Pantonix 20 mg

Indication:

Pantonix 20 mg is indicated for the treatment of-

• Gastro-oesophageal Reflux Disease (GORD): Treatment of erosive esophagitis and associated symptoms like heartburn.
• Peptic Ulcers: Treatment of benign gastric ulcers and duodenal ulcers.
• Zollinger-Ellison Syndrome: And other pathological hypersecretory conditions.
• NSAID-associated Ulcers: Prevention of gastroduodenal ulcers induced by non-selective NSAIDs in patients at risk.
• H. pylori Eradication: Used in combination with appropriate antibiotics.

Dogase & Adminstration:

Adults (Oral):

• GORD: 20–40 mg once daily for 4–8 weeks.
• Gastric/Duodenal Ulcers: 40 mg once daily or more time with doctors advice for 2–8 weeks.
• Zollinger-Ellison Syndrome: Initially 80 mg daily, adjusted according to response (doses above 80 mg should be divided).
• NSAID Prophylaxis: 20 mg once daily.

Children (Oral – Based on BNFC):

• Used for GORD and acid-related dyspepsia. Dosing is often restricted to children over 12 years (adult dose) or weight-based as per clinical specialist guidance (e.g., 20 mg for weight 15–40 kg, 40 mg for weight >40 kg).
• Administration: Tablets should be swallowed whole with water before a meal (usually breakfast). Do not crush or chew the tablets.

Injection Dosage for Adults:

• Standard Dose: 40 mg once daily via intravenous route.
• Zollinger-Ellison Syndrome: Initial dose is 80 mg once or twice daily. The dose can be titrated upwards depending on acid output.
• Upper GI Bleeding: High-dose protocols (e.g., 80 mg bolus followed by infusion) may be used under specialist supervision.

Injection Dosage for Children (Based on BNFC):

• Children 1 month to 18 years: Dosage is weight-dependent, typically 1 mg/kg once daily (Maximum 40 mg per day).

 Administration Of Injection:

• IV Injection: Reconstitute the 40 mg vial with 10 mL of Normal Saline. Inject slowly over 2 to 5 minutes.
• IV Infusion: Dilute the reconstituted solution in 100 mL of Normal Saline or 5% Dextrose. Infuse over 15 to 30 minutes.

”রেজিস্ট্রার চিকিৎসকের পরামর্শ অনুযায়ী ঔষধ সেবন করুন”

Pharmacology:

• Mechanism of Action: Pantoprazole is a substituted benzimidazole. It suppresses the final step in gastric acid production by covalently binding to the H+/K+-ATPase enzyme system (the proton pump) at the secretory surface of the gastric parietal cells.
• Pharmacodynamics: This inhibition is dose-dependent and affects both basal and stimulated acid secretion. Since the binding is irreversible, the effect lasts longer than the drug’s plasma half-life, usually up to 24 hours or more.
• Pharmacokinetics: It is rapidly absorbed after oral administration. It undergoes extensive hepatic metabolism via the cytochrome P450 system (primarily CYP2C19 and CYP3A4). It is highly protein-bound (about 98%).

Side Effects:

Common: Benign gastric polyps, headache, diarrhea, nausea, and flatulence.Long-term use risks: Bone fractures, hypomagnesemia and Clostridium difficile infection.

Drug Interaction:

Pantoprazole is a proton pump inhibitor (PPI) that decreases gastric acid production. Because it alters the pH level of the stomach and is metabolized by the liver, it can interact with several categories of drugs.

pH-Dependent Absorption Interactions:
By increasing the gastric pH, Pantoprazole can significantly reduce the absorption and therapeutic efficacy of medications that require an acidic stomach environment to dissolve:

• Antifungals: Decreases the absorption of Ketoconazole, Itraconazole, and Posaconazole.
• Anti-HIV Medications (Antivirals): Co-administration with protease inhibitors like Atazanavir and Nelfinavir is strictly contraindicated because it significantly drops their blood levels, leading to treatment failure.
• Iron Supplements: Reduces the solubility and bioavailability of oral iron salts (e.g., Ferrous Sulfate).
• Cancer Medications: Absorption of drugs like Erlotinib and Dasatinib may be significantly reduced.

Hepatic Enzyme Interactions (CYP450 System)
Pantoprazole is extensively metabolized in the liver by the CYP2C19 and CYP3A4 enzyme systems. It has a relatively weak affinity for these enzymes compared to Omeprazole, leading to fewer interactions, but notable ones include:

• Warfarin (Anticoagulant): Co-administration may increase the International Normalized Ratio (INR) and prothrombin time, which can lead to abnormal bleeding. Regular monitoring of INR is highly recommended.
• Methotrexate (Cancer/Rheumatoid Arthritis drug): Concurrent use with high-dose methotrexate may increase and prolong serum levels of methotrexate, potentially leading to toxic reactions.
• Phenytoin & Diazepam: Minor risks of increased plasma concentrations, though less significant than with other PPIs.

 Interactions Affecting Pantoprazole Metabolism:

• CYP2C19 Inducers: Drugs like Rifampicin and St. John’s Wort can accelerate the liver’s breakdown of Pantoprazole, reducing its efficacy.
• CYP2C19 Inhibitors: Drugs like Fluvoxamine may increase Pantoprazole concentrations in the bloodstream.

 Interaction with Clopidogrel:
Unlike Pantoprazole does not significantly interfere with the antiplatelet activity of Clopidogrel, making it a preferred PPI choice for patients taking blood thinners for cardiovascular protection.

Pregnancy & Lactation:

• Pregnancy: Use only if the potential benefit justifies the potential risk to the fetus.
• Lactation: Pantoprazole is excreted in breast milk; a decision should be made whether to discontinue nursing or the drug.

Over Dosage:

Overdose data is limited. Doses up to 240 mg IV have been administered without adverse effects. Management is symptomatic.

Therapeutic Class:

Proton Pump Inhibitor (PPI); Anti-ulcerant.

Storage Conditions:

Store below at 30°C  temperature in a dry place. Away from light and out of reach of children. Do not use the medication after its expiration date.