Pantoprazole

Therapeutic indications

Pantoprazole is a drug that is used to treat stomach and esophagus problems including acid reflux. Its mode of action is by reduction of acidity in the stomach, which could otherwise cause problems such as heartburn, difficulties in swallowing and prolonged coughs. It is also prescribed for Zollinger-Ellison syndrome (a condition associated with too much acid production of acid in the stomach).

Too much acid in the stomach is associated with stomach conditions such as ulcers and oesophageal cancer. By taking this drug that reduces the amount of acid in the stomach and esophagus, Pantoprazole, therefore, helps prevent the development of these conditions.

Do I need a prescription?

Pantoprazole is a prescription drug that requires a medical examination.

Dosage

General dosage information uses the weight of the patient and is given as follows:

• For less than 15 to 40kg, take 20mg is given daily orally
• For more than 40kg, take 40mg once daily
• The normal duration should be a maximum of 8 weeks

Chemical Composition

Major or active ingredients include calcium stearate, crospovidone, hypromellose, iron oxide, mannitol, methacrylic acid copolymer, Polysorbate 80, povidone, propylene glycol, sodium carbonate, sodium lauryl sulfate, titanium dioxide, and triethyl citrate.

Inactive ingredients include crospovidone, hypromellose, methacrylic acid copolymer, microcrystalline cellulose, Polysorbate 80, povidone, sodium carbonate, sodium lauryl sulfate, talc, titanium dioxide, triethyl citrate, and yellow ferric oxide. Usually sold in forms tablet or capsule. It can be given by intravenous fusion or granule suspension.

Mechanism of Action (MOA)

Pantoprazole is in a class of drugs called proton pump inhibitors (PPIs). They work by reducing the amount of acid production in the stomach by preventing (inhibiting) acid producing cells from doing so in the lining of the stomach. The drug also shuts down pumping action of these stomach lining cells from producing acid in the stomach, hence relieving ulcers

Contraindications

Several conditions may prevent you from using these drugs due to a potential worsening of side effects of the drug may not work effectively. Inform the doctor if you have or history of any of the following conditions:

• Diarrhea
• Hypomagnesemia (this is a condition where blood has very low levels of magnesium)
• Osteoporosis (low bone density)
• Seizures
• Systemic lupus erythematosus (SLE)
• Aged people, especially those above 50 may experience worse conditions
• Lab tests. Pantoprazole can lead to certain false lab results. Inform the doctor if you are taking the drug
• Pantoprazole can interfere with certain urine tests. Prior information to examining and prescribing doctor is recommended.
• Digoxin
• Methotrexate
• Diuretics or water pills
• Vitamin supplements
• Herbal drugs (Ginkgo Bilopa, Evening Primrose Oil, 5-HTP, Azo Crabberry, Valerian Root, etc).

Side effects

Common side effects

• Headaches
• Nausea
• Diarrhea
• Allergic reactions that include:
• Hives
• Watery or bloody diarrhea
• Difficulties in breathing
• Swelling of face, lips, throat, tongue
• Dizziness

Rare side effects

• Clostridium difficile
• systemic cutaneous lupus
• erythematosus
• dry mouth
• Blurred vision
• Flushing of skin
• Breath odor may feel fruity
• Heightened hunger levels
• Increased thirst
• Frequent urination
• Weight loss that is unexplained
• Vomiting
• Sweating

Very rare incidents

• Decreased or lack of body movements
• Blindness
• Bloating
• Bloody and sometimes cloudy urine
• Chills
• Clay-colored stools
• Skins may be loose or blister
• Constipation
• Unexplained ringing sound in ears or nose
• Decreased vision
• Drowsiness
• Fast heartbeat
• Difficulty in breathing
• Feeling of lightheadedness
• Fever
• trembling
• Headaches
• Aura of movements
• Indigestion
• Pains at joints
• Light colored stool
• Decreased appetite
• Muscle cramps
• Muscle pain or stiffness
• Stomach upsets
• Paling of skin
• Red skin lesions
• Reddening of eyes and irritation
• Mouth may develop sores, white spots or ulcers
• Bloody vomits
• Yellowing of skin
• Sore throat
• Unexplained bleeding
• Glands may swell
• Seizures
• Puffiness of eyelids, lips, face or tongue
• Feeling of spinning
• Reduced sense of hearing
• General body weakness and tiredness
• In case of overdose, seek medical emergency immediately
• Less common side effects
• Belching
• Bloating
• Stomach gas or intestines
• Sleeplessness

What to do if you skip a dose

The drug should be taken at the same time every day. If a dose is missed, you should never take two doses. Dosage schedules should be spaced as evenly as possible. If missed and it is about time for the next dose, you should avoid taking the drug and only take at the regular time.

Normal dosage depends on the medical condition of a patient and other interactions, contraindications that may be associated with the drug. Common dosing for various illnesses such as:

• Erosive Esophagitis: Take 40 mg daily in the form of a pill orally for a period of 8 weeks. If you have not recovered well, you may continue with the drug for another 8 weeks. If you have not recovered after 16 weeks, seek a further medical examination. There is not enough evidence of the efficacy of Pantoprazole beyond 16 weeks.
• MaintainingHealing of Erosive Esophagitis: take 40mg orally daily. Do not take beyond 12months.
• Gastroesophageal Reflux Disease (GERD): This can be done for adults through either parenteral or orally:
• For parenteral: administer 40mg daily for 7-10 days through intravenous infusion. This should be stopped if a patient can take the drug orally.
• Orally: take 40mg daily, once a day up to 8 weeks. Additional 8 weeks may be considered where a patient has not healed properly.

Duodenal ulcers: take 40mg for 7 days. Take with other medicines clear out Helicobacter pylori. Recommended drugs include clarithromycin, amoxicillin, and metronidazole. After these drugs, continue with Pantoprazole for another 28days.

Helicobacter pylori: Take 40mg twice daily for 7 days but consider taking other medicines such as amoxicillin or metronidazole. 

Gastric Ulcer: If you are an adult, you should take 40mg of Pantoprazole dose twice daily. 87% of patients got better after finishing this dose for 4 weeks while 97% after 8 weeks.

Zollinger-Ellison Syndrome: They are administered orally or via parenteral. For parenteral, the dose should be 80mg through an infusion of lasting15 minutes. More than 240 mg of this drug in a day or usual dose of 80mg for a period of more than 6 days has not been determined. This means that exceeding the allowed dose should be done only if approved by a doctor.

Stress Ulcer Prophylaxis: This is usually treated with 80mg twice a day. Bolus infusion for 15 minutes is also given but total dosage should not exceed 240mg a day. 240mg can be divided into 3 equal infusions for the same time of 15 minutes.

Precautions

• The drug is designed to be ingested wholly and never by chewing or crushing and mixing with water.
• The drug, tablet for granule suspension can be taken with apple or orange juice. For those unable to swallow, they can take it via nasogastric tube.
• Take note to take the drug on an empty stomach preferably 30 to 60 minutes bore small.
• Pantoprazole should be prescribed by people aged above 5. There are not enough studies on the effects and efficacy of the drug on young people below 5.
• The drug should be discontinued if it took for a period of more than 8 weeks to give time for the stomach or esophagus to heal.
• Note that Pantoprazole is not meant for immediate relief of stomach upsets caused by too much acid and heartburn.
• Heartburn is often confused with heart attacks and pantoprazole is erroneously prescribed for such conditions. Thorough medical exam and analysis should be done and appropriate medicine given for actual illness. Some symptoms associated with a heart attack include chest pain that spreads to arms and shoulders accompanied by nausea, sweating, and a general feeling of illness. Such should be reported to a doctor.
• There is an increased risk for people taking higher doses for using the drug for the long term. These complications include an increased risk of bone fracture.
• Long term users of more than three years have been shown to have a higher risk of developing vitamin B-12 deficiency. This can lead to serious harm to nerves and deterioration of some brain functions
• Patients that are allergic to Pantoprazole or its ingredients. You should inform a doctor if you are allergic to drugs such as dexlansoprazole (Dexilant), esomeprazole (Nexium, in Vimovo), lansoprazole (Prevacid), omeprazole (Prilosec, in Zegerid), rabeprazole (AcipHex)
• Inform a doctor if you react with rilpivirine that is available in drugs such as Edurant, Complera, and Odefsey. It may not be advisable to take it alongside Pantoprazole.
• Long term use of Pantoprazole can cause chronic stomach inflammation. The risk is especially higher for people with H. Pylori.
• Pantoprazole may lead to low blood count or hypomagnesemia. Some people develop this condition after taking the medicine for a few months although it can take a year of treatment with this drug.
• There is limited information on the effects of this drug on old people. Geriatric-specific issues are yet to fully study and documented for the drug to be recommended for the elderly. People aged above 50 are likely to experience severe side effects such as broken bones.
• In cases of diarrhea, do not take antidiarrhea drugs unless a doctor advises so.
• If pregnant or planning to or breastfeeding, seek medical advice first.
• When taking the drug to clear H. pylori, make sure you take full dose to the end.
• Please note that long term use may interfere with the absorption of Vitamin B12

Different Brands and Manufacturing companies of the drug

Pantoprazole is sold under a brand name of Protonix. It is sold in original and generic forms.  Drugs that contain pantoprazole as an ingredient include the following but availability depends on region. The list is not comprehensive.

• Assuage 40mg Table
• Cocid 20MG Tablet
• Controsec 40MG Injection
• Drupan 40MG Tablet
• Dyspan 40MG Tablet
• Ec Pan 40MG Tablet
• Gastropan 40MG Tablet
• Mopant 40MG Tablet
• Lulipan 40MG Tablet

Substitutes for the drug

• Omeprazole
• Nexium ((esomeprazole)
• Prevacid
• Zantac (ranitidine)-given over the counter or prescription
• Pepcid(famotidine) -given over the counter or prescription
• Maalox (aluminum / magnesium / simethicone) -given over the counter
• Tums (calcium carbonate)-given over the counter
• Alka-Seltzer (aspirin / citric acid / sodium bicarbonate) -given over the counter

Drug Interactions

In case of any drug interaction, the drug can still be administered if it is necessary for the specified condition of a patient. In such cases, a doctor will adjust the dosage or use other ways of managing these effects.

• Rilpivirine (not usually recommended for taking with any other drug)

• Atazanavir
• Bosutinib
• Cilostazol
• Citalopram
• Dasatinib
• Erlotinib
• Eslicarbazepine Acetate
• Gefitinib
• Ketoconazole
• Ledipasvir
• Methotrexate
• Mycophenolate Mofetil
• Nelfinavir
• Nilotinib
• Pazopanib
• Saquinavir
• Velpatasvir
• Vismodegib

It is not recommended to take the drug with the following drugs due to the risk of increased side effects although taking both could be for the best interest of the patient. These include the following:

• Levothyroxine
• Warfarin

Interactions may occur when the drug is taken with certain foods or at around the time the drug is consumed. Consuming these foods can aggravate side effects. Inform a doctor that you intend to consume these foods for appropriate advice for special instructions. Some of these foods include:

• Cranberry
• Tobacco
• Alcohol

General Information

• The medicine is available in forms of a tablet, enteric coated tablet or a packet.
• When taking 40mg of dose, divide it into two equal doses of 20mg
• The drug can be taken in pregnancy. Studies done on animals indicated no problem or adverse effect of the drug during pregnancy. However, this hasn’t been done on humans but those that have been carried out showed no risk to the fetus or pregnant women. They are assumed to be safe to pregnant mothers in all trimesters.
• Do not exceed 8 weeks unless guided by a physician. There is no general safety information for more than this duration.
• Dose adjustments are not needed for conditions such as renal disease, liver disease, dialysis (for hemodialysis). No information is available for peritoneal dialysis
• You can take the drug with other antacids as this does not affect absorption
• You should not expect immediate relief of stomach acid but you expect some relief after 1 day of treatment. Continue as advised by a doctor even if you don’t feel well.
• If in need of fast relief for acid control, consider an IV dose of 160mg. This works within an hour.

Additional prescription information

Therapies for Helicobacter pylori infection

• Triple Therapy: People that take Pantoprazole 40mg twice daily for 7 days to clear Helicobacter pylori, followed with amoxicillin and metronidazole had more than 95% success rate. This followed a study on 242 patients that followed this programme.
• Quadrate Therapy: Alternative study was done on patients with Helicobacter pylori infection. 40mg of Pantoprazole was given twice orally for 7 days alongside bismuth subcitrate and tetracycline but four times daily. Metronidazole 200mg was also taken 3 times daily and another 400mg before going to sleep at night. Eradication rate of this bacteria was 82%.

References

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