Home Drug Guide Pantoprazole Sodium

Drug Guide

Generic Name

Pantoprazole Sodium

Brand Names Protonix, Protonix IV, Pantoprazole Sodium in 0.9% Sodium Chloride

Classification

Therapeutic: Gastric acid secretion inhibitor

Pharmacological: Proton pump inhibitor (PPI)

FDA Approved Indications

Gastroesophageal reflux disease (GERD)
Erosive esophagitis
Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)

Mechanism of Action

Pantoprazole is a proton pump inhibitor that irreversibly binds to H+/K+ ATPase enzyme system (the proton pump) of gastric parietal cells, blocking the final step of acid production and reducing gastric acid secretion.

Dosage and Administration

Adult: Typically, 40 mg once daily before a meal; duration varies based on condition.

Pediatric: Use not recommended in children under 5 years old; dosing depends on condition and weight.

Geriatric: Adjust dosage based on renal function. No specific dose adjustment needed solely due to age.

Renal Impairment: Adjust dose in severe renal impairment; monitor renal function.

Hepatic Impairment: Use with caution; start at lower end of dosing range and titrate as needed.

Pharmacokinetics

Absorption: Absorption is rapid, with bioavailability of approximately 77%.

Distribution: Widely distributed; plasma protein binding is about 98%.

Metabolism: Primarily hepatic, via CYP2C19 and CYP3A4 enzyme pathways.

Excretion: Excreted mainly in feces (70%) and urine (20%).

Half Life: Approximately 1-2 hours.

Contraindications

Hypersensitivity to pantoprazole or benzimidazole drugs.

Precautions

Use with caution in patients with hepatic impairment.
Potential risk for Clostridioides difficile-associated diarrhea; monitor for symptoms.
Long-term use may increase risk of vitamin B12 deficiency, osteoporosis-related fractures, and magnesium deficiency.

Adverse Reactions - Common

Headache (Common)
Diarrhea (Common)
Nausea and vomiting (Common)
Abdominal pain (Common)

Adverse Reactions - Serious

Clostridioides difficile-associated diarrhea (Less common)
Hypomagnesemia (Rare)
Severe skin reactions (Rare)
Anaphylaxis (Rare)

Drug-Drug Interactions

Atazanavir, nelfinavir (reduced absorption with PPIs)
Methotrexate (increased serum levels)
Warfarin (potential increased bleeding risk)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for symptom relief of acid-related disorders, liver function tests, magnesium levels if used long-term.

Diagnoses:

Risk for infection (C. difficile), altered bowel elimination, risk for electrolyte imbalance.

Implementation: Administer 1 hour before meals. Be aware of potential drug interactions.

Evaluation: Assess symptom improvement, monitor for adverse effects, periodic assessment of magnesium and vitamin B12 levels for long-term therapy.

Patient/Family Teaching

Take as prescribed, preferably before meals.
Report persistent diarrhea, severe abdominal pain, or signs of allergic reactions.
Do not abruptly stop without consulting healthcare professional.

Special Considerations

Black Box Warnings:

None currently.

Genetic Factors: CYP2C19 polymorphisms can affect metabolism as poor metabolizers may have higher plasma levels.

Lab Test Interference: May cause falsely elevated serum gastrin levels.

Overdose Management

Signs/Symptoms: Dizziness, nausea, increased secretions, or seizures in severe overdose.

Treatment: Supportive care; no specific antidote. Consider activated charcoal if ingestion was recent; maintain airway and support vital functions.

Storage and Handling

Storage: Store at room temperature (20-25°C), away from moisture and light.

Stability: Stable under recommended storage conditions for up to 2 years.