Pantonix

Indications

Pantonix 20 mg (pantoprazole) is used when suppression of gastric acid secretion is needed, such as in peptic ulcer disease, gastroesophageal reflux disease (GERD), NSAID induced gastric or duodenal ulcer, Helicobacter pylori eradication in combination with antibiotics and Zollinger-Ellison syndrome.

Pharmacology

Pantoprazole is a proton pump inhibitor that blocks the final step of gastric acid production. It covalently binds to the H+/K+ ATPase enzyme system on the gastric parietal cell surface, leading to inhibition of both basal and stimulated gastric acid secretion, regardless of the stimulus, and this effect can last for more than 24 hours.

Dosage & Administration

• Benign gastric ulcer (oral): 40 mg once daily in the morning for 4 weeks; if not fully healed, treatment may be continued for another 4 weeks.
• Gastroesophageal reflux disease (oral): 20-40 mg once daily in the morning for 4 weeks; if not fully healed, treatment may be continued for a further 4 weeks. Usual maintenance dose is 20 mg daily, which may be increased to 40 mg daily if needed.
• Duodenal ulcer (oral): 40 mg once daily in the morning for 2 weeks; if not fully healed, treatment may be continued for another 2 weeks.
• Duodenal ulcer associated with Helicobacter pylori (oral): 40 mg twice daily in combination with antibiotics, such as amoxycillin 1 g and clarithromycin 500 mg both twice daily for one week, or clarithromycin 250 mg and metronidazole 400 mg both twice daily for one week.
• Prophylaxis of NSAID associated gastric or duodenal ulcer (oral): 20 mg once daily in patients who require long term NSAID treatment.
• Zollinger-Ellison syndrome (oral): initially 80 mg once daily, then adjusted according to response (in elderly, maximum 40 mg daily); daily doses above 80 mg are given in 2 divided doses.
• Duodenal ulcer and gastric ulcer (IV injection): 40 mg once daily for 7-10 days.
• GERD with history of erosive esophagitis (IV injection): 40 mg once daily for 7-10 days.
• Prevention of rebleeding in peptic ulcer (IV): 80 mg as an initial dose, followed by continuous infusion at 8 mg per hour for 72 hours.
• Prophylaxis of acid aspiration (IV): 80 mg every 12 hours for 24 hours, followed by 40 mg every 12 hours.
• Long term management of Zollinger-Ellison syndrome and other pathological hypersecretory conditions (IV): 80 mg every 12 hours, which may be increased to 80 mg every 8 hours if needed; higher doses may be titrated according to acid output.

Interaction

No significant drug interactions have been observed with pantoprazole in clinical studies.

Contraindications

Pantoprazole is contraindicated in patients with known hypersensitivity to pantoprazole or to any component of the formulation.

Side Effects

Pantonix is generally well tolerated in both short term and long term treatment. Common side effects include headache and diarrhea. Less common side effects may include abdominal pain, flatulence, skin rash, insomnia and hyperglycemia.

Pregnancy & Lactation

Pantoprazole is classified as US FDA pregnancy category B. Adequate and well controlled studies in pregnant women are not available, so this drug should be used during pregnancy only if clearly needed. Pantoprazole has been shown to be excreted in human breast milk, therefore a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the benefit of therapy for the mother.

Precautions & Warnings

Patients should be advised not to split, chew or crush Pantonix tablets, as they are enteric coated. Long term therapy with pantoprazole may lead to malabsorption of cyanocobalamin (vitamin B12) or may increase the risk of osteoporosis related disorders, so periodic review is recommended in long term use.

Overdose Effects

No specific symptoms of pantoprazole overdosage are known in humans. Since pantoprazole is highly protein bound, it is not readily dialyzable. In case of overdose, management should be symptomatic and supportive, as no specific antidote is recommended.

Storage Conditions

Store Pantonix in a dry place away from light and heat, at normal room temperature, and keep it out of the reach of children.