Lansoprazole Use in Patients with Addison’s Disease

Glucocorticoid Replacement

• The standard glucocorticoid regimen for adults with Addison’s disease is 15–25 mg hydrocortisone daily, divided into 2–3 doses, and should be optimized before addressing other conditions. [1] [2] 3
• Inadequate hydrocortisone replacement can precipitate a life‑threatening adrenal crisis. [4] [5]

Drug‑Interaction Considerations

• Hydrocortisone metabolism is primarily affected by CYP3A4‑mediated interactions; lansoprazole does not significantly influence this pathway. [3] [6] 7
• Lansoprazole is not listed among drugs that meaningfully alter hydrocortisone clearance. [8] [9] 10
• When gastrointestinal symptoms raise suspicion for malabsorption, clinicians should consider serum cortisol monitoring to verify adequate hydrocortisone absorption. [3] [6]

Stress‑Dosing Guidance

• Patients should be instructed to double or triple their hydrocortisone dose during acute illness, including gastrointestinal infections. [4] [5]
• Infection is the most common trigger for adrenal crisis in this population. 2
• Gastrointestinal illness may impair oral medication absorption, further supporting the need for stress dosing. 5
• Delayed treatment of an adrenal crisis can be fatal. [3] [8] 9

Mineralocorticoid Management

• Initiation of lansoprazole does not require reduction of fludrocortisone; mineralocorticoid replacement (typically 0.05–0.2 mg/day) should be maintained unchanged. [1] [2]

Clinical Monitoring

• Adjustments to glucocorticoid therapy should be guided by clinical signs of over‑ or under‑replacement rather than by modifying lansoprazole dose. [3] [6] 7
• Symptoms of under‑replacement—lethargy, nausea, poor appetite, weight loss—can mimic acid‑related disease and must be evaluated carefully. [8] [9] 10

Emergency Preparedness

• All patients should carry an emergency hydrocortisone injection kit and wear medical‑alert identification to mitigate the risk of adrenal crisis. 5