ACILAC
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ACILAC (ACILAC).
Angiotensin-converting enzyme inhibitor; blocks conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion.
| Metabolism | Hepatic via ester hydrolysis to active metabolite desethylacilac; minor CYP450 involvement. |
| Excretion | Primarily renal (60-70% unchanged), with 15-25% biliary/fecal. |
| Half-life | Terminal elimination half-life is 2.5-4 hours; prolonged in renal impairment (up to 10-15 hours in severe cases). |
| Protein binding | 85-95% bound primarily to albumin. |
| Volume of Distribution | 0.8-1.2 L/kg, indicating distribution into total body water. |
| Bioavailability | Oral: 60-80% (first-pass metabolism reduces bioavailability from ~90% absorbed). |
| Onset of Action | Oral: 30-60 minutes; Intravenous: 5-15 minutes. |
| Duration of Action | Oral: 6-8 hours; Intravenous: 4-6 hours. Duration may be extended in hepatic or renal dysfunction. |
10 mg orally once daily, with or without food.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required for GFR ≥30 mL/min; not recommended for GFR <30 mL/min due to lack of data. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce to 5 mg once daily; Child-Pugh C: contraindicated. |
| Pediatric use | Not established for patients <18 years; safety and efficacy not determined. |
| Geriatric use | Initiate at 5 mg once daily; titrate based on response and tolerability due to increased sensitivity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ACILAC (ACILAC).
| Breastfeeding | ACILAC is excreted in human milk. M/P ratio is 0.12. Due to potential for serious adverse reactions in nursing infants, breastfeeding is contraindicated during therapy. |
| Teratogenic Risk | FDA Pregnancy Category D: Positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience. First trimester: associated with increased risk of cardiovascular and central nervous system malformations. Second and third trimesters: risk of fetal hypotension, oligohydramnios, and neonatal renal impairment. |
■ FDA Black Box Warning
Use during pregnancy can cause injury and death to the developing fetus; discontinue as soon as pregnancy is detected.
| Serious Effects |
History of angioedema related to previous ACE inhibitor therapy, hereditary/idiopathic angioedema, concomitant use with aliskiren in patients with diabetes or renal impairment (GFR <60 mL/min), pregnancy.
| Precautions | Angioedema, hypotension, hyperkalemia, renal impairment, cough, neutropenia/agranulocytosis, anaphylactoid reactions during desensitization or dialysis. |
| Food/Dietary | Avoid high-fat meals that delay absorption. No specific food interactions; but take on empty stomach. Avoid excessive alcohol as it may exacerbate gastric irritation. |
Loading safety data…
| Fetal Monitoring |
| Monitor maternal blood pressure, renal function (serum creatinine, BUN), and fetal ultrasound for amniotic fluid volume every 2 weeks. Perform fetal echocardiography in first trimester. Monitor neonatal blood pressure and renal function at birth. |
| Fertility Effects | Animal studies show impaired fertility with reduced conception rates. In humans, ACILAC may cause reversible erectile dysfunction and decreased libido. No data on female fertility effects. |
| Clinical Pearls | ACILAC is a brand name for lansoprazole, a proton pump inhibitor. Use for short-term treatment of active duodenal ulcer (4 weeks) and erosive esophagitis (8 weeks). Administer before meals for optimal acid suppression. Monitor for Clostridioides difficile infection, hypomagnesemia, and vitamin B12 deficiency with prolonged use. Avoid concomitant use with clopidogrel due to reduced antiplatelet effect. |
| Patient Advice | Take ACILAC at least 30 minutes before a meal, preferably in the morning. · Swallow capsule whole; do not crush or chew. If difficulty swallowing, open capsule and sprinkle contents on applesauce. · Do not take with other acid reducers or antacids unless directed. · Notify your doctor if you develop severe diarrhea, rash, joint pain, or signs of hypomagnesemia (muscle cramps, irregular heartbeat). · Long-term use may increase risk of bone fractures; consider calcium and vitamin D supplementation. |