Pantoprazole (Protonix) is a proton-pump inhibitor that inhibits the secretion of acid by the stomach. Compared to other PPIs like esomeprazole, it is slightly less potent and does not have any significant drug interactions.
Pantoprazole Uses:
It is used for:
-
symptomatic treatment of healing of (GERD) gastroesophageal reflux disease,
-
gastric and duodenal ulcers,
-
For the eradication of Helicobacter pylori infection,
-
Prevention and treatment of NSAID (non-steroidal anti-inflammatory drug) associated gastritis,
-
for the management of Zollinger-Ellison syndrome and other hypersecretory states, and
-
non-variceal upper gastrointestinal bleeding, or non-ulcer dyspepsia.
Oral pantoprazole is used in the treatment of the following conditions:
- For the healing and symptomatic relief of short-term (8 weeks) treatment of Erosive esophagitis associated with gastroesophageal reflux disease in adults and children older than 5 years of age.
- For reducing the relapse rates, as maintenance therapy of healing of erosive esophagitis, and for the reduction of heartburn associated with gastroesophageal reflux disease (GERD).
- For the long-term treatment of hypersecretory conditions like Zollinger-Ellison syndrome.
Intravenous pantoprazole is used for the treatment of the following conditions:
- For the short-term (up to 10 days) treatment of adult patients with Gastroesophageal reflux disease and erosive esophagitis.
- For pathological hypersecretory conditions like Zollinger-Ellison syndrome.
-
Off Label Uses of Pantoprazole in Adults include:
- Treatment of dyspepsia;
- eradication of Helicobacter pylori infection;
- Prevention of NSAID-induced ulcers and rebleeding in peptic ulcers.
- For the prophylaxis of stress ulcers in critically ill patients
Pantoprazole vs Omeprazole:
Pantoprazole and Omeprazole are both potent proton pump inhibitors. However, because of their pharmacokinetic properties, they have slight differences. Long term use of PPIs has been associated with an increased risk of cardiovascular events. However, the increased risk of adverse cardiovascular events has mostly been associated with omeprazole.
Here is a table comparing pantoprazole and Omeprazole:
|
|
Pantoprazole |
Omeprazole |
| Enzymatic metabolism | CYP2C19 and CYP3A4 | CYP2C19 |
| Effects on Platelets reactivity Interaction with Clopidogrel | Not associated with an increased platelet reactivity No | Associated with an increased platelet reactivity Yes |
| Half-life | 1 hour | 1.5 hours |
| Pregnancy risk category | B | C |
| Available as a non-prescription drug | No | Yes |
| Cost | Costly compared to omeprazole | Less costly |
| Dosage formulations | Oral delayed-release tablet, Oral suspension IV injection/infusion | Oral delayed-release tablet, Oral delayed-release capsule, Oral suspension IV injection/infusion |
| Standard dosage? | 40 mg once daily | 20 mg once daily |
| Age limitations | Adults and children 5 years and older | Adults and children 1 year and older |
Other differences between omeprazole and pantoprazole are mainly because of their interactions with other drugs.
Here is a table of some important drug interactions:
Class |
Examples |
Omeprazole |
Pantoprazole |
| Antiretrovirals | Rilpivirine Nelfinavir Atazanavir Saquinavir Ritonavir | Yes | Yes |
| Anticoagulant | Warfarin | Yes | Yes |
| Antiplatelet | Clopidogrel | Yes | No |
| Antimetabolite | Methotrexate | Yes | Yes |
| Immunosuppressive | Mycophenolate mofetil Tacrolimus | Yes | Yes |
| Antifungal | Ketoconazole Itraconazole Voriconazole | Yes | Yes |
| Chemotherapy | Erlotinib Dasatinib Nilotinib | Yes | Yes |
| Iron salts | Ferrous fumarate Ferrous gluconate Ferrous sulfate Ferrous succinate | Yes | Yes |
| Benzodiazepine | Diazepam Midazolam | Yes | No |
| Antiepileptic | Phenytoin | Yes | No |
| Antibiotic | Clarithromycin Rifampin | Yes | Yes |
| Selective serotonin reuptake inhibitor (SSRI) antidepressant | Citalopram | Yes | No |
| Herbal | St. John’s Wort | Yes | Yes |
Does Pantoprazole cause stomach cancer?
Pantoprazole use in animals has been associated with benign and malignant neoplasms, however, human data is limited in this regard. It has been associated with an increased risk of gastric gland polyps. Furthermore, it may mask the symptoms of gastric cancer and lead to a delay in the diagnosis and treatment.
Pantoprazole dose in Adults
Pantoprazole dose in the treatment of dyspepsia:
- 20 to 40 mg orally once a day for four weeks.
Dosage in the treatment of Erosive esophagitis associated with GERD (Acid reflux):
-
Oral pantoprazole:
-
Treatment:
- Pantoprazole 40 mg once a day for up to 8 weeks.
- The treatment may be prolonged in patients who have not healed after 8 weeks of the therapy.
- Patients with GERD who have minimal symptoms may be treated with lower doses of 20 mg once a day.
-
Maintenance of healing:
- 40 mg once a day;
- Lower doses (20 mg per day) may be used.
- Prolonged treatment beyond 12 months has not been studied.
-
-
Intravenous pantoprazole:
- 40 mg once a day for 7 - 10 days
Dosage in the treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome:
-
Oral tablets:
- 40 mg two times a day initially.
- The dose should be adjusted based on the patients' requirements.
- Doses up to 240 mg per day have been used rarely.
-
Intravenous formulation:
- 80 mg every two times a day.
- Higher doses ranging between 160 - 240 mg have been used for short periods (up to 7 days)
Dose in the Prevention of rebleeding in peptic ulcer bleed (off-label use):
-
Intravenous formulations:
-
Continuous infusion:
- A loading dose of 80 mg intravenously is given followed by an 8 mg/hour continuous infusion for 72 hours.
-
Intermittent dosing:
- After a loading dose of 80 mg intravenously, a dose of 40 mg six to twelve hourly for 72 hours may be given.
- It may also be administered without a loading dose.
- Intravenous therapy must be followed by oral therapy.
-
-
Oral formulations:
-
For the treatment of Gastric ulcer:
- 40 mg once a day for 4 - 8 weeks.
-
For the treatment of duodenal ulcer:
- 40 mg once a day for 2 - 4 weeks.
-
Dose as off-label use in the treatment of Helicobacter pylori eradication:
-
H. Pylori eradication regimens - American College of Gastroenterology guidelines :
-
Clarithromycin triple regimen:
- 40 - 80 mg two times a day + clarithromycin 500 mg two times a day + either amoxicillin 1 gm two times a day or metronidazole 500 mg three times per day for 14 days.
-
Bismuth quadruple regimen:
- 40 mg two times a day + tetracycline 500 mg four times per day + metronidazole 250 mg four times a day or 500 mg 3 or 4 times per day + either bismuth subcitrate 120 - 300 mg four times per day or bismuth subsalicylate 300 mg four times a day for 10 - 14 days.
-
Concomitant regimen:
- 40 mg two times a day + amoxicillin 1 gm two times a day + clarithromycin 500 mg two times a day + either metronidazole or tinidazole 500 mg two times a day for 10 to 14 days.
-
Sequential regimen:
- 40 mg two times a day + amoxicillin 1 gm two times a day for 5 to 7 days.
- After 5 - 7 days, continue pantoprazole + clarithromycin 500 mg two times a day + either metronidazole or tinidazole 500 mg two times a day for 5 - 7 days.
-
Hybrid regimen:
- 40 mg two times a day + amoxicillin 1 gm two times a day for 7 days.
- After 7 days, add clarithromycin 500 mg two times a day and either add metronidazole or tinidazole 500 mg two times a day for 7 days.
-
Levofloxacin triple regimen:
- 40 mg two times a day + amoxicillin 1 gm two times a day + levofloxacin 500 mg once a day for 10 - 14 days.
-
Dosage as off-label use in the Prevention of NSAID-induced ulcers:
- 20 - 40 mg orally once a day.
-
When and how to discontinue the therapy?
- Most experts recommend a step-down approach.
- The dose should be reduced by half after 2 - 4 weeks or as alternate days therapy in patients taking the lowest possible dose.
Pantoprazole dose in Childrens
Pantoprazole dosage in children for the treatment of GERD (Gastroesophageal reflux disease):
-
Infants and Children less than 5 years of age:
- 1.2 mg/kg/day orally once a day for four weeks.
-
Children 5 to 11 years:
- 20 - 40 mg orally once a day.
- 20 mg may be appropriate for smaller children.
-
Children and Adolescents 12 to 16 years:
- 20 - 40 mg orally once a day
- 20 mg may be appropriate for smaller children.
Dosage in the treatment of Erosive esophagitis associated with GERD:
-
Children 1 - 5 years:
- 0.3, 0.6, or 1.2 mg/kg/day orally once a day for 8 weeks.
- A fixed-dose of 15 mg and 20 mg may be used for one-year-old and 2 - 5 years of age children respectively.
-
Children older than 5 years and Adolescents:
-
Weight more than 15 to less than 40 kgs:
- 20 mg once daily for up to 8 weeks
-
Weight more than 40 kgs:
- 40 mg once daily for up to 8 weeks
-
Intravenous pantoprazole in the treatment of Gastric acid suppression (in children who can not tolerate oral therapy):
-
Weight-based dosing:
-
Children older than 2 years of age and Adolescents:
- 0.8 or 1.6 mg/kg intravenously once a day.
- A maximum single dose of 80 mg may be used.
-
-
Body surface area (BSA)-based dosing:
-
Infants, Children, and Adolescents:
- 40 mg/1.73 m² /day intravenously.
- The dose may be increased to 80 mg/1.73 m² /day if the response to treatment is inadequate.
-
Pregnancy Risk Category: B
- Pantoprazole might be recommended for pregnant patients who have not responded to H2 blockers and antacids.
Pantoprazole use during breastfeeding:
- It is excreted in breastmilk and is therefore safe to use while breastfeeding.
- It is important to weigh the risks and benefits of breastfeeding therapy for mothers as well as the potential exposure of infants.
Pantoprazole dose in kidney disease:
Dosage adjustment in kidney disease is not necessary. It is not removed by hemodialysis.
Pantoprazole dose in liver disease:
Dose adjustment in liver disease is not necessary.
Pantoprazole Side Effects:
-
Central nervous system:
- Headache
-
Cardiovascular:
- Facial Edema
- Edema
- Thrombophlebitis
-
Central Nervous System:
- Dizziness
- Vertigo
- Depression
-
Dermatologic:
- Skin Rash
- Urticaria
- Pruritus
- Skin Photosensitivity
-
Endocrine & Metabolic:
- Increased Serum Triglycerides
-
Gastrointestinal:
- Diarrhea
- Abdominal Pain
- Vomiting
- Constipation
- Flatulence
- Nausea
- Xerostomia
-
Hematologic & Oncologic:
- Leukopenia
- Thrombocytopenia
-
Hepatic:
- Increased Liver Enzymes
- Hepatitis
-
Hypersensitivity:
- Hypersensitivity Reaction
-
Neuromuscular & Skeletal:
- Arthralgia
- Increased Creatine Phosphokinase
- Myalgia
-
Ophthalmic:
- Blurred Vision
-
Respiratory:
- Upper Respiratory Tract Infection
-
Miscellaneous:
- Fever
Pantoprazole Contraindications:
- Allergy to pantoprazole Anaphylaxis can manifest as hypotension, anaphylactic shock and bronchospasm.
- Avoid using it in combination with rilpivirine or rilpivirine-containing products.
Warnings and precautions
-
Carcinoma
- Although animal studies have shown that it is associated with benign and malignant Neoplasms, there are limited data on its association with cancer.
-
Clostridium difficile-associated diarrhea (CDAD), formerly Clostridium, is now Clostridioides
- There has been an increase in the risk of CDAD due to the use of proton pump inhibitors, (PPIs).
- CDAD should be considered for patients with diarrhea, especially elderly patients who are hospitalized.
- The lowest effective dose of PPIs (including pantoprazole) should be administered and the duration should not exceed 30 minutes.
-
Cutaneous and systemic Lupus Erythematosus
- Pantoprazole has been linked to autoimmune diseases such as Lupus.
- The majority of cases reported involved cutaneous lupus, which is most commonly subacute and can last for weeks or months.
- It is rarer to get systemic lupus, which can occur in a matter of days. This is most common in young adults.
- The patient must stop receiving treatment and be referred to the specialist.
- After discontinuing treatment, symptoms usually improve in 4-12 weeks.
-
Fractures
- Pantoprazole and other PPIs have been linked to an increased risk for bone fractures.
- The hip, spine and wrist are the most common fractures that PPIs cause.
- Patients who are on long term therapy (one year or more) and those on high doses of PPIs should be evaluated for osteoporosis and fracture risk.
- Adequate calcium intake and Vitamin D supplementation are necessary for these patients.
-
Polyps of the fundic gland:
- Long-term use of PPIs (more than a year) has been linked to an increased risk for polyp formation in stomach fundus.
- The best PPIs should not be taken for longer than necessary and at the lowest dose.
- Diagnosis of gastrointestinal polyps can lead to dyspepsia or gastrointestinal bleeding, anemia, and intestinal obstruction.
-
Gastrointestinal infections:
- Use of PPIs can increase the risk of gastrointestinal infections such as salmonella or campylobacter.
- Patients on long-term PPIs and those with achlorhydria are at increased risk of developing typhoid fever in developing countries.
-
Hepatic effects
- It may increase liver enzymes.
-
Hypomagnesemia:
- With prolonged PPI use (3 months or more), hypomagnesemia has been reported as either symptomatic or asymptomatic.
- Baseline serum magnesium levels should always be checked when PPIs are to be used for long-term use.
- Patients on medications that can cause hypomagnesemia, or medication that may increase the risk of arrhythmias, should have their baseline serum magnesium levels checked before initiating long-term PPIs.
- When the medication is stopped along with magnesium supplementation, hypomagnesemia will usually disappear within 2 weeks.
-
Reactions that are related to infusion:
- Pantoprazole intravenous administration may cause thrombophlebitis or other allergic reactions such as Stevens-Johnson Syndrome, erythema multiforme and toxic epidermal necrolysis.
-
Interstitial nephritis:
- Acute interstitial Nephritis may be a sign of idiopathic hypersensitivity reactions. This can occur at any stage during treatment.
-
Vitamin B complex deficiency:
- Long-term (more than two years) use may lead to malabsorption, which can manifest as diarrhea or deficiency in B complex vitamins.
- Malabsorption is more common in younger patients and females.
- When PPI treatment is stopped, the condition will improve.
-
Gastric cancer:
- PPIs can mask the symptoms of gastrointestinal malignancies.
Pantoprazole: Drug Interaction
|
Risk Factor C (Monitor therapy) |
|
|
Amphetamine |
Proton Pump Inhibitors may increase the absorption of Amphetamine. |
|
Bisphosphonate Derivatives |
Proton Pump Inhibitors may diminish the therapeutic effect of Bisphosphonate Derivatives. |
|
Capecitabine |
Proton Pump Inhibitors may diminish the therapeutic effect of Capecitabine. |
|
Cefpodoxime |
Proton Pump Inhibitors may decrease the serum concentration of Cefpodoxime. |
|
Clopidogrel |
Pantoprazole may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Due to the possible risk for impaired clopidogrel effectiveness, clinicians should carefully consider the need for proton pump inhibitor therapy in patients receiving clopidogrel. Other acid-lowering therapies do not appear to share this interaction. |
|
CYP2C19 Inducers (Moderate) |
May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). |
|
Cysteamine (Systemic) |
Proton Pump Inhibitors may diminish the therapeutic effect of Cysteamine (Systemic). |
|
Dexmethylphenidate |
Proton Pump Inhibitors may increase the absorption of Dexmethylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption. |
|
Dextroamphetamine |
Proton Pump Inhibitors may increase the absorption of Dextroamphetamine. Specifically, the dextroamphetamine absorption rate from mixed amphetamine salt extended release (XR) capsules may be increased in the first hours after dosing. |
|
Doxycycline |
Proton Pump Inhibitors may decrease the bioavailability of Doxycycline. |
|
Fluconazole |
May increase the serum concentration of Proton Pump Inhibitors. |
|
Indinavir |
Proton Pump Inhibitors may decrease the serum concentration of Indinavir. |
|
Iron Salts |
Proton Pump Inhibitors may decrease the absorption of Iron Salts. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Isomaltoside; Iron Sucrose. |
|
Lumacaftor |
May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). |
|
Methotrexate |
Proton Pump Inhibitors may increase the serum concentration of Methotrexate. |
|
Methylphenidate |
Proton Pump Inhibitors may increase the absorption of Methylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption. |
|
Multivitamins/Minerals (with ADEK, Folate, Iron) |
Proton Pump Inhibitors may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be decreased. |
|
Mycophenolate |
Proton Pump Inhibitors may decrease the serum concentration of Mycophenolate. Specifically, concentrations of the active mycophenolic acid may be reduced. |
|
Raltegravir |
Proton Pump Inhibitors may increase the serum concentration of Raltegravir. |
|
Riociguat |
Proton Pump Inhibitors may decrease the serum concentration of Riociguat. |
|
Saquinavir |
Proton Pump Inhibitors may increase the serum concentration of Saquinavir. |
|
SORAfenib |
Proton Pump Inhibitors may decrease the absorption of SORAfenib. |
|
Tipranavir |
May decrease the serum concentration of Proton Pump Inhibitors. These data are derived from studies with Ritonavir-boosted Tipranavir. |
|
Voriconazole |
May increase the serum concentration of Proton Pump Inhibitors. Proton Pump Inhibitors may increase the serum concentration of Voriconazole. Management: In patients receiving omeprazole 40 mg/day or greater, reduce omeprazole dose by half when initiating voriconazole. |
|
Risk Factor D (Consider therapy modification) |
|
|
Atazanavir |
Proton Pump Inhibitors may decrease the serum concentration of Atazanavir. Management: See full drug interaction monograph for details. |
|
Bosutinib |
Proton Pump Inhibitors may decrease the serum concentration of Bosutinib. Management: Consider alternatives to proton pump inhibitors, such as short-acting antacids or histamine-2 receptor antagonists. Administer alternative agents more than 2 hours before or after bosutinib. |
|
Cefditoren |
Proton Pump Inhibitors may decrease the serum concentration of Cefditoren. Management: If possible, avoid use of cefditoren with proton pump inhibitors (PPIs). Consider alternative methods to minimize/control acid reflux (eg, diet modification) or alternative antimicrobial therapy if use of PPIs can not be avoided. |
|
CYP2C19 Inducers (Strong) |
May increase the metabolism of CYP2C19 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. |
|
Dabrafenib |
May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP2C19 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). |
|
Enzalutamide |
May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Conversely, concentrations of active metabolites may be increased for those drugs activated by CYP2C19. Management: Concurrent use of enzalutamide with CYP2C19 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C19 substrate should be performed with caution and close monitoring. |
|
Gefitinib |
Proton Pump Inhibitors may decrease the serum concentration of Gefitinib. Management: Avoid use of proton pump inhibitors (PPIs) with gefitinib when possible. If required, administer gefitinib 12 hours after administration of the PPI or 12 hours before the next dose of the PPI. |
|
Itraconazole |
Proton Pump Inhibitors may increase the serum concentration of Itraconazole. Proton Pump Inhibitors may decrease the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any proton pump inhibitors (PPIs). Exposure to Tolsura brand itraconazole may be increased by PPIs; consider itraconazole dose reduction. |
|
Ketoconazole (Systemic) |
Proton Pump Inhibitors may decrease the serum concentration of Ketoconazole (Systemic). Ketoconazole (Systemic) may increase the serum concentration of Proton Pump Inhibitors. Management: Avoid concomitant administration of proton pump inhibitors (PPIs) and ketoconazole when possible due to the risk of ketoconazole therapeutic failure. Administration of ketoconazole with an acidic beverage (eg, cola) may facilitate ketoconazole absorption. |
|
Ledipasvir |
Proton Pump Inhibitors may decrease the serum concentration of Ledipasvir. Management: PPI doses equivalent to omeprazole 20 mg or lower may be given with ledipasvir under fasted conditions. Administration with higher doses of PPIs, 2 hours after a PPI, or in combination with food and PPIs may reduce ledipasvir bioavailability. |
|
Mesalamine |
Proton Pump Inhibitors may diminish the therapeutic effect of Mesalamine. Proton pump inhibitor-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Consider avoiding concurrent administration of high-dose proton pump inhibitors (PPIs) with sustainedrelease mesalamine products. |
|
Nilotinib |
Proton Pump Inhibitors may decrease the serum concentration of Nilotinib. Management: Avoid this combination when possible since separation of doses is not likely to be an adequate method of minimizing the interaction. |
|
Posaconazole |
Proton Pump Inhibitors may decrease the serum concentration of Posaconazole. |
|
Risedronate |
Proton Pump Inhibitors may diminish the therapeutic effect of Risedronate. Proton Pump Inhibitors may increase the serum concentration of Risedronate. This applies specifically to use of delayed-release risedronate. |
|
Secretin |
Proton Pump Inhibitors may diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of proton pump inhibitors (PPIs) and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details. |
|
Risk Factor X (Avoid combination) |
|
|
Acalabrutinib |
Proton Pump Inhibitors may decrease the serum concentration of Acalabrutinib. |
|
Cefuroxime |
Proton Pump Inhibitors may decrease the absorption of Cefuroxime. |
|
Dacomitinib |
Proton Pump Inhibitors may decrease the serum concentration of Dacomitinib. Management: Avoid concurrent use of dacomitinib with proton pump inhibitors. Antacids may be used. Histamine H2-receptor antagonists (HR2A) may be used if dacomitinib is given at least 6 hours before or 10 hours after the H2RA. |
|
Dasatinib |
Proton Pump Inhibitors may decrease the serum concentration of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of the proton pump inhibitor if some acid-reducing therapy is needed. |
|
Delavirdine |
Proton Pump Inhibitors may decrease the serum concentration of Delavirdine. Management: Chronic therapy with proton pump inhibitors (PPIs) should be avoided in patients treated with delavirdine. The clinical significance of short-term PPI therapy with delavirdine is uncertain, but such therapy should be undertaken with caution. |
|
Erlotinib |
Proton Pump Inhibitors may decrease the serum concentration of Erlotinib. |
|
Nelfinavir |
Proton Pump Inhibitors may decrease serum concentrations of the active metabolite(s) of Nelfinavir. Proton Pump Inhibitors may decrease the serum concentration of Nelfinavir. |
|
Neratinib |
Proton Pump Inhibitors may decrease the serum concentration of Neratinib. Specifically, proton pump inhibitors may reduce neratinib absorption. |
|
PAZOPanib |
Proton Pump Inhibitors may decrease the serum concentration of PAZOPanib. |
|
Pexidartinib |
Proton Pump Inhibitors may decrease the serum concentration of Pexidartinib. Management: If acid-reduction is needed, consider administering an antacid 2 hours before or after pexidartinib, or administer pexidartinib 2 hours before or 10 hours after an H2 receptor antagonist. |
|
Rilpivirine |
Proton Pump Inhibitors may decrease the serum concentration of Rilpivirine. |
|
Velpatasvir |
Proton Pump Inhibitors may decrease the serum concentration of Velpatasvir. |
Monitor:
- Monitor the patient for Clostridium deficille associated diarrhea
- Serum gastrin levels
- Magnesium levels
- Bone density and fracture risk.
- Monitor acid output measurements in patients with hypersecretory disorders (keep less than 10 mEq/hour as the target level (<5 mEq/hour if prior gastric acid-reducing surgery)
How to administer Pantoprazole (Protonix)?
Intravenous formulation:
(When administering, flush your intravenous line using dextrose water or normal saline.
-
Administration in a 2-minute injection
- You can administer the reconstituted solution (4mg/ml) intravenously for up to 2 minutes.
-
AdministratiAs a 15-minute infusion
- Infusions may be administered at 7 ml/minute (3 mg/minute), over 15 minutes.
-
Continuous infusion:
- It can be administered intravenously to patients suffering from active peptic ulcer bleeding.
Oral formulations - When is the best time to take Pantoprazole in an oral formulation?
-
Tablet pantoprazole:
- You should not crush, chew, or break the tablet.
- It should be taken whole, with or without food.
- It does not affect the absorption of an antacid if it is taken concurrently.
- You should take it 30 minutes to an hour before breakfast, or twice daily before dinner.
-
Oral suspension with delayed release
- It can be taken in apple juice, applesauce, but not mixed with water or other foods.
- You should not crush or chew the granules.
- You should take it about 30 minutes before you eat.
-
Oral administration of applesauce
- You can sprinkle the granules on a teaspoon of applesauce, and then swallow it within ten minutes.
-
Oral administration of apple juice
- You can also take 5 ml apple juice.
- Mix the granules with 5 mL apple juice. Stir for 5 seconds and then swallow immediately.
- You should rinse the container at least twice more to ensure that there are no granules.
-
Administration of the naogastric tube:
- You can administer the granules via a nasogastric tube.
- Mix the granules with 10 ml apple juice. The 60 ml feeding needle is shaken and emptied.
- You can add 10 ml more apple juice once or twice to the feeding syringe, and then empty it so that there are no granules.
Pantoprazole Mechanism of action:
Pantoprazole, a proton pump inhibitor, inhibits Hydrogen Potassium(H+/K+), which is found in the stomach's parietal cells. It also inhibits acid secretion in the stomach. After intravenous administration of 15 to 30 minutes and 2.5 hours respectively, acid secretion is reduced. Maximum effect can be observed 2 hours after intravenous administration.
Oral pantoprazole can be taken quickly absorbed The duration of the drug's action is 24 hours. 98% of the drug has been bound to proteins, most notably albumin. It is Highly metabolizedCYP2C19 or CYP3A4 are metabolized by the liver. Its metabolites do not have any acid-suppressing activity. It has been abioavailability77% Half-life elimination in neonates takes approximately 3 hours. Children after intravenous or oral administration are 1.22, 1.27, and adults one hour. The half-life elimination patient's with CYP2C19 deficiencies have a shortened waking time of 3.5 - 10 hours. The Time to achieve peak effect Children can experience a peak effect after oral or intravenous administration of 0.34 to 2.54 hours. Adults experience peak effects in 2.5 hours after oral administration. It is excretedThe drug is mainly found in the urine (71% as metabolic compounds) and in the feces (18%). With age and increasing body weight, clearance also increases.
Pantoprazole Brand Names:
- Protonix
- Abbott-Pantoprazole
- ACT Pantoprazole
- AG-Pantoprazole
- AG-Pantoprazole Sodium
- APO-Pantoprazole
- Auro-Pantoprazole
- BIO-Pantoprazole
- DOM-Pantoprazole
- JAMP-Pantoprazole
- M-Pantoprazole
- Mar-Pantoprazole
- MINT-Pantoprazole
- MYLAN-Pantoprazole T
- MYLANPantoprazole
- NRA-Pantoprazole
- Panto IV
- Pantoloc
- Pantoprazole
- Pantoprazole T
- Pantoprazole-20
- Pantoprazole-40
- PMS-Pantoprazole
- Priva-Pantoprazole
- RAN-Pantoprazole
- RATIO-Pantoprazole
- RIVA-Pantoprazole
- SANDOZ Pantoprazole
- Tecta
- TEVA-Pantoprazole
- TEVA-Pantoprazole Magnesium
- VAN-Pantoprazole
- Acernix
- Acipan
- Alapanzol
- Alpanzole
- Altana
- Anagastra
- Antopral
- Anxel
- Apton
- Axepron
- Azatol
- Azidex
- Bio-Panto
- Branzol
- Ciproton
- Conpanzole
- Controloc
- Duonazole
- Eumac
- Eupantol
- Fozole
- Futapan
- Gastenz
- Gastroloc
- Gastromax
- Gastropan
- Inipomp
- Ipraalox
- Kaiji
- Kuppam
- Leminter
- Luganor
- Luoxu
- Mefogin
- Nelpaza
- Nixpan
- Noacid
- Nocid
- Nolpaza
- Ottozol
- Ozpan
- Panfred
- Panloc
- Panoz
- Panprax
- Panrazol
- Pantasan
- Pantazol
- Pantec
- Pantecta
- Panteon
- Pantex
- Pantin
- Panto
- Panto-Byk
- Pantoavenir IV
- Pantoc
- Pantocar
- Pantocid
- Pantodac
- Pantodar
- Pantokem
- Pantol
- Pantoline
- Pantoloc
- Pantoloc Control
- Pantomax
- Pantomed
- Pantop
- Pantopan
- Pantoprix
- Pantoprol
- Pantopump
- Pantor
- Pantostac
- Pantostad
- Pantover
- Pantoz
- Pantozol
- Pantul
- Panwin
- Panzol
- Panzole
- Panzor
- Pauly
- Pentowin
- Peptazol
- Peptazole
- Pepticus
- Peucetol
- Pozola
- Prompin
- Propanzol
- Protium
- Protocid
- Proton
- Protopan
- Prozolan
- Pulcet
- Razon
- Regad
- Rifun 40
- Salpraz
- Segregam
- Somac
- Sozol
- Stripole
- Sunpraz
- Tecta
- Tonval
- Topazol
- Toprazol
- Toprazole
- Topzole
- Trupan
- Ulcemex
- Ulceron
- Ulcoreks
- Ulprix
- Unigastrozol
- Vencid
- Vomizole
- Xotepic
- Zolpra
- Zoltum
- Zurcal
- Zurcazol
Pantoprazole Brands in Pakistan:
Pantoprazole [Inj 40 Mg] |
|
| B-Penta | Wellborne Pharmachem And Biologicals |
| Crest | S.J. & G. Fazul Ellahie (Pvt) Ltd. |
| Lesprot | Nabiqasim Industries (Pvt) Ltd. |
| Neege | Sami Pharmaceuticals (Pvt) Ltd. |
| Pantozole | Safe Pharmaceutical (Pvt) Ltd. |
| Panzol | Mediceena Pharma (Pvt) Ltd. |
| Pepfas | Fassgen Pharmaceuticals |
| Peprazole-L | Friends Pharma (Pvt) Ltd |
| Protonix | Wilshire Laboratories (Pvt) Ltd. |
| W.Pentop | Welwrd Pharmaceuticals |
| Zentro | Bosch Pharmaceuticals (Pvt) Ltd. |
Pantoprazole [Inf 40 Mg] |
|
| Panazole Infusion | Mediate Pharmaceuticals (Pvt) Ltd |
Pantoprazole [Tabs 20 Mg] |
|
| Charpant | Zephyr Pharmatec (Pvt) Ltd. |
| Erabact | Nabiqasim Industries (Pvt) Ltd. |
| Pantocare | Aims Traders |
| Praze | Medisave Pharmaceuticals |
| Rabol | Standpharm Pakistan (Pvt) Ltd. |
| Rager | Shaheen Pharmaceuticals |
| Zentro | Bosch Pharmaceuticals (Pvt) Ltd. |
Pantoprazole [Tabs 40 Mg] |
|
| Acidrol | Medisearch Pharmacal(Pvt) Ltd |
| Apentral | Alson Pharmaceuticals |
| Aptizole | Global Pharmaceuticals |
| Apton | Aries Pharmaceuticals (Pvt) Ltd |
| Arodium | Ardin Pharmaceuticals |
| Atopazole | Pakistan Pharmaceutical Products (Pvt) Ltd. |
| Awamed | Usawa Pharmaceuticals |
| B-Penta | Wellborne Pharmachem And Biologicals |
| Biotop | V Care International |
| Biozole | Bio Labs (Pvt) Ltd. |
| Biskar | Heal Pharmaceuticals Pvt Ltd |
| Contazol | Convell Laboratories |
| Crest | S.J. & G. Fazul Ellahie (Pvt) Ltd. |
| Dewpan | Bloom Pharmaceuticals (Pvt) Ltd. |
| Elspar | Meezab International |
| Esophil | Zesion Pharmaceutical (Pvt) Ltd |
| Evotium | Eastwest Pharma |
| Florozole | Florence Farmaceuticals (Pvt) Ltd |
| Freesia | Nexus Pharma (Pvt) Ltd |
| Gastripan | Albro Pharma |
| Gastrosec | Hansel Pharmacueutical Pvt (Ltd) |
| Gatrocid | Geofman Pharmaceuticals |
| Gem-Sr | Wilsons Pharmaceuticals |
| Glovar | Olive Health Care (Pvt)Limited |
| H-Gone | Neo Medix |
| Helepant | Everest Pharmaceuticals |
| Helepant | Everest Pharmaceuticals |
| Helepant | Everest Pharmaceuticals |
| Kinzole | Tagma Pharma (Pvt) Ltd. |
| Lantonix | Lowitt Pharmaceuticals (Pvt) Ltd |
| Lappantox | Everest Pharmaceuticals |
| Lexcid | Eg Pharma |
| Lopaze | Danas Pharmaceuticals (Pvt) Ltd |
| Losung | Ambrosia Pharmaceuticals |
| Maxor | Raazee Theraputics (Pvt) Ltd. |
| N-Pan | Innvotek Pharmaceuticals |
| Neege | Sami Pharmaceuticals (Pvt) Ltd. |
| Neupanto | Neutro Pharma (Pvt) Ltd. |
| Opara Tab | Mass Pharma (Private) Limited |
| Operazol | Standpharm Pakistan (Pvt) Ltd. |
| P-Zac | Eros Pharmaceuticals |
| Pamzim | Dr. Raza Pharma (Private) Limited |
| Panazole Tablet | Gray`S Pharmaceuticals |
| Paneez | Breeze Pharma (Pvt) Ltd |
| Panguard | Pakheim Internanational Pharma |
| Panroz | Xenon Pharmaceuticals (Pvt) Ltd. |
| Pant | Nenza Pharmaceuticals (Pvt) Limited |
| Pantac | Mass Pharma (Private) Limited |
| Pantacool | Alkemy Pharmaceutical Laboratories (Private) Ltd. |
| Pantafaz | Fozan Pharmaceuticals Industriers (Pvt) Ltd |
| Pantakure | Kurative Pak (Pvt) Ltd |
| Pantayan | Roryan Pharmaceutical Industries (Pvt) Ltd |
| Pantecta | Opal Laboratories (Pvt) Ltd. |
| Panther | Cherwel Pharmaceuticals (Pvt) Ltd |
| Pantocare | Aims Traders |
| Pantolive | Olive Laboratories |
| Pantonyx | Onyx Pharmaceutical |
| Pantop | Medisure Laboratories Pakistan (Pvt.) Ltd. |
| Pantosaf | Saaaf Pharmaceuticals |
| Pantroloc | Atco Laboratories Limited |
| Pantroz | Z-Jans Pharmaceutical (Pvt) Ltd. |
| Pantulcer | Polyfine Chempharma (Pvt) Ltd. |
| Panzol | Mediceena Pharma (Pvt) Ltd. |
| Pazol | Fynk Pharmaceuticals |
| Pegust | Honig Pharmaceuticals Laboratories |
| Pensodin | Webros Pharmaceuticals |
| Pentasia | Medera Pharmaceuticals (Pvt) Ltd. |
| Pentazole | Jawa Pharmaceuticals(Pvt) Ltd. |
| Pento | Linear Pharma |
| Pentoloc | Paramount Pharmaceuticals |
| Pentozol | Ferroza International Pharmaceuticals (Pvt) Ltd. |
| Pepcure | Batala Pharmaceuticals. |
| Pepfas | Fassgen Pharmaceuticals |
| Peptia | Pulse Pharmaceuticals |
| Perizole | Hygeia Pharmaceuticals |
| Petarol | Regent Laboratories Ltd. |
| Petronex | Unimark Pharmaceuticals |
| Pezole | Medera Pharmaceuticals (Pvt) Ltd. |
| Praze | Medisave Pharmaceuticals |
| Pristij | Webros Pharmaceuticals |
| Progard | Akson Pharmaceuticals (Pvt) Ltd. |
| Protemed | Mediate Pharmaceuticals (Pvt) Ltd |
| Protium | Abbott Laboratories (Pakistan) Limited. |
| Protofix | Pharmacare Laboratories (Pvt) Ltd. |
| Protomak | Makson Pharmaceuticals |
| Protonix | Wilshire Laboratories (Pvt) Ltd. |
| Protonol | Akson Pharmaceuticals (Pvt) Ltd. |
| Pstra | Nimrall Laboratories |
| Psyd | Saydon Pharmaceutical Industries (Pvt) Ltd. |
| Rakazol | Rakaposhi Pharmaceutical (Pvt) Ltd. |
| Rakazole | Rakaposhi Pharmaceutical (Pvt) Ltd. |
| Repp | Wns Field Pharmaceuticals |
| Rogit | Goodman International, |
| Sb-Zol | Unison Chemical Works |
| Shazol | Shazals Pharmaceuticals |
| Taxedac | Unipharma (Pvt) Ltd. |
| Topaz | Gene-Tech Laboratories |
| Toprazole | Dyson Research Laboratories |
| Tropizol | Schazoo Zaka |
| Ultomed | Medicraft Pharmaceuticals (Pvt) Ltd. |
| Unipro | Martin Dow Pharmaceuticals (Pak) Ltd. |
| Xantamep | Karachi Chemical Industries |
| Zentro | Bosch Pharmaceuticals (Pvt) Ltd. |
| Zopent | Hilton Pharma (Pvt) Limited |
| Zopium | Pearl Pharmaceuticals |
| Zotonix | Consolidated Chemical Laboratories (Pvt) Ltd. |
Pantoprazole [Vag Tabs 40 Mg] |
|
| Praxol | Alliance Pharmaceuticals (Pvt) Ltd. |
Pantoprazole [Caps 10 Mg] |
|
| Palio | Stalwart Pharmaceuticals (Pvt) Ltd |
| Panpra | Envoy Pharma |
Pantoprazole [Caps 20 Mg] |
|
| Panzium | Searle Pakistan (Pvt.) Ltd. |
| Pento | Linear Pharma |
|
Pantoprazole [Caps 40 Mg] |
|
| Aptec | Aries Pharmaceuticals (Pvt) Ltd |
| Brazole | Winbrain Research Laboratories |
| Creszole | Crest Pharmaceuticals |
| Duozole | Goodman Laboratories |
| Hoze | Max Pharmaceuticals |
| Nixpro | Indus Pharma (Pvt) Ltd. |
| Oliprazole | Olive Pharmaceuticals |
| Pancap | Bio Labs (Pvt) Ltd. |
| Panem | Genome Pharmaceuticals (Pvt) Ltd |
| Panem | Genome Pharmaceuticals (Pvt) Ltd |
| Panprazole | Macquins International |
| Pantev | Everest Pharmaceuticals |
| Pantoadvan | Advanced Pharmaceuticals |
| Pantogen | Genera Pharmaceuticals |
| Pantoloc | Aries Pharmaceuticals (Pvt) Ltd |
| Pantoswan | Swan Pharmaceuticals(Pvt) Ltd |
| Pantozol | Valor Pharmaceuticals |
| Panzium | Searle Pakistan (Pvt.) Ltd. |
| Peprozol | Friends Pharma (Pvt) Ltd |
| Perozib | Axis Pharmaceuticals |
| Pois | Panacea Pharmaceuticals |
| Solus | Hygeia Pharmaceuticals |
 for extensive stage small cell lung cancer.webp)
