Zoton FasTab

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Zoton FasTab on Prescriptsy

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Zoton FasTab is an orodispersible tablet formulation of lansoprazole, a proton pump inhibitor (PPI), manufactured by Pfizer.

Each tablet contains lansoprazole 15 mg or 30 mg in a rapidly disintegrating MUPS (Multiple Unit Pellet System) formulation that dissolves on the tongue without water, releasing enteric-coated microgranules for absorption in the duodenum.

Zoton FasTab is prescribed for the treatment of gastro-oesophageal reflux disease (GORD), healing and maintenance of duodenal and gastric ulcers, NSAID-associated gastric and duodenal ulcers, eradication of Helicobacter pylori (in combination with antibiotics), and Zollinger-Ellison syndrome.

It is a prescription-only medicine (POM) in the United Kingdom.

Acid-related gastrointestinal disorders are among the most common conditions managed in UK primary care.

Gastro-oesophageal reflux disease affects an estimated 10 to 20% of the adult population in the UK, with symptoms of heartburn and acid regurgitation significantly impacting quality of life, sleep, and productivity.

Peptic ulcer disease (gastric and duodenal ulcers) has declined in prevalence with the widespread use of PPIs and H.

pylori eradication therapy but remains clinically important, particularly in the context of NSAID and aspirin use.

PPIs have revolutionised the management of acid-related disorders since their introduction in the late 1980s, and lansoprazole is one of the most widely prescribed PPIs in the UK.

This page provides a comprehensive clinical guide to Zoton FasTab, covering its mechanism of action, dosage, side effects, long-term safety considerations, and how to obtain it in the United Kingdom.

Important safety information about Zoton FasTab

Before reading further, note these essential safety points about Zoton FasTab.

• Alarm symptoms (unintended weight loss, difficulty swallowing, vomiting blood, black stools) must be investigated before starting PPI treatment, as PPIs can mask symptoms of gastric cancer.
• Use the lowest effective dose for the shortest duration necessary. Review long-term PPI use at least annually.
• Long-term PPI use is associated with potential risks including low magnesium, vitamin B12 deficiency, increased bone fracture risk, and C. difficile infection.
• Do not chew or crush the microgranules after the tablet dissolves, as this destroys the enteric coating.
• Take in the morning, 30 minutes before food, for best acid suppression.

Understanding gastric acid secretion and acid-related disorders

Gastric acid (hydrochloric acid, HCl) is secreted by parietal cells in the gastric mucosa of the stomach body and fundus.

Acid secretion is stimulated by 3 main pathways: histamine (from enterochromaffin-like cells, acting on H2 receptors), acetylcholine (from the vagus nerve, acting on muscarinic M3 receptors), and gastrin (from G cells in the antrum, acting on CCK-B receptors).

All 3 pathways converge on the hydrogen-potassium ATPase (H+/K+ ATPase, the proton pump) on the apical (luminal) surface of the parietal cell, which is the final common pathway for acid secretion.

The proton pump actively transports hydrogen ions into the gastric lumen in exchange for potassium ions, generating a pH as low as 1.0 in the gastric juice.

Gastro-oesophageal reflux disease occurs when gastric acid refluxes through an incompetent lower oesophageal sphincter into the oesophagus, causing mucosal damage (erosive oesophagitis) or symptoms without visible damage (non-erosive reflux disease).

Peptic ulcers develop when the protective mucosal barrier (mucus, bicarbonate, prostaglandins, mucosal blood flow) is overwhelmed by aggressive factors (acid, pepsin, Helicobacter pylori infection, NSAID-induced prostaglandin depletion).

Helicobacter pylori is a gram-negative spiral bacterium that colonises the gastric mucosa, causing chronic gastritis and predisposing to duodenal ulcer, gastric ulcer, and gastric cancer.

How Zoton FasTab works

Lansoprazole is a substituted benzimidazole PPI. It is a prodrug that requires acid activation.

After oral absorption, lansoprazole circulates in the blood and accumulates selectively in the highly acidic secretory canaliculus of the parietal cell (pH approximately 1.0).

In this acidic environment, the prodrug is protonated and undergoes acid-catalysed conversion to the active sulphenamide form.

The sulphenamide reacts with sulfhydryl groups on cysteine residues of the H+/K+ ATPase, forming a covalent disulphide bond.

This irreversibly inactivates the proton pump, and acid secretion from that pump molecule is permanently abolished.

Acid secretion is only restored when new proton pump molecules are synthesised and inserted into the canalicular membrane, which occurs with a half-life of approximately 50 hours.

Because activation requires an acidic environment, lansoprazole only acts on actively secreting proton pumps.

Taking the dose 30 minutes before a meal ensures that the drug reaches peak plasma concentration at the time when parietal cells are transitioning from a resting state (with fewer pumps on the canalicular surface) to an active secretory state (stimulated by the meal), maximising the number of pumps available for inactivation.

A single 30 mg dose of lansoprazole inhibits approximately 80 to 90% of maximal acid output, with the full effect established after 3 to 5 days of daily dosing (as successive doses inactivate progressively more of the pump population).

The orodispersible FasTab formulation uses MUPS technology.

The tablet matrix disintegrates rapidly on the tongue, releasing hundreds of enteric-coated microgranules (approximately 1 mm diameter) that are swallowed with saliva.

The enteric coating (methacrylic acid copolymer) resists dissolution in the acidic stomach but dissolves in the alkaline environment of the duodenum (pH above 5.5), releasing lansoprazole for absorption.

This design achieves the same pharmacokinetic profile as standard lansoprazole capsules while offering the convenience of administration without water.

Clinical evidence for lansoprazole

Lansoprazole has been extensively studied in randomised controlled trials for all its licensed indications.

For GORD, lansoprazole 30 mg daily achieves healing of erosive oesophagitis in approximately 80 to 90% of patients at 8 weeks, comparable to omeprazole 20 mg.

For duodenal ulcer healing, lansoprazole 30 mg daily achieves healing in approximately 90 to 95% at 4 weeks.

For gastric ulcer healing, healing rates of 80 to 90% are achieved at 8 weeks. For H.

pylori eradication, triple therapy with lansoprazole 30 mg twice daily plus 2 antibiotics achieves eradication rates of 80 to 90% in antibiotic-susceptible strains.

Comparative studies have found no clinically significant differences in efficacy between lansoprazole and other PPIs (omeprazole, esomeprazole, pantoprazole, rabeprazole) at standard doses for healing oesophagitis or ulcers.

The choice between PPIs in UK practice is often driven by local formulary preference, cost, and specific drug interaction profiles.

Dosage and administration

Place 1 Zoton FasTab on the tongue. Allow to dissolve (approximately 30 seconds). Swallow the microgranules with saliva. Do not chew.

Take 30 minutes before a meal (usually breakfast) for optimal effect. GORD healing: 30 mg daily for 4 to 8 weeks; maintenance 15 mg daily.

Duodenal ulcer: 30 mg daily for 2 to 4 weeks. Gastric ulcer: 30 mg daily for 4 to 8 weeks. NSAID ulcer prophylaxis: 15 to 30 mg daily.

H. pylori eradication: 30 mg twice daily for 7 days with 2 antibiotics. Zollinger-Ellison: starting dose 60 mg daily, adjusted to response.

Severe hepatic impairment: maximum 15 mg daily.

Side effects of Zoton FasTab

Short-term side effects

Headache, dizziness, nausea, diarrhoea, constipation, abdominal pain, and flatulence are common (1 to 10%). These are generally mild and transient. Dry mouth, rash, fatigue, and liver enzyme elevation are uncommon.

Long-term risks

Hypomagnesaemia (MHRA Drug Safety Update: check magnesium levels before prolonged treatment and periodically thereafter). Vitamin B12 deficiency (due to reduced acid-dependent B12 release from food proteins).

Iron deficiency (reduced non-haem iron absorption). Bone fracture risk (modestly increased hip, wrist, and spine fractures with long-term use, particularly at high doses). C.

difficile infection (reduced gastric acid barrier function). Fundic gland polyps (benign, reversible). Rebound acid hypersecretion on abrupt discontinuation after 8 or more weeks of use.

Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Exclude gastric malignancy before starting treatment if alarm symptoms are present. Use the lowest effective dose for the shortest duration. Review continued need annually.

Do not co-administer with atazanavir. Monitor magnesium levels before and during long-term use. Consider calcium and vitamin D supplementation in patients at risk of osteoporosis.

Reduce dose in severe hepatic impairment. Pregnancy: use only if benefit outweighs risk. Breastfeeding: avoid or use with caution.

Appropriate prescribing of PPIs

PPIs are among the most prescribed medications in the UK, with over 50 million prescriptions dispensed annually.

However, studies suggest that up to 50 to 70% of PPI prescriptions may be inappropriate (no clear indication, excessive dose, or unnecessarily prolonged duration).

NHS England and NICE have issued guidance encouraging deprescribing of PPIs where clinically appropriate.

A structured approach to PPI deprescribing involves reviewing the original indication, assessing current symptom control, attempting a step-down from full dose to half dose (for example 30 mg to 15 mg), followed by a trial of discontinuation with on-demand use if symptoms recur.

Patients should be counselled that rebound acid hypersecretion may cause temporary symptom worsening for 2 to 4 weeks after stopping, and that this does not indicate that long-term PPI therapy is necessary.

For patients with uncomplicated GORD symptoms without oesophagitis, on-demand (as-needed) PPI use is often sufficient and is recommended by NICE as a cost-effective strategy.

For patients with documented erosive oesophagitis (LA Grade C or D), Barrett's oesophagus, or a history of peptic ulcer complicated by bleeding, long-term PPI therapy is clinically justified and should be continued.

Zoton FasTab for patients with swallowing difficulties

The orodispersible FasTab formulation is particularly valuable for patients with dysphagia (difficulty swallowing), which is common in elderly patients, patients with neurological conditions (stroke, Parkinson's disease, motor neurone disease), patients with oesophageal stricture, and patients receiving palliative care.

The microgranules released from the FasTab can also be dispersed in a small amount of water (approximately 15 mL) and administered via a nasogastric tube (8 French gauge or larger), making it suitable for enterally fed patients.

When administering via a tube, disperse the tablet in water, draw up into a syringe, and administer promptly.

Flush the tube with water after administration to ensure complete delivery.

How to get Zoton FasTab in the UK

Zoton FasTab is available on NHS prescription from your GP or an authorised online prescriber registered with the General Pharmaceutical Council (GPhC).

Generic lansoprazole capsules are more commonly dispensed due to lower cost, but the FasTab formulation is specifically indicated when an orodispersible option is needed (difficulty swallowing, nasogastric tube administration).

The standard NHS prescription charge in England is 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Lansoprazole 15 mg is also available without prescription as a pharmacy medicine (P) for short-term symptomatic relief of reflux.

Sources

• Zoton FasTab 30 mg, Summary of Product Characteristics (EMC)
• Lansoprazole, British National Formulary (BNF)
• NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults
• GORD in adults, NICE CKS
• Lansoprazole, NHS
• MHRA Yellow Card Scheme