Pantoprazole dosing

The PPIs (omeprazole, esomeprazole, lansoprazole, rabeprazole, and pantoprazole) dose-dependently inhibit basal and stimulated gastric acid secretion. When PPI therapy is initiated, the degree of acid suppression increases over the first 3 to 4 days of therapy, as more and more proton pumps are inhibited. Upon discontinuation of therapy, full restoration of acid secretion takes 3 to 5 days. Because PPIs inhibit only those proton pumps that are actively secreting acid, they are most effective when taken 15 to 30 minutes before meals. ... 

Negative results with pantoprazole in this area are less than conclusive, since the interaction potential with theophylline has only been studied at a pantoprazole dose of 30 mg applied by 2-min injections [58], so that the period of liver exposure was lower than in the clinical setting. Even so, a nonsignificant decrease in elimination half-life by 10% was noted. Lansoprazole hastening of theophylline elimination appears inconsiderable from a practical point of view. More important are concerns over possible links between cancerogenesis and inducibility of lA isoforms. The ambiguities of this issue have been mooted previously. In the present context, it may suffice to emphasize that the 1A induction by PPIs is trivial in magnitude, probably transient and may even have positive aspects [41]. 

Comparable daily doses of PPIs are omeprazole 20 mg = esomeprazole 20 mg = lansoprazole 30 mg = rabeprazole 20 mg = pantoprazole 40 mg. The PPIs degrade in acidic environments and are therefore formulated in delayed-release capsules or tablets.16 Lansoprazole, esomeprazole, and omeprazole contain enteric-coated (pH-sensitive) granules in a capsule form. For patients unable to swallow the capsule or in pediatric patients, the contents of the capsule can be mixed in applesauce or placed in orange juice. If a patient has a nasogastric tube, the contents of an omeprazole capsule can be... 

Pantoprazole (Protonix) [Gastric Acid Suppressant/Proton Pump Inhibitor] Uses GERD, erosive gastritis, ZE synd, PUD Action Proton pump inhibitor Dose 40 mg/d PO do not crush/chew tabs 40 mg IV/d (not >3 mg/min, use Protonix filter) Caution [B, /-] Disp Tabs, inj SE Chest pain, anxiety, GI upset Interactions t Effects OF warfarin t effects of photosensitivity W/ St. John s wort X effects OF ketoconazole EMS t Effects of anticoagulants may affect glucose (hypoglycemia) OD Unlikely to cause life-threatening Sxs... 

Pantoprazole is subject to low first-pass hepatic extraction, as reflected in an estimated absolute oral bioavailability of 77%. On repeated oral administration, the pharmacokinetics of pantoprazole (20 and 40 mg once daily) are similar to those after single dose administration [1,18]. The absolute bioavailability was 70% in patients with severe liver cirrhosis, and more than 90% in healthy elderly subjects [18]. 

When pantoprazole was administered to patients with stable renal impairment undergoing hemodialysis the AUC and t r values were only 46% and 65%, respectively, of that observed in healthy volunteers. CL increased by 117%, and Vd was increased by 45%. It was not considered necessary to reduce the dose of pantoprazole in patients with renal impairment [22]. 

Doses up to 240 mg pantoprazole are well tolerated. It has no specific antidote and measures other than symptomatic treatment may be recommended [1],... 

Pantoprazole-sodium has a lower variability in pharmacokinetics compared with omeprazole, particularly with respect to bioavailability. The pharmacokinetics of pantoprazole-sodium are almost the same in patients with gastrointestinal diseases and those with renal failure, and in the elderly, so that no dose adjustment is required. In addition, pantoprazole-sodium has a low potential for drug-drug interaction, which is a considerable benefit because many patients who require pantoprazole are elderly and are receiving co-medications [13]. 

A 34-year-old alcoholic man with acute pancreatitis was given continuous intravenous infusion of haloperidol (2 mg/hour) for agitation after 7 hours he received a bolus dose of haloperidol 10 mg for worsening agitation and 20 minutes later, QT interval was 560 ms (420 ms before treatment) (131). He developed torsade de pointes and ventricular fibrillation, which resolved with electric defibrillation. He was a smoker and was also taking tiapride and alprazolam for depression, in addition to pantoprazole, piperazilline + tazobactam, paracetamol, and vitamins Bi, B6, and B 12-... 

PHENYTOIN PROTON PUMP INHIBITORS Possible t efficacy and adverse effects of phenytoin Unclear possible altered metabolism via CYP2C19 1 dose may be required. Use the proton pump inhibitor regularly, not PRN monitor phenytoin levels when starting or stopping treatment. Patients have received omeprazole for 3 weeks without altered phenytoin levels. Effect not reported with pantoprazole or rabeprazole... 

BZDs PROTON PUMP INHIBITORS -OMEPRAZOLE/ ESOMEPRAZOLE T efficacy and adverse effects, e.g. prolonged sedation Inhibition of metabolism via CYP4S0 (some show competitive inhibition via CYP2C19) Monitor for t side-effects, and 1 dose as necessaiy. Likely to delay recovery after procedures for which BZDs have been used. Consider alternative proton pump inhibitor, e.g. lansoprazole or pantoprazole... 

ANTICOAGULANTS-ORAL PROTON PUMP INHIBITORS Possibly t anticoagulant effect when esomeprazole, lansoprazole or omeprazole is added to warfarin Uncertain at present. Omeprazole and lansoprazole are known to induce CYP1A2, which plays a role in activation of coumarins Monitor INR more closely. 1 dose may be required. If 10%, 20% or 30% over range, omit dose for 1, 2 or 3 days respectively consider i maintenance dose by 10%. Regular dosing of a proton pump inhibitor is preferable if affects INR significantly. Not reported with pantoprazole or rabeprazole... 

Omeprazole carries a higher risk for interactions as it has a high affinity for CYP2C19 and a somewhat lower affinity for CYP3A4. Pantoprazole (which is further metabolized by non-saturable phase II reactions after initial metabolism by CYP isoenzymes) has a lower potential for interaction associated with CYP450 inhibition, It is also likely that, despite the limited information, esomeprazole, lansoprazole and rabeprazole also have weaker potential for interaction compared with omeprazole. Pantoprazole has been reported to be used without dose adjustments in critical care patients with organ dysfunction. 

Lamouliatte H, Samoyeau R, De Mascarel A, Megraud F. Double vs. single dose of pantoprazole in combination with clarithromycin and amoxycillin for 7 days, in eradication of Helicobacter pylori in patients with non-ulcer dyspepsia. Aliment Pharmacol Ther 1999 13(ll) 1523-30. 

Pantoprazole 20 mg/day (low dose) and ranitidine 300 mg/day (standard dose) have been compared in the treatment of mild gastro-esophageal reflux disease in a double-bhnd, multicenter trial in 201 patients (28). Overall symptom control and heahng rates were significantly better with pantoprazole. There was no significant difference in reported adverse events between the treatment groups. The more commonly reported were diarrhea, headache, and abdominal pain. 

Reversible peripheral edema has been reported in five women taking the proton pump inhibitors omeprazole, lansoprazole, or pantoprazole for 7-15 days for peptic disorders in recommended standard doses (29). Edema disappeared within 2-3 days of withdrawal and reappeared in all five patients after re-exposure. High-dose intravenous infusions of omeprazole and pantoprazole (8 mg/hour) caused peripheral edema in three of six young female volunteers and two of six female volunteers respectively. The edema disappeared within 24 hours of stopping the infusion. Similar high doses of omeprazole did not produce edema in male volunteers. Subsequent studies performed on 10 female volunteers to elucidate the cause of the edema did not show any changes in concentrations of serum hormones or Cl esterase inhibitor. 

Co-administration of either lansoprazole or pantoprazole in healthy subjects did not affect the steady-state pharmacokinetics of theophylline in therapeutic doses (74). 

The absorption of panloprazole is rapid (C u, of 2.5 ig/ nL, Tmu 2.S hours) after single or multiple oral 40-mg doses. Pantoprazole is well absorbed (—77% bioavailability). Admini.stration of pantoprazole with food may delay its absorption but does not alter its bioavailability. Pantoprazole... 

Prilosec, Rapinex, Zegerid) and its S-isomer, esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix). These drugs have different substitutions on their pyridine and/or benzimidazole groups but are remarkably similar in their pharmacological properties. Omeprazole is a racemic mixture of R- and S-isomers the S-isomer, esomeprazole (S-omeprazole), is eliminated less rapidly than R-omeprazole, which theoretically provides a therapeutic advantage because of the increased half-life. Despite claims to the contrary, all proton-pump inhibitors have equivalent efficacy at comparable doses. 

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