What is Dexo and How Does It Work?
Dexo, available under brand names like Dexilant, is a prescription medication whose active ingredient is dexlansoprazole. It belongs to a class of drugs known as proton pump inhibitors (PPIs). Dexlansoprazole is the R-enantiomer of lansoprazole, another common PPI. The primary function of a PPI is to reduce the amount of acid produced in the stomach.
The Pharmacology: A Dual Delayed-Release System
Dexo works by specifically blocking the final step of acid production in the stomach. It does this by irreversibly inhibiting an enzyme system called the hydrogen/potassium adenosine triphosphatase (H+/K+ ATPase), also known as the 'proton pump', which is found in the parietal cells of the stomach lining.
A unique feature of dexlansoprazole is its dual delayed-release (DDR) formulation. The capsule contains two types of enteric-coated granules that dissolve at different pH levels. The first batch of granules releases the drug in the proximal duodenum (the first part of the small intestine), leading to an initial peak in plasma concentration within one to two hours. The second batch releases the drug further down in the small intestine, causing a second peak four to five hours after administration. This innovative system provides a more sustained level of the medication in the blood, prolonging the acid suppression effect over 24 hours. A significant advantage of this is that the medication can be taken without regard to meals, unlike many other PPIs.
What Conditions Does Dexo Treat?
Dexo is prescribed by doctors to treat several conditions related to excessive stomach acid.
Key Indications:
- Healing of Erosive Esophagitis (EE): Dexo is effective in healing all grades of erosive esophagitis, which is inflammation and injury to the esophagus caused by stomach acid. The typical treatment duration for healing is usually a defined period.
- Maintenance of Healed Erosive Esophagitis: After the esophagus has healed, Dexo can be used as a maintenance therapy to prevent the return of EE and to provide relief from heartburn. This maintenance period can last for a specific duration in adults.
- Symptomatic Non-Erosive Gastroesophageal Reflux Disease (GERD): Dexo is used to treat heartburn associated with GERD, where there is no esophageal erosion. The standard course for this is also a defined period.
Side Effects, and Important Precautions
Dexo is available in various strengths of delayed-release capsules and is approved for adults and children 12 years of age and older. The specific dosage and duration depend on the condition being treated.
Common and Serious Side Effects
Like all medications, Dexo can cause side effects. The most commonly reported ones are generally mild and may include:
- Diarrhea
- Abdominal pain
- Nausea and vomiting
- Flatulence (gas)
- Upper respiratory infections
Long-term use (typically over a year) or high doses of PPIs like dexlansoprazole may be associated with more serious risks:
- Bone Fractures: An increased risk of fractures of the hip, wrist, or spine.
- Vitamin B12 Deficiency: Long-term use (typically for several years) can lead to difficulty absorbing vitamin B12.
- Hypomagnesemia: Low magnesium levels in the blood, which can be serious, have been reported in patients treated for a certain duration.
- Clostridioides difficile-Associated Diarrhea: PPI therapy may increase the risk of this severe form of diarrhea.
- Fundic Gland Polyps: A type of benign growth in the stomach lining can occur, especially with use longer than one year.
Drug Interactions and Contraindications
Dexo should not be taken by individuals with a known hypersensitivity to dexlansoprazole or any of its components. It is also contraindicated with rilpivirine-containing products (an HIV medication).
Patients should inform their doctor of all medications they are taking, as Dexo can interact with several drugs, including:
- Warfarin (a blood thinner)
- Methotrexate (used for cancer and autoimmune diseases)
- Digoxin (a heart medication)
- Tacrolimus (an immunosuppressant)
- Drugs whose absorption depends on gastric pH, like iron salts, ketoconazole, and certain antiretrovirals such as atazanavir.
Dexo vs. Other Stomach Acid Reducers
Several types of medications are available to treat acid-related conditions. Dexo is a newer-generation PPI, but it's helpful to see how it compares to others.
| Feature | Dexo (Dexlansoprazole) | Omeprazole (Prilosec) | Esomeprazole (Nexium) | H2 Blockers (e.g., Famotidine) |
|---|---|---|---|---|
| Drug Class | Proton Pump Inhibitor (PPI) | Proton Pump Inhibitor (PPI) | Proton Pump Inhibitor (PPI) | Histamine H2-receptor antagonist |
| Mechanism | Blocks the proton pump to stop acid production at the source. | Blocks the proton pump to stop acid production at the source. | Blocks the proton pump to stop acid production at the source. | Blocks histamine signals that tell the stomach to produce acid. |
| Dosing Schedule | Can be taken once daily, with or without food. | Often recommended to be taken before a meal. | Often recommended to be taken before a meal. | Can be taken before or after meals, often for relief. |
| Release | Dual Delayed-Release for prolonged effect. | Standard or delayed-release. | Standard or delayed-release. | Standard release. |
| Availability | Prescription only. | Available both by prescription and over-the-counter (OTC). | Available both by prescription and OTC. | Primarily available OTC. |
Conclusion
Dexo (dexlansoprazole) is a potent and effective proton pump inhibitor used for managing significant acid-related conditions like erosive esophagitis and GERD. Its unique dual delayed-release formulation offers prolonged acid control and the convenience of being taken without regard to meals. While it offers significant benefits, it is a prescription medication that carries potential side effects and risks, particularly with long-term use. As with any medication, it is crucial to use Dexo under the guidance of a healthcare professional who can weigh the benefits against the potential risks for an individual's specific condition.
For more details, you may consult the official FDA label for DEXILANT.
