsules is pH-dependent. The interaction can result in increased early absorption of the dexmethylphenidate and decreased delayed absorption.

METHYLPHENIDATE (Ritalin LA® brand): The release of methylphenidate from Ritalin LA® capsules is pH-dependent. The interaction can result in increased early absorption of the methylphenidate and decreased delayed absorption.

Significance
AMPHETAMINES:Patients who take prescription amphetamines should be monitored for increased response in the immediate period after administration or faster offset of effect at the end of the day when lansoprazole is started.

Patients taking lansoprazole should be warned that recreational amphetamines will be absorbed more quickly and this could lead to toxicity.

DEXMETHYLPHENIDATE (Focalin XR® brand) or METHYLPHENIDATE (Ritalin LA® brand):If lansoprazole is started in a patient using Ritalin LA® capsules or Focalin XR® capsules, monitor for changes in therapeutic effect, especially increased response in the immediate period after administration of a dose and/or a reduced response or faster offset of action than expected at the end of the day. This product's specifically cautions against concomitant use of drugs that alter gastric pH.

Serious Risk for Harm

AMPHETAMINES: If you take amphetamines while you are taking lansoprazole, your body will absorb more of the amphetamine. This is like taking too much amphetamine, and you could overdose.

Serious Risk for Harm

DEXMETHYLPHENIDATE:(specific to Focalin XR® brand): Taking lansoprazole with this form of dexmethylphenidate can speed up how fast the medication is released. This is like taking too much dexmethylphenidate. The beneficial effects of Focalin XR® may not last as long as expected.

Serious Risk for Harm

METHYLPHENIDATE: (interaction is specific to Ritalin LA® brand): Taking lansoprazole with this form of methylphenidate can speed up how fast the medication is released. This is like taking too much methylphenidate. The beneficial effects of Ritalin LA® may not last as long as expected.

Phencyclidine/ Ketamine

PCP, angel dust, PeaCe Pill, rocket fuel, love boat, embalming fluid, elephant tranquilizer, hog, illy, wet, wet stick, dipper, toe tag, cadillac, snorts, or surfer, Special K, vitamin K, CVR, cat tranquilizer, cat valium, jet, kit kat, Ketalar®

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

LSD/ Hallucinogens

acid, blotter, cartoon acid, hit, purple haze, trip, white lightning, raggedy ann, sunshine, window-pane, microdot, boomers, buttons, mesc, peyote, salvia, morning glory seeds, flying saucers, licorice drops, pearly gates, magic mushrooms, shrooms

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Benzodiazepines

benzos, downers, tranquilizers, tranks, Ativan®, Halcion®, Klonopin®, Rivotril®, Restoril®, Serax®, Valium®, Xanax®, Rohypnol® (roofies, rope, the forget or date rape pill)

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Interaction

DIAZEPAM: No significant differences were observed in the plasma elimination half-life, clearance, or volume of distribution of diazepam (100 mcg/kg IV) in a study comparing the effects of lansoprazole co-administration (60 mg daily for 10 days).

Mechanism

DIAZEPAM: The interaction potential with other benzodiazepines is unknown. Lansoprazole may inhibit CYP2C19 and may affect the pharmacokinetics of other benzodiazepines.

Significance

DIAZEPAM: While lansoprazole does not appear to interact with diazepam, the potential effects on other benzodiazepines are unknown.

Lansoprazole does not appear to inhibit CYP2C19 to a clinically relevant extent, so interactions with other benzodiazepines may be minimal.

Think First

DIAZEPAM: Lansoprazole does not appear to change how diazepam works.

Unknown Dangers

OTHER BENZODIAZEPINES: Unknown dangers.

References

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ALSO SEE OMEPRAZOLE

Carrillo JA, Benitez J. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinet 2000; 39: 127-53.

Landes BD, Petite JP, Flouvat B. Clinical pharmacokinetics of lansoprazole. Clin Pharmacokinet 1995; 28: 458-70.

Lefebvre RA, Flouvat B, Karolac-Tamisier S et al. Influence of lansoprazole treatment on diazepam plasma concentrations. Clin Pharmacol Ther 1992; 52: 458-63.

Lexi-Comp ONLINE, Lexi-Comp ONLINE Interaction Analysis, Hudson, Ohio: Lexi-Comp, Inc.; 2021; Jul 10, 2021.

Martin de Argila C. Safety of potent gastric acid inhibition. Drugs. 2005; 65: 97-104.

Moody D, Liu F, Fang W. In vitro Inhibition of Methadone and Oxycodone Cytochrome P450-Dependent Metabolism: Reversible Inhibition by H2-Receptor Agonists and Proton-Pump Inhibitors. J Anal Toxicol 2013; 37: 476-85.

Preston CL (Ed), Stockley’s Interactions Checker. [online] London: Pharmaceutical Press. (accessed on Jul 10, 2021).

Therapeutic Research Center. Natural Medicines [Internet]. Somerville (MA): Lansoprazole; [cited Jul 10, 2021].

Vakily M, Lee RD, Wu J et al. Drug interaction studies with dexlansoprazole modified release (TAK-390MR), a proton pump inhibitor with a dual delayed-release formulation: results of four randomized, double-blind, crossover, placebo-controlled, single-centre studies. Clin Drug Invest 2009; 29: 35-50.

The Drug Cocktails website – “Facts for Youth about mixing Medicine, Booze and Street Drugs” (the “Site”) has been developed as a resource for youth and staff within Children’s & Women’s Health Centre of British Columbia Branch (C&W) for Provincial Health Services Authority and its branch agencies (PHSA)(C&W and PHSA together the “Societies”). There are support systems at the Societies which may not exist in other clinical settings and therefore adoption or use of this manual is not the responsibility of the Societies. Agencies other than the Societies should use Cocktails as a guideline for reference purposes only. The contents of this website were current at the time of development in July 2013. The Societies are not responsible for information that has changed after that time, whether incorporated into the Site or not.

The Site contains best practice knowledge, but practice standards may change as more knowledge is gained. Decision making in a specific context remains the responsibility of attending professionals. Nothing on the Site should in any way be construed as being either official or unofficial policy of the Societies.

Contact information and links to websites contained on the Site are provided for convenience only. The Societies cannot guarantee that the information, links or content from these links remain current. Providing a contact or link does not mean that the Societies endorse the views, products or services that may be offered via the link. The Societies assume no responsibility or liability arising from any error in, or omission of, information or from the use of any information, link, contact, opinion, advice or similar, provided on the Site.

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References

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