Pantoprazole
Protonix | Pantoloc
FDA ApprovedGastrointestinal AgentsProton Pump Inhibitors
FDA: 2000Half-life: 1 hourPregnancy: Category B
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Overview
Proton pump inhibitor for gastric acid suppression, used in GERD, erosive esophagitis, and Zollinger-Ellison syndrome.
Indications
- Gastroesophageal reflux disease (GERD)
- Erosive esophagitis
- Zollinger-Ellison syndrome
- H. pylori eradication (combination)
Contraindications
- Hypersensitivity to substituted benzimidazoles
- Concomitant use with rilpivirine
Classification
Mechanism of Action
Irreversibly inhibits H+/K+ ATPase (proton pump) in gastric parietal cells, suppressing basal and stimulated gastric acid secretion.
Pharmacodynamics
Produces dose-dependent inhibition of gastric acid. Maximum effect at day 2-3 of once-daily dosing.
Pharmacokinetics
- Absorption
- Rapid absorption. Enteric-coated tablet delays onset.
- Distribution
- Protein binding 98%. Volume of distribution 11-24 L.
- Metabolism
- Hepatic via CYP2C19 (major), CYP3A4. Polymorphic metabolism.
- Excretion
- Renal (71%), fecal (18%).
- Half-life
- 1 hour
- Bioavailability
- 77%
- Protein Binding
- 98%
Dosage
Typical dosage: 20-40mg once daily
Available Forms
- Tablet (delayed-release)
- Granules
- IV injection
Side Effects
Common
- Headache
- Diarrhea
- Nausea
- Abdominal pain
- Flatulence
Serious
- C. difficile-associated diarrhea
- Bone fractures (long-term)
- Hypomagnesemia
Rare
- Interstitial nephritis
- Subacute cutaneous lupus erythematosus
Drug Interactions
moderate
PPIs may increase methotrexate levels by inhibiting renal elimination.
moderate
Less interaction than omeprazole, but some CYP2C19 inhibition possible.
Warnings
Pregnancy
Category B
Toxicity
LD50 >4000 mg/kg (oral, rat)
Overdose
No specific symptoms expected. Treatment: supportive care.
References
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