ZOLPANZ

Indications

• Gastroesophageal reflux disease (GERD)
• Erosive esophagitis
• Zollinger-Ellison syndrome
• Prevention of gastric ulcers
• H. pylori eradication (in combination therapy)

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 inhibiting the H+/K+ ATPase enzyme system (proton pump) located in the parietal cells of the stomach lining. This inhibition prevents the final step of gastric acid production, leading to a significant reduction in gastric acidity.

Pharmacodynamics

The pharmacodynamic effects of pantoprazole involve a reduction in gastric acid secretion, which can lead to increased gastric pH. This action helps to alleviate symptoms associated with acid-related disorders and promotes healing of the gastric and esophageal mucosa. The onset of action typically occurs within 1 hour, with the maximum effect seen after several days of continuous use.

Pharmacokinetics

Pantoprazole is well absorbed from the gastrointestinal tract, with peak plasma concentrations reached approximately 2 to 4 hours after oral administration. It undergoes extensive hepatic metabolism, primarily via the cytochrome P450 system. The drug has a half-life of about 1 hour; however, its effects can last much longer due to the irreversible inhibition of the proton pump. Pantoprazole is eliminated primarily through urine, with less than 1% of the dose excreted unchanged.

Contra-indications

• Hypersensitivity to pantoprazole or any of its excipients
• Concomitant use with rilpivirine-containing products

Adverse effects

• Headache
• Dizziness
• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Flatulence
• Constipation
• Rash
• Fatigue
• Palpitations
• Bone fractures
• Kidney injury

Interactions

• May reduce the absorption of drugs that require an acidic pH for absorption, such as ketoconazole and atazanavir
• Increased risk of gastrointestinal infections when used with certain antibiotics
• May interact with warfarin, leading to altered anticoagulation effects

Precautions

• Long-term use may lead to vitamin B12 deficiency
• Monitor for signs of Clostridium difficile infection in the colon
• Caution in patients with liver disease, as dose adjustment may be necessary
• Use with caution in patients with a history of osteoporosis or fractures

Pregnancy

Limited data on the use of pantoprazole in pregnancy. It should only be used if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

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

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Oral tablets (delayed-release)
• Intravenous injection