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Pantoprazole is used for short-term treatment of erosion and ulceration of the esophagus caused by gastroesophageal reflux disease. Initial treatment is generally of eight weeks' duration, after which another eight-week course of treatment may be considered if necessary. It can be used as a maintenance therapy for long-term use after initial response is obtained. Pantoprazole may also be used in combination with antibiotics to treat ulcers caused by Helicobacter pylori. When treating H. pylori ulcers, pantoprazole is given twice daily, in contrast to gastroesophageal reflux disease, where it is usually given once daily. Typical treatment courses for H. pylori range from 10 to 14 days.
- Infection: Stomach acid plays a role in killing ingested bacteria. Use of pantoprazole may increase the chance of developing infections such as pneumonia, particularly in hospitalized patients.
- Gastrointestinal: abdominal pain (3%), diarrhea (4%), flatulence (4%)
- Neurologic: headache (5%)
- Gastrointestinal: atrophic gastritis, Clostridium difficile diarrhea
- Hematologic: thrombocytopenia (less than 1%)
- Immunologic: Stevens-Johnson syndrome, toxic epidermal necrolysis
- Musculoskeletal: Muscle disorders, bone fracture and infection, Clostridium difficile infection, osteoporosis-related hip fracture, rhabdomyolysis
- Renal: interstitial nephritis (rare)
- Nutrition: may reduce the absorption of important nutrients, vitamins and minerals, as well as medications, leaving users at increased risk for pneumonia
- Cardiovascular: increase in a chemical that suppresses the production of nitric oxide by 25% in humans, which has proven to relax and protect arteries and veins, causes blood vessels to constrict, a development that could lead to a number of cardiovascular problems if continued for a prolonged time
Pantoprazole is metabolized in the liver by the cytochrome P450 system. Metabolism mainly consists of demethylation by CYP2C19 followed by sulfation. Another metabolic pathway is oxidation by CYP3A4. Pantoprazole metabolites are not thought to have any pharmacological significance. Pantoprazole is relatively free of drug interactions; however, it may alter the absorption of other medications that depend on the amount of acid in the stomach, such as ketoconazole or digoxin. Generally inactive at the acidic pH of stomach, thus it is usually given with a prokinetic drug. Pantoprazole binds irreversibly to H+K+ATPase (proton pumps) and suppresses the secretion of acid. As it binds irreversibly to the pumps, new pumps have to be made before acid production can be resumed. The drug's plasma half-life is about 2 hours.
Pantoprazole was developed by Altana (owned by Nycomed) and was licensed in the USA to Wyeth (which was taken over by Pfizer). It was initially marketed under the brand name Protonix by Wyeth-Ayerst Laboratories, and now is available as a generic. It is available by prescription in delayed-release tablets. It is also available for intravenous use.
As of March 2015 Pantoprazole was available as a generic drug from a range of international suppliers under many brand names.
- Katz, Philip O; Gerson, Lauren B; Vela, Marcelo F (19 February 2013). "Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease". The American Journal of Gastroenterology 108 (3): 308–328. doi:10.1038/ajg.2012.444. PMID 23419381.
- Dammann, HG; Fölsch, UR; Hahn, EG; von Kleist, DH; Klör, HU; Kirchner, T; Strobel, S; Kist, M (March 2000). "Eradication of H. pylori with pantoprazole, clarithromycin, and metronidazole in duodenal ulcer patients: a head-to-head comparison between two regimens of different duration.". Helicobacter 5 (1): 41–51. doi:10.1046/j.1523-5378.2000.00006.x. PMID 10672051.
- Chey, WD; Wong, BC; Practice Parameters Committee of the American College of, Gastroenterology (August 2007). "American College of Gastroenterology guideline on the management of Helicobacter pylori infection.". The American journal of gastroenterology 102 (8): 1808–25. doi:10.1111/j.1572-0241.2007.01393.x. PMID 17608775.
- Herzig, SJ; Doughty, C; Lahoti, S; Marchina, S; Sanan, N; Feng, W; Kumar, S (November 2014). "Acid-suppressive medication use in acute stroke and hospital-acquired pneumonia.". Annals of neurology 76 (5): 712–8. doi:10.1002/ana.24262. PMID 25164323.
- [Dr. John Cooke, chair of Methodist Hospital's cardiovascular services] [Houston Chronicle Health Zone dated Thursday, July 11, 2013 chron.com/refluxmeds] (Journal: Circulation)
- Meyer, U A (1996). "Metabolic interactions of the proton-pump inhibitors lansoprazole, omeprazole and pantoprazole with other drugs". European journal of gastroenterology & hepatology 8 (Suppl 1): S21–25. doi:10.1097/00042737-199610001-00005.
- Steinijans, V. W.; Huber, R.; Hartmann, M.; Zech, K.; Bliesath, H.; Wurst, W.; Radtke, H. W. (1996). "Lack of pantoprazole drug interactions in man: An updated review". International Journal of Clinical Pharmacology and Therapeutics 34 (6): 243–262. PMID 8793611.
- Sachs G, Shin JM, Hunt R (December 2010). "Novel approaches to inhibition of gastric acid secretion". Curr Gastroenterol Rep 12 (6): 437–47. doi:10.1007/s11894-010-0149-5. PMC 2974194. PMID 20924727.
- Drugs.com Pantoprazole internatinal availability Page accessed March 30, 2015]