PANTOCID 40 mg INJECTION

Indications

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease
• Zollinger-Ellison syndrome
• Prevention of stress ulcer bleeding

Dosage

Children: Refer to the BNF for Children for specific dosing information.

Adults: Refer to the BNF for specific dosing information.

Mechanism of action

Pantoprazole works by irreversibly binding to the H+/K+ ATPase enzyme, also known as the gastric proton pump, located on the luminal surface of the gastric parietal cells. This action inhibits the final step of gastric acid secretion, leading to a significant reduction in gastric acidity.

Pharmacodynamics

Pantoprazole exhibits a dose-dependent inhibition of gastric acid secretion. The onset of action is typically within 1 hour, with peak effects observed around 2 to 4 hours post-administration. The duration of action can last up to 24 hours. Pantoprazole is more effective in inhibiting gastric acid secretion in a stimulated state, such as after meal intake.

Pharmacokinetics

Pantoprazole is well absorbed from the gastrointestinal tract, with bioavailability being around 77% when taken orally. It undergoes extensive hepatic metabolism, primarily via the cytochrome P450 system, particularly CYP2C19 and CYP3A4. The elimination half-life is approximately 1 hour, but its effects on acid secretion can last much longer due to the irreversible action on the proton pump. Excretion occurs mainly via the urine, with around 80% of the drug being eliminated as metabolites.

Contra-indications

• Hypersensitivity to pantoprazole or any component of the formulation
• Concomitant use with nelfinavir

Adverse effects

• Headache
• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Flatulence
• Constipation
• Rash
• Dizziness
• Fatigue

Interactions

• May reduce the effectiveness of drugs that require an acidic gastric pH for absorption (e.g., ketoconazole, atazanavir)
• May interact with warfarin and increase the risk of bleeding
• Concomitant use with methotrexate may increase the risk of toxicity

Precautions

• Use with caution in patients with hepatic impairment
• Long-term use may lead to vitamin B12 deficiency
• Monitor for signs of Clostridium difficile-associated diarrhea
• Consider potential risk of gastric cancer in long-term use

Pregnancy

Pantoprazole should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Limited data on human use.

Breast-feeding

Pantoprazole is excreted in human milk, caution should be exercised when administering to nursing women.

Storage

Store in a cool, dry place, away from direct sunlight. Keep out of reach of children.

Formulations

• Tablets (Enteric-coated)
• Injection (Powder for solution)