Pantoprazole

Pantoprazole Brand Name– Protonix

What is Pantoprazole

Pantoprazole is an oral and intravenous gastric proton pump inhibitor (PPI).

It is indicated in adults for the short-term treatment and maintenance therapy of erosive esophagitis associated with gastroesophageal reflux disease (GERD) and for the treatment of Zollinger-Ellison syndrome.

In pediatric patients, pantoprazole is primarily used for GERD and erosive esophagitis.

Other uses for pantoprazole include stress ulcer prophylaxis and the treatment of peptic ulcer disease. It has been shown to be effective in the management of duodenal ulcer or gastric ulcer, including those caused by Helicobacter pylori (H. pylori).

Pantoprazole, in combination with appropriate antibiotic therapy, is used to eradicate H. pylori.

When compared to omeprazole (20 mg once daily), pantoprazole (40 mg once daily) has more potent antisecretory activity, but similar clinical efficacy in treating peptic ulcer disease or GERD.

On the basis of available research, no clear advantage has been demonstrated for the use of 1 PPI over another in the treatment of GERD. Instead, a key to optimizing effectiveness is tailoring dosage timing and considering twice-daily dosing; traditional delayed-release PPIs should be administered 30 to 60 minutes before a meal for maximal pH control.

A 1-time switch to a different PPI in a refractory patient may be useful.

PPIs are often used for stress ulcer prophylaxis in critically ill patients; however, evidence for benefit is lacking, and use may increase the risk of adverse reactions such as pneumonia and Clostridioides difficile infection.

Reserve stress ulcer prophylaxis for patients with risk factors for clinically significant gastrointestinal bleeding (e.g., multiple organ dysfunction, prolonged mechanical ventilation, coagulopathy, persistent shock, concomitant corticosteroid therapy).

Pantoprazole does not significantly inhibit hepatic CYP isoenzymes and compared to other currently available PPIs, it has the lowest potential for hepatic drug interactions.

Indications

1. duodenal ulcer
2. dyspepsia
3. eosinophilic esophagitis
4. esophagitis
5. gastric ulcer
6. gastroesophageal reflux disease (GERD)
7. Helicobacter pylori (H. pylori) eradication
8. NSAID-induced ulcer prophylaxis
9. pyrosis (heartburn)
10. stress gastritis prophylaxis
11. upper GI rebleeding prophylaxis
12. Zollinger-Ellison syndrome

For the short-term treatment of frequent dyspepsia† or pyrosis (heartburn)† that occurs >= 2 times per week

Side Effects

1. abdominal pain
2. agranulocytosis
3. anaphylactic shock
4. anaphylactoid reactions
5. anemia
6. angina
7. angioedema
8. arrhythmia exacerbation
9. arthralgia
10. asthenia
11. atrial fibrillation
12. atrial flutter
13. bleeding
14. blurred vision
15. bone fractures
16. cholecystitis
17. cholelithiasis
18. confusion
19. constipation
20. depression
21. diarrhea
22. dizziness
23. drowsiness
24. dysgeusia
25. dyspepsia
26. ecchymosis
27. edema
28. elevated hepatic enzymes
29. eosinophilia
30. erythema multiforme
31. fatigue
32. fever
33. flatulence
34. gastric polyps
35. GI bleeding
36. hallucinations
37. headache
38. heart failure
39. hepatic failure
40. hepatitis
41. hyperbilirubinemia
42. hypertension
43. hypertriglyceridemia
44. hypomagnesemia
45. hyponatremia
46. hypotension
47. infection
48. injection site reaction
49. insomnia
50. interstitial nephritis
51. jaundice
52. leukocytosis
53. leukopenia
54. lupus-like symptoms
55. malaise
56. migraine
57. myalgia
58. myocardial infarction
59. nausea
60. palpitations
61. pancreatitis
62. pancytopenia
63. peripheral vasodilation
64. pernicious anemia
65. phlebitis
66. photosensitivity
67. pruritus
68. pseudomembranous colitis
69. rash
70. rhabdomyolysis
71. rhinitis
72. seizures
73. sinus tachycardia
74. Stevens-Johnson syndrome
75. syncope
76. thrombocytopenia
77. thrombosis
78. tinnitus
79. toxic epidermal necrolysis
80. urticaria
81. vertigo
82. vitamin B12 deficiency
83. vomiting
84. weight gain
85. weight loss
86. xerostomia

Monitoring Parameters

• LFTs
• serum magnesium

Contraindications

• bone fractures
• breast-feeding
• diarrhea
• gastric cancer
• geriatric
• hepatic disease
• hypomagnesemia
• infants
• laboratory test interference
• long QT syndrome
• neonates
• new primary malignancy
• osteopenia
• osteoporosis
• pregnancy
• proton pump inhibitors (PPIs) hypersensitivity
• pseudomembranous colitis
• rebound acid hypersecretion
• systemic lupus erythematosus (SLE)
• vitamin B12 deficiency
• zinc deficiency

Interactions

• Acalabrutinib
• Alendronate
• Alendronate; Cholecalciferol
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Amiloride; Hydrochlorothiazide, HCTZ
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamine; Dextroamphetamine Salts
• Ampicillin
• Ampicillin; Sulbactam
• Anticholinergics
• Atazanavir
• Atazanavir; Cobicistat
• Atenolol; Chlorthalidone
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azilsartan; Chlorthalidone
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benztropine
• Bisacodyl
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bosutinib
• Budesonide
• Budesonide; Formoterol
• Bumetanide
• Calcium Carbonate; Risedronate
• Candesartan; Hydrochlorothiazide, HCTZ
• Capecitabine
• Captopril; Hydrochlorothiazide, HCTZ
• Cefpodoxime
• Ceftibuten
• Cefuroxime
• Chlordiazepoxide; Clidinium
• Chlorothiazide
• Chlorthalidone
• Chlorthalidone; Clonidine
• Cyanocobalamin, Vitamin B12
• Cysteamine
• Dacomitinib
• Dasatinib
• Delavirdine
• Dexmethylphenidate
• Dextroamphetamine
• Dicyclomine
• Digoxin
• Dolutegravir; Rilpivirine
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Enalapril; Hydrochlorothiazide, HCTZ
• Eprosartan; Hydrochlorothiazide, HCTZ
• Erlotinib
• Ethacrynic Acid
• Flavoxate
• Fosinopril; Hydrochlorothiazide, HCTZ
• Furosemide
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• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Homatropine; Hydrocodone
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Indacaterol; Glycopyrrolate
• Iron
• Itraconazole
• Ketoconazole
• Ledipasvir; Sofosbuvir
• Letermovir
• Loop diuretics
• Mefloquine
• Mepenzolate
• Mesalamine, 5-ASA
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• Methylphenidate
• Metolazone
• Mycophenolate
• Nelfinavir
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• Nilotinib
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• Oxybutynin
• Pazopanib
• Pexidartinib
• Polyethylene Glycol; Electrolytes; Bisacodyl
• Ponatinib
• Posaconazole
• Propantheline
• Rilpivirine
• Risedronate
• Saquinavir
• Scopolamine
• Secretin
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• Sofosbuvir; Velpatasvir
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• Solifenacin
• St. John’s Wort, Hypericum perforatum
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• Trihexyphenidyl
• Trospium
• Warfarin