PANTOPRAZOLE

PANTOPRAZOLE

PANTOPRAZOLE

PANTOPRAZOLE

Overview & uses

Pantoprazole is a drug used to reduce the amount of acid secreted in stomach.

Indication (uses)

  • For short term treatment of erosive esophagitis associated with Gastroesophageal Reflux Disease (GERD).
  • For the treatment of Pathological Hypersecretory Conditions including Zollinger-Ellison syndrome.
  • For the maintenance of the healing of Erosive esophagitis.

Pharmacological classification

Proton pump inhibitor for the reduction of gastric acid secretion

Brand names

Protonix

Dosage form

  • Delayed release tablets in strengths of 40 mg and 20 mg for oral use.
  • Delayed release oral suspension in the strength of 40 mg in a unit dose packet.

Mechanism of action

All proton pump inhibitors are inactive at neutral pH. But, as soon as pH drops below 5, the drug rearranges into two positively charged ions and binds with H+K+ATPase enzyme by forming a covalent bond and inactivates the enzyme. It also inhibits the mucosal carbonic anhydrase enzyme.

How to take Pantoprazole tablets (solutab) or capsules?

  • Pantoprazole tablets can be taken without any regard to food.
  • Pantoprazole granules or suspension should be taken 30 minutes before food.
  • Tablet and granules/suspension should be swallowed whole and should not be chewed, crushed or spit.

Dosage

  • Not recommended for children below 1 year as the efficacy of pantoprazole in patients with less than 1 year of age is not established.

For short term treatment of erosive esophagitis associated with Gastroesophageal Reflux Disease (GERD)

For adults

    • 40 mg once a day for up to 8 weeks.

For children of 5 years or older of age

    • Equal to or more than 15 kg but less than 40 kg body weight:
      • 20 mg once a day for up to 8 weeks.
    • For children with 40 kg or more body weight:
      • 40 mg once a day for up to 8 weeks.
    • For the maintenance of healing of erosive esophagitis:
      • For adults:
        • 40 mg once a day.
      • For the treatment of Pathological Hypersecretory Conditions including Zollinger-Ellison syndrome:
        • For adults:
          • 40 mg twice a day.

GERIATRIC DOSE ADJUSTMENT

  • No adjustments needed.

RENAL DOSE ADJUSTMENTS

  • No adjustments needed.

HEPATIC DOSE ADJUSTMENT

  • No adjustments needed for doses up to 40 mg.
  • Data not available for doses higher than 40 mg.

OVERDOSAGE

  • No specific antidote is known.
  • Dialysis does not aid in excess drug removal as Pantoprazole is extensively protein bound.
  • Supportive treatment should be given as and when required.
  • Contact the emergency department of your local hospital in cases of overdose or suspected overdose.

Side effects or unwanted effects

  • The most common adverse reaction is diarrhea.
    • Consult your doctor as soon as possible. This may require discontinuation of the treatment with pantoprazole
  • Headache, nausea, vomiting, abdominal pain, flatulence, dizziness and arthralgia were also observed in adult patients.
    • Ask your pharmacist to recommend a suitable medicine and consult your doctor.
  • Atrophic gastritis.
  • Upper respiratory tract infection, diarrhea, vomiting, rash, fever, headache and abdominal pain was absorbed in pediatric patients.
  • Longtime treatment with pantoprazole may lead to vitamin B12 deficiency.
  • Treatment with proton pump inhibitor may be associated with an increased risk of Clostridium difficile associated diarrhea, particularly in hospitalized patients.
  • Longtime treatment with pantoprazole may increase the risk of osteoporosis-related fractures of hip, wrist or spine.
  • Change of taste or a bad taste, acne, back pain and drowsiness was reported by patients taking pantoprazole for a long period of time.
    • Ask your pharmacist to recommend a suitable medicine and consult your doctor.
  • Hypomagnesemia in patients taking proton pump inhibitors for over a year, characterized by arrhythmias, seizures and tetany.
    • Consult your doctor as soon as possible. This may require magnesium supplement and discontinuation of the proton pump inhibitor.
  • May give false positive urine test for tetrahydrocannabinol in patients on proton pump inhibitor treatment.

WARNINGS

  • Treatment with proton pump inhibitor may be associated with an increased risk of Clostridium difficile associated diarrhea, particularly in hospitalized patients.
  • Longtime treatment with pantoprazole may increase the risk of osteoporosis-related fractures of hip, wrist or spine.
  • Contraindicated in patients with a known hypersensitivity to pantoprazole or any of the content of the formulation.

Pregnancy

Category B, which means that Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

  • No sufficient human studies have been conducted regarding the use of pantoprazole in pregnant women.

Nursing

  • Data not available whether pantoprazole is secreted in the mother’s milk of humans or not.
  • Caution should be exercised while administering pantoprazole to a nursing mother as many drugs are secreted in milk.
  • Caution should be exercised as many drugs are found to be secreted in human milk which causes unwanted exposure of the drug to infant and a potential for side effects associated with that drug.

Interactions

Drug interactions

  • Pantoprazole decreases gastric pH. Any drug, whose absorption is dependent on gastric pH, affects the absorption of that drug when co-administered with Pantoprazole.
    • Absorption of Ketoconazole, Atazanavir, Erlotinib, iron salts and mycophenolate mofetil is decreased while absorption of digoxin in increased.
  • Pantoprazole increases the concentration of Saquinavir.
  • Pantoprazole decreases the concentrations of Rilpivirine, Atazanavir and Nelfinavir.
    • Concomitant use of Pantoprazole with above-mentioned drugs is contraindicated as such combination would decrease the efficacy of anti-HIV treatment and may pose a risk of viral resistance.
  • Concomitant use of Pantoprazole and warfarin should be done under strict monitoring, particularly for the increases in INR and prothrombin time.
  • Concomitant use of Pantoprazole and methotrexate may lead to increased and prolonged plasma concentration of methotrexate and/or its metabolite hydromethotrexate.
  • No dose adjustment is required for clopidogrel when co-administered with pantoprazole.

Drug-food interactions

  • Pantoprazole granules or suspension should be taken on an empty stomach at least 30 minutes before meals.
  • Pantoprazole tablet can be taken without any regard to food.
  • Avoid alcohol when on pantoprazole treatment. Pantoprazole may cause drowsiness or dizziness which may worsen when combined with alcohol.

Note: The sole purpose of every information shared on this article is to bring awareness. Do not use this information as aa piece of medical adviceor prescription advice or as a tool for the treatment, diagnosis or prevention of the disease.