Pantoprazole

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[edit] BRAND NAMES

[edit] STRUCTURE

Pantoprazole.jpg

[edit] MECHANISM OF ACTION

Pantoprazole is a proton pump inhibitor. it decreases the amount of acid produced in the stomach by inhibition of H+/K+ ATPase located in the luminal membrane of gastric parietal cells

[edit] INDICATIONS

  • Treatment of Gastroesophageal reflux disease (GERD) and Erosive esophagitis
  • Hypersecretory conditions including Zollinger-Ellison syndrome

[edit] DOSAGE

  • Gastroesophageal Reflux Disease and Erosive esophagitis:
    • Adults: 40mg/day for up to 8 weeks
    • 5-17 Year Olds:
      • 15-40 kg, 20 mg once daily for up to 8 weeks
      • More than 40 kg, 40 mg once daily for up to 8 weeks
  • Maintenance of healing of erosive esophagitis: 40 mg once daily
  • Zollinger-Ellison syndrome: 40 mg twice daily

[edit] CONTRAINDICATIONS

  • Known hypersensitivity to Pantoprazole or to substituted benzimidazoles

[edit] WARNINGS AND PRECAUTIONS

  • Symptomatic response does not preclude presence of gastric malignancy.
  • Atrophic gastritis has been noted with long-term therapy.
  • PPI therapy may be associated with increased risk of Clostridium difficile associated diarrhea.
  • Bone Fracture: Long-term and multiple daily dose PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist or spine.
  • Hypomagnesemia has been reported rarely with prolonged treatment with PPIs

[edit] INTERACTIONS

  • Atazanavir and Nelfinavir: Pantoprazole reduces plasma levels of Atazanavir and Nelfinavir. Concomitant use is not recommended
  • Patients treated with proton pump inhibitors and warfarin concomitantly may need to be monitored for increases in INR and prothrombin time
  • May interfere with the absorption of drugs where gastric pH is important for bioavailability (e.g.,ketoconazole, ampicillin esters, iron salts, and digoxin)
  • May produce false-positive urine screen for tetrahydrocannabinol (THC). An alternative confirmatory method should be considered to verify positive results
  • Methotrexate: Pantoprazole may increase serum level of methotrexate

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category B (US). Reproduction studies have been performed in rats at oral doses up to 88 times the recommended human dose and in rabbits at oral doses up to 16 times the recommended human dose and have revealed no evidence of impaired fertility or harm to the fetus due to pantoprazole. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
  • Nursing Mothers: Pantoprazole and its metabolites are excreted in the milk of rats. Pantoprazole excretion in human milk has been detected in a study of a single nursing mother after a single 40 mg oral dose. The clinical relevance of this finding is not known. Many drugs which are excreted in human milk have a potential for serious adverse reactions in nursing infants. Based on the potential for tumorigenicity shown for pantoprazole in rodent carcinogenicity studies, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the benefit of the drug to the mother.

[edit] SIDE EFFECTS

  • Most common adverse reactions in adults are (>2%): headache, diarrhea, nausea, abdominal pain, vomiting, flatulence, dizziness, and arthralgia.
  • Most common adverse reactions in pediatric use (>4%) are upper respiratory infections, headache, fever, diarrhea, vomiting, rash, and abdominal pain.

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES

Heartburn/Gastritis/Gastric ulcer/Duodenal ulcer/Gastroesophageal reflux
H2 antagonists Famotidine   Nizatidine   Ranitidine (Zantac)
Proton-pump inhibitors Dexlansoprazole (Dexilant)   Esomeprazole (Nexium)   Lansoprazole (Prevacid)   Omeprazole (Losec, Prilosec)   Omeprazole/Sodium bicarbonate (Zegerid)   Pantoprazole (Controloc, Pantecta, Pantoloc, Protonix) (  Rabeprazole (Aciphex, Pariet)
Prostaglandins Misoprostol (Cytotec)
Other drugs Alginic acid   Magaldrate   Sucralfate
Combination Regimens Bismuth Subcitrate Potassium/Metronidazole/Tetracycline (Pylera)   Lansoprazole/Amoxicillin/Clarithromycin (Prevpac)