Pan D

Therapeutic indications

An indication is the medical condition, illness or disease for which a patient is prescribed. Pan D is used to manage symptoms associated with taking certain drugs. The drug belongs to a group of dopamine drugs that are used to prevent nausea and feeling of the tendency to vomit.

These are conditions that are especially for people that are prone to these side effects or contraindications, such as those suffering from gastrointestinal problems.Some of the drugs used to treat Parkinson’s Disease are also known to cause these problems of nausea and vomiting tendency. Pan D is also prescribed for conditions related to acidity, heartburn, Gastroesophageal reflux disease (GERD), Gastric ulcer, Zollinger Ellison syndrome among others.

Do I need a prescription?

Pan-D capsule Sr is prescribed in 10mg which should be taken 15-30 minutes before meals. Adults should not take more than 30 mg a time. Note that there this is only a general rule as prescription also depends on other factors such as body weight, age and whether you are taking other medications.

Chemical composition

Pan D is composed of Pantoprazole Sodium Sesquihydrate(40mg) and Domperidone(30mg). Other excipients in the drug include Lake of indigo carmine, red ferric oxide, yellow ferric oxide, and titanium oxide.

Mechanism of Action (MOA)

Pan D works by tightening muscles near stomach entry and relaxes those at the exit. The effect of this is a faster movement of food from the stomach to intestines which reduces the feeling of nausea, the tendency to throw up from the stomach. It also reduces other symptoms such as a feeling of sickness and stomach fullness. Pan D also works by blocking or reducing stimulation of vomiting trigger in the brain, hence reducing nausea and urge to vomit.

The drug speeds movement of food from the stomach to intestines and also stimulates the part of the brain called ‘vomiting center’ from triggering a person to vomit. It also suppresses nerves from coming from the gut, hence preventing vomiting and nausea. Domperidone is specifically used to help speed up the speed of getting rid of food from the stomach. This lowers stomach upset symptoms, prevents the urge of throwing up, feeling of fullness and heartburns. Pantoprazole, one of the drugs classified as “proton pump inhibitors” is mainly used to treat peptic ulcers. These are sores or small wounds in the stomach wall. They are also called gastric ulcers, duodenal ulcers, stomach ulcers or simply ulcers. It is usually prescribed for patients with GERD, ulcers, Zollinger-Ellison Syndrome and erosive esophagitis. The drug works by inhibiting the amount of acid produced in the stomach.

Contraindications

• Allergies to Pan D (either Pantoprazole or Domperidone) or its excipients
• Bleeding
• Pituitary gland tumors
• Heart /cardiac disease
• Low levels of magnesium, potassium, and calcium in the blood
• Severe liver disease
• Broken bones
• Atrophic gastritis
• Congestive heart failure
• Clostridium difficile bacteria related colitis
• Taking with CYP3A4 inhibitors
• Interstitial nephritis
• Low magnesium level in the blood
• Pregnancy and lactation (inadequate studies have been done to study the effect of this drug)

Side effects

Less serious and common side effects include

• Diarrhea
• Headaches
• Difficulties in breathing
• Skin rash
• Dry mouth

Serious side effects that are less common include

• Irregular heartbeat
• Dizziness or faintness
• Males swelling in breasts
• Irregular menstrual periods
• Swelling of face, lips, organs, tongue, hands, and feet
• Milk discharge from breasts
• Rhinitis
• Irregular heartbeats
• Loss of sex drive
• Growths in male breasts
• Drug dependent
• Blurred vision
• Itchy skin that is severe
• Frequent urination
• Akathisia
• Asthenia
• Chest pains
• Jaundice
• GIT infections
• Anaphylaxis
• Angioedema
• Dyspnea
• Erythema multiforme
• Gastroenteritis
• Hyperglycemia
• Rashes
• Pruritus (from Pantoprazole)
• Infections at site of injection
• Leg cramps
• Optic neuropathy
• Anterior ischemia
• Dry mouth
• Pancreatis
• Lethargy
• Vertigo
• Fever
• Irritability
• Conjunctivitis
• Increased urination
• Dysuria
• Edema
• Nervousness
• Urticaria
• Stomatitis
• Palpitations
• Asthenia
• Intolerance to drugs

Drug Interactions

These are unintended reactions in the body that result from taking Pan D with other drugs. Such effects may be side effects or may aggravate the usual side effects of Pan D. This also means that efficacy of this drug may reduce significantly. Besides vitamins, herbal and mineral supplements, you should inform the doctor if you are taking these drugs that may interact with the drug. The following drugs are known to react with this drug:

• Amiodarone
• Amprenavir
• Antacids
• Aprepitant
• Atazanavir
• Atropine
• Clarithromycin
• Diltiazem
• Erlotinib
• Erythromycin
• Heart medicine (used to regularize heartbeat) such as bromocriptine
• Antidepressants (MAOI) such as phenelzine, isocarboxazid.
• Mood medines such as mesoridazine, thioridazine
• Painkillers such as morphine, codeine
• Herbal tonic supplements

What to Do If You Skip a Dose

You can take the missed dose later, but this should not be too close to the next dose. You should not take two doses together at any time, or when you have missed a dose.’ This is an overdose which could cause other complications.

Dosage

• Take 1 capsule (or tablet) daily before breakfast
• When treating nausea and vomiting, take 10-20mg daily at intervals of between 4 and 8 hours. The maximum is 80mg per day.
• For non-ulcer dyspepsia, take 10-30mg of Pan D at intervals of 4 hours or three times of a day and another dose at night.
• The drug is also indicated for migraines. Take 20mg of Pan D every after 4 hours
• To treat Rectal Nausea and vomiting, the recommended dose is 60mg daily
• For administration, the capsule should be swallowed. Do not crush or empty its contents. Where a vial is used it must be reconstituted with 0.9% sodium chloride before injection w/v 10 mL before injection. Once prepared, it can be administered in two ways: it can be administered as a slow injection via intravenous (IV) where this process can take between 2 and 15mins. Alternatively, this solution can be prepared by diluting further with another 0.9% sodium chloride injection w/v 100ml or using 5% glucose. This is given as a short term infusion but must be used within 12 hours after it has been prepared.

Precautions

• The drug may not be taken during pregnancy unless advised by a doctor. This is because of its tendency to cause a surge in certain hormones and subsequent imbalances that may cause acid reflux and issues related to gastric acid
• Please inform your doctor if you are taking vitamin, mineral or other herbal supplements when taking this drug.
• The drug may interfere with absorption of other drugs, although this is theoretically and has not been proven. This is because of long time taken while inhibiting production of gastric acid and where acid pH is dependent for the process of absorption. Drugs that may be affected include ketoconazole, ampicillin esters and iron salts.
• Inform the doctor if are pregnant or you are anticipating medical procedures such as surgery. Such conditions may make you to be susceptible to the drug.
• Do not drive or operate machinery when taking this drug.
• Be cautious when taking this drug if you have a liver disease or have a deficiency of Vitamin B12
• The drug may not be used with other QT-prolonging agents
• The drug may not be taken by old people unless advised by a doctor
• Do not take the drug if you have a heart disease
• Do not take the drug if you have problems with absorption of hyperkaliemia or hypomagnesia (low magnesium levels in the blood)
• Although the drug is not habit forming, users should avoid taking drugs without prescription by a qualified doctor. This will reduce the chances of becoming dependent on drugs
• Whereas you can take Pan D when breastfeeding, Domperidone is not advised and advise from a doctor is needed
• The drug can be stopped immediately without the need for tapering. Some people may experience rebound effects and in such cases, tapering may be recommended.
• There may be no effect if you take a single dose of expired drug of Pan D. However, seek medical advice if you feel sick or unwell. Efficacy of expired Pan D drug may be reduced and, in that case, a doctor may need for appropriate advise. People with serious conditions such as heart disease, seizures or major allergies may find expired drugs inappropriate and may need to consult a doctor first.
• You should never change or stop taking your dose as advised by doctor, unless advised so.
• Do not take alcohol when in medication of Pan D. This can increase stomach acidity, cause acid reflux and reduce efficacy of the drug for indicated condition. After a dose, allow at least 3 days of your last dose before taking Pan D.
• Do not share medicine even, each patient is unique (in age, and medical history). and only a doctor can determine appropriate medicine
• If you get persistent watery diarrhea, fever, or stomachaches, seek medical assistance immediately
• Do not start another dose after the initial one, even if symptoms or condition persists. Long term use of the drug is associated with weak bones due to the possibility of inhibiting magnesium and calcium absorption. Seek medical advice if symptoms do not go away after 14 days
• Take calcium and magnesium supplements
• If taking any other medicine, please let your doctor know

Different brands and manufacturing companies the Drug

The following manufacturers use similar composition and strength of Pan D.

• Pan D capsule by Alkem
• Dyoflux tablet by Sundyota Numandis Pharma
• Ecpan DSR Caosule by Icon Life Sciences
• Aciban DSR Capsule by Madila Pharmaceuticals
• Anelo DSR Tablet by A N Pharmacia Laboratories
• Athzol DSR Capsule by Athens Lab

Substitutes of the Drug

The following drugs contain similar constituents and have comparable or similar strength as Pan D 40MG/40Mg Capsule Sr. The drugs usually sold in 10 tablets or capsules. The list is not comprehensive and availability depends on region.

• Paridon D 30mg/40mg by Symbiosis Labs
• Dyspan D Sr Capsule by Graciois Pharmaceuticals
• Panage D 30mg/40mg Capsue by Riob Lifesciences Pvt Ltd
• Pantofer D Sr Capsule by BioPhar Lifeciences Pvt Ltd
• Pantakind D Sr Capsule by Mankinf Pharma Ltd
• Pantofresh D Sr Capsule by Samarth Life Sciences Pvt Ptd
• Zipant D Sr
• Pantorite D Capsule
• Aciba DSR Tablet
• Anleo DSR Tablet
• Athzol DSR Capsule
• Auxitop DSR Capsule
• LPanto D Capsule
• Nupenta DSR Capsule
• Dompan SR Tablet
• Dyoflux Tablet
• Ecpan DSR Capsule

Recommendations

• The drug does not interact with most of the other drugs such as Theophylline, cisapride, antipyrine, caffeine, carbamazepine, diazepam, diclofenac, digoxin, ethanol, glyburide, oral contraceptives (levonorgestrel, ethynylestradiol), metoprolol, nifedipine, phenytoin or warfarin. Hence, there is no need for adjustment of dosage.
• Pan D does not harm kidneys, heart in any way
• It has a mild effect on the liver
• Take the form that is most appropriate and palatable to you. Various forms are available and these include tablets, drops, capsules and suspensions.
• All the above doses should be taken orally and on an empty stomach
• To maintain its efficacy and stability, store the drug in room temperatures of 15^ο to 30^οC

Other Facts about the drug

• The effects of the drug last about 6 hours and although its peak effects are felt between 30 and 60 minutes
• Pan D is most effective and most used for the treatment of intractable nausea and vomiting, gastric ulcers and gastrin-secreting tumor. Less common uses with least efficacy include nausea, benign gastric ulcer, heartburn, belching and bloating and feeling of the fullness of the stomach.

References
https://medlineplus.gov/ency/patientinstructions/000381.htm
https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/pharmacy-education-materials/downloads/ppi-adult-factsheet.pdf
https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/protonpump-education.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855237/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885718/

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