Pantoprazole (PANTOLOC)

Gastrointestinal Drug

Drug class: Proton Pump Inhibitors (PPI)

Pantoprazole (中文: 泮托拉唑)

Drug Class

Proton Pump Inhibitor (PPI)

Common Strengths of Pantoprazole tablet

Pantoprazole tablets are available in the following strengths:

• 20 mg delayed-release oral tablets

• 40 mg delayed-release oral tablets

• Intravenous (IV) formulation for injection

Drug Trade Name of Pantoprazole tablet

PANTOLOC

Drug Usage

Pantoprazole is used for:

Gastric ulcer, duodenal ulcer

Treatment of gastroesophageal reflux disease (GERD)

Prevention of gastric damage in patients taking NSAIDs

Zollinger-Ellison syndrome (and other hypersecretory conditions)

Eradication of Helicobacter pylori

Mechanism of Action

Inhibits (H+/K+ )-ATPase enzyme in the gastric parietal cells, blocking the final step of gastric acid production in the stomach, significantly reducing gastric acidity for up to 24 hours or more.

Route of Administration

Oral and intravenously (injection)

Dosages

Gastric ulcer, duodenal ulcer: By intravenous injection, or by intravenous infusion 40mg daily until oral administration can be resumed

Gastric ulcer, duodenal ulcer: By mouth, 40 mg daily; increased if necessary up to 80mg daily

GERD: 20-80 mg daily for 4 weeks, continue for further 4 weeks if not fully healed, dose to be taken in the morning; maintenance 20 mg daily and increased to 40 mg daily, increased only if symptoms return

Propylaxis of NSAID-associated ulcer: 20 mg daily

Zollinger-Ellison syndrome (and other hypersecretory conditions): intially 80 mg daily, adjusted according to response

Helicobacter pylori eradication: 40 mg twice daily

Renal Dose Adjustments

There are no specific renal dose adjustments recommended based on the estimated glomerular filtration rate (eGFR) for pantoprazole; however, caution should be exercised in severe renal impairment.

Side Effects

Frequency	Adverse reactions
Common Side Effects
	Diarrhea
	Abdominal pain
	Nausea
	Vomiting
	Flatulence
Serious Side Effects of long-term use
	Osteoporosis-related fractures
	Clostridium difficile infection
	Low blood magnesium and Vit B12
	Acute Interstitial Nephritis

Pharmacokinetics

Onset Time: Effects can be observed within 2 to 3 hours after oral administration.

Duration of Action: The acid-suppressive effect lasts approximately 24 hours.

Drug Precautions

Pregnancy: avoid unless the potential benefit outweighs risk

Breastfeeding: void unless the potential benefit outweighs risk

Children and Elderly: Use in children over 5 years is generally safe; elderly patients may require monitoring due to the potential increased risk of side effects such as bone fractures, kidney problems, and Clostridium difficile infection.

Monitoring Items

Regular monitoring of magnesium and vitamin B12 levels

Drug Interactions

Drug Interactions: can interact with other medications primarily through two mechanisms:

• Alteration of Gastric pH: Pantoprazole increases gastric pH, which can affect the solubility and absorption of drugs that require an acidic environment for optimal absorption. For example, drugs like ketoconazole and atazanavir have significantly reduced bioavailability when taken with PPIs due to this pH alteration.
• Inhibition of Cytochrome P450 Enzymes: which can lead to increased plasma concentrations of drugs metabolized by these pathways. This is particularly relevant for medications such as warfarin, clopidogrel, and certain antiepileptics like phenytoin.
• Methotrexate: Pantoprazole can affect the pharmacokinetics of methotrexate, potentially leading to increased toxicity.

Summary of Key Drug Interactions:

• Clopidogrel: Reduced effectiveness; increased cardiovascular risk
• Warfarin: Increased anticoagulation effect; monitor INR
• Methotrexate: Increased toxicity risk; monitor renal function
• Phenytoin: Altered metabolism; monitor drug levels.
• Atazanavir: Reduced bioavailability; consider alternatives

FAQ

How should I take the tablet?

Take pantoprazole on an empty stomach, ideally 30 minutes before meals, swallowing the tablet whole without crushing or chewing. Consuming them with food may reduce their effectiveness.

What should I avoid while taking?

Limit or avoid highly acidic foods and drinks like coffee and soda

What happens if I miss a dose?

Take as soon as remembered unless close to next dose; do not double up on doses