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Pantoprazole

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Pantoprazole, sold under the brand name Protonix, among others, is a medication used for the treatment of stomach ulcers, short-term treatment of erosive esophagitis due to gastroesophageal reflux disease (GERD), maintenance of healing of erosive esophagitis, and pathological hypersecretory conditions including Zollinger–Ellison syndrome.<ref name=AHFS2018>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name=":0">Template:Cite book</ref> It may also be used along with other medications to eliminate Helicobacter pylori.<ref name=BNF74>Template:Cite book</ref> Pantoprazole is a proton-pump inhibitor (PPI) and its effectiveness is similar to that of other PPIs.<ref name=TI2016>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It is available by mouth and by injection into a vein.<ref name=AHFS2018/>

Common side effects include headaches, diarrhea, abdominal pain, and joint pain.<ref name=AHFS2018/><ref name=":0" /> More serious side effects may include severe allergic reactions, a type of chronic inflammation known as atrophic gastritis, Clostridioides difficile colitis, low magnesium, and vitamin B12 deficiency.<ref name=AHFS2018/> Use in pregnancy appears to be safe.<ref name=AHFS2018/> Pantoprazole is a proton pump inhibitor that decreases gastric acid secretion.<ref name=AHFS2018/> It works by inactivating (H+/K+)-ATPase function in the stomach.<ref name=Ric1998>Template:Cite journal</ref><ref name=AHFS2018/>

The study of pantoprazole began in 1985, and it came into medical use in Germany in 1994.<ref>Template:Cite book</ref> It is available as a generic medication.<ref name=AHFS2018/><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In 2022, it was the sixteenth most commonly prescribed medication in the United States, with more than 30Template:Nbspmillion prescriptions.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In Australia, it was one of the top 10 most prescribed medications between 2017 and 2023.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Medical usesEdit

Pantoprazole is used for short-term treatment of erosion and ulceration of the esophagus for adults and children five years of age and older caused by gastroesophageal reflux disease.<ref name=Label /> It can be used as a maintenance therapy for long-term use after initial response is obtained, but there have not been any controlled studies about the use of pantoprazole past a duration of 12 months.<ref name=Label /> Pantoprazole may also be used in combination with antibiotics to treat ulcers caused by Helicobacter pylori.<ref>Template:Cite journal</ref> It can also be used for long-term treatment of Zollinger-Ellison syndrome.<ref name=Label /> It may be used to prevent gastric ulcers in those taking NSAIDs.<ref name=BNF74/>

For improved efficacy of pantoprazole, the oral tablet formulation is taken half an hour prior to ingestion of food.<ref name=":0" /> In the hospital, intravenous administration is indicated when patients are unable to take the medication by mouth.<ref name=":2">Template:Cite journal</ref>

ChildrenEdit

Pantoprazole is only indicated for the short-term treatment of erosive esophagitis in children ages seven and older; and the safety and effectiveness of pantoprazole have only been established in the treatment of erosive esophagitis in children.<ref name=Label />

Adverse effectsEdit

InfectionEdit

Stomach acid plays a role in killing ingested bacteria. Use of pantoprazole may increase the chance of developing infections such as pneumonia, particularly in hospitalized patients.<ref>Template:Cite journal</ref>

ElderlyEdit

The incidence of adverse effects occurring in people aged 65 years and older was similar to that in people aged 65 years and less.<ref name=Label />

PregnancyEdit

In reproductive studies using doses largely greater than the recommended doses performed on rats and rabbits, there was no evident harm on the development of the baby.<ref name=Label /><ref name="Drugs.com pregnancy" />

Breast feedingEdit

Pantoprazole has been found to pass through the breast milk. Additionally, in rodent cancer studies, pantoprazole has been shown to potentially cause tumor growth. The clinical relevance of the finding is unknown, but risks and benefits are recommended for consideration in determining the use of therapy for the mother and child.<ref name=Label /><ref name="Drugs.com pregnancy" />

CommonEdit

  • Gastrointestinal: abdominal pain (6%), diarrhea (9%), flatulence (4%), nausea (7%), vomiting (4%)<ref name=Label>{{#invoke:citation/CS1|citation

|CitationClass=web }}</ref>

RareEdit

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Long-term useEdit

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  • Hypomagnesia has been observed in people on medications like pantoprazole when taken for longer periods of time (generally one year or more, although cases have been reported with regimens as short as three months).<ref name=":122">{{#invoke:citation/CS1|citation

|CitationClass=web }}</ref>

  • Deficiencies such as vitamin B12 deficiency, iron deficiency, and calcium deficiency may be seen with long term use.<ref name=":0" /> Vitamin B12 deficiency is due to the change in the acidic environment within the stomach with the use of pantoprazole which prevents peptidases from being activated.<ref name=":1">Template:Cite book</ref> This prevents the cleaving of R-factor from vitamin B12 and prevents its absorption.<ref name=":1" />
  • Rebound hypergastrinemia may be seen when stopping the medication after long term use.<ref>Template:Cite book</ref><ref name=":1" />

DiscontinuationEdit

In people taking PPIs for longer than six months, a dose taper is recommended prior to discontinuation.<ref>Template:Cite journal</ref>

InteractionsEdit

Due to its effect of reducing stomach acidity, use of pantoprazole can affect absorption of drugs that are pH-sensitive, such as ampicillin esters, ketoconazole, atazanavir, iron salts, amphetamine and mycophenolate mofetil.<ref name=Label /><ref name=":0" /> Additional medications that are affected include bisphosphonate derivatives, fluconazole, clopidogrel, and methotrexate.<ref name=":0" />

PharmacologyEdit

File:Pantoprazole 20mg.jpg
Wyeth pantoprazole 20 mg (Protonix®)
File:PantoIV.jpg
Vial of generic pantoprazole for IV administration

The mechanism of action of pantoprazole is to inhibit the final step in gastric acid production.<ref name=Label /> In the gastric parietal cell of the stomach, pantoprazole covalently binds to the H+/K+ ATP pump to inhibit gastric acid and basal acid secretion.<ref name=Label /> The covalent binding prevents acid secretion for up to 24 hours and longer.<ref name=Label />

Pantoprazole is metabolized in the liver by the cytochrome P450 system.<ref>Template:Cite journal</ref> Metabolism mainly consists of demethylation by CYP2C19 followed by sulfation. Another metabolic pathway is oxidation by CYP3A4. Pantoprazole metabolites are not thought to have any pharmacological significance. It is usually given with a prokinetic drug because of inactivity in the acidic environment of the stomach. Pantoprazole binds irreversibly to H+K+ATPase (proton pumps) to suppress the secretion of acid. Due to irreversible binding of the pumps, new pumps have to be made before acid production can be resumed.<ref name=Ric1998 /> The drug's plasma half-life is about two hours.<ref>Template:Cite journal</ref> After administration, the time for the drug to reach peak plasma concentrations is 2 to 3 hours.<ref name=":2" /> The percentage of the drug that is protein bound is 98%.<ref name=":2" />

HistoryEdit

Pantoprazole was discovered by scientists at Byk Gulden, a subsidiary of Altana; the drug discovery program started in 1980, producing pantoprazole in 1985. The compound was actually created by chemists working to scale up a different chemical that had been chosen as a development candidate.<ref name=SennBilfinger>Template:Cite book</ref>Template:Rp Byk Gulden partnered with Smith Kline & French in 1984.<ref name=SennBilfinger/>Template:Rp The compound's development names were BY1029 and SK&F96022.<ref name=SennBilfinger/>Template:Rp By 1986 the companies had created the sodium salt, pantoprazole sodium sesquihydrate, and decided to develop it as it was more soluble and stable, and was more compatible with other ingredients used in the formulation.<ref name=SennBilfinger/>Template:Rp It was first marketed in Germany in 1994.<ref name=SennBilfinger/>Template:Rp Wyeth licensed the US patent from Altana,<ref name=Law360>Template:Cite news</ref> and obtained marketing approval from the US FDA in 2000 under the trade name Protonix.<ref>Template:Cite journal</ref><ref name="FDA approval">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

In 2004, worldwide sales of the drug were $3.65 billion, about half of which were in the US.<ref name=Law360/>

In 2007, Altana's drug business was acquired by Nycomed.<ref name=WSJ/> Nycomed was in turn acquired by Takeda in 2011<ref>Template:Cite news</ref> and Wyeth was acquired by Pfizer in 2009.<ref>Template:Cite news</ref>

The patent protecting the drug was set to expire in 2010, but Teva Pharmaceuticals filed an Abbreviated New Drug Application (ANDA) in 2007, and Wyeth and Nycomed sued Teva for patent infringement, but Teva decided to launch its generic drug "at risk" that year, before the patent had been invalidated.<ref>Template:Cite news</ref><ref>Template:Cite journal</ref> Wyeth launched an authorized generic in 2008.<ref name=WSJ>Template:Cite news</ref> Pfizer and Takeda's patent exclusivity expired in 2010, and an administrative exclusivity they had for pediatric use expired in January 2011, and full generic competition began.<ref>Template:Cite news</ref> The litigation between Teva and Pfizer/Takeda was settled in 2013, with Teva paying the patent holders $2.15 billion in damages for its early launch.<ref>Template:Cite news</ref>

Society and cultureEdit

Template:As of, the drug was marketed under many brands worldwide, including as a combination drug with domperidone, a combination with itopride, in combination with both clarithromycin and amoxicillin, in combination with levosulpiride, and in combination with naproxen.<ref name=brands/>

Template:Collapse top Template:As of, it was marketed under many brands worldwide, including: Acernix, Aciban, Acida, Acido-X, Acidrol, Acidwell, Acilib, Acilibre, Acillect, Acipan, Acrid, Alapanzol, Amphoter, Anagastra, Anesteloc, Antaxid, Antopral, Anulacid, Anxel, Apazol, Appryo, Aptizole, Apton, Armcid, Asoprazole, Aspan, Aurizol-P, Awamed, Azatol, Biotop V, Brandocare, Branzol, Buffet, Buscopan Reflusso, Caprol, Ciprazol, Citrel, Clessol, Comenazol, Conoran, Contix, Contracid, Contraflux, Contro-Cap, Controloc, Cool Pan, Delpanto EC, Digene Total, Digespan, Dosanloc, Empaflun, Eracid, Erprazol, Esopan, Eupantol, Exopan, Extream, Extreme, F-Pan, Farmazol, Fenix, Fexmor, Fu Shi Tan, Fulpan, Fupan, Gastblok, Gastenz, Gastrazol-L, Gastriwin, Gastrolan, Gastroloc, Gastromax, Gastronorm, Gastroprozal, Gastrostad, Gastrowell, Gastrozol, Gerdamegh, Gerprazol, Gesoflux, Gondea, Gopan, Hansazol, Hasanloc, Helix, Iboprot, Inipant, Inipepsia, Inipomp, IPP, Ippracid, Ipraalox, Kaiji, Kairol, Letopra, Loxanto, Luoxu, Lupipan, Maalox, Mag, Manez, Marozel, Monpan, Nelgast, Nexpan, Noacid, Noacid, Nolpaza, Normogastrol, Noxadif, Ntap, Nuosen, Nupenta, Oritop, Osipan, Ozepran, Ozpan, Ozzion, P-20, P-40, P-Bit, P-OD, P-PPI, P-Zole, Pacid, Paciddia, Palio, Palmy, Pamel, Pamtrazol, Pamyl, Pan, Panbloc, Pancleus, Pancrazio, Pandev, Pane, Panfast, Pangest, Panglen, Panlan, Panlisu, Panloc, Panloz, Panmeilu, Panocer, Panogastin, Panopaz, Panor, Panoral, Panore, Panpot, Panpra, Panprabene, Panprax, Panprazol, Panprazox, Panpro, Panproton, Panpure, Panrazol, Panrazole, Panrbe, Panref, Pansa, Pansec, Panso, Pantac, Pantacid, Pantact, Pantagi, Pantakind, Pantaltius, Pantap, Pantasur, Pantaz, Pantazol, Pantecta, Pantex, Pantexel, Pantezol, Panthec, Panthron, Pantid, Pantin, Pantip, Pantium, Panto, Panto-Denk, Panto-Gas, Pantobex, Pantoc, Pantocal, Pantocar, Pantocare, Pantocas, Pantocer, Pantocid, Pantocim, Pantocom, Pantocure, Pantodac, Pantodar, Pantofin, Pantofir, Pantogastrix, Pantogen, Pantogerolan, PantoJenson, Pantokem, Pantokool, Pantolax, Pantoline, Pantoloc, Pantolok, Pantolup, Pantomax, Pantomed, Pantometylentina, Pantomyl, Pantonis, Pantonix, Pantop, Pantopacid, Pantopan, Pantopaz, Pantopep, Pantopi, Pantopra-Q, Pantopraz, Pantoprazal, Pantoprazol, Pantoprazole, Pantoprazolo, Pantoprazolum, Pantoprem, Pantoprix, Pantoprol, Pantopump, Pantor, Pantorc, Pantoren, Pantorica, Pantosal, Pantosan, Pantosec, Pantosid, Pantostad, Pantotab, Pantotis, Pantover, Pantoz, Pantozim, Pantozol, Pantozole, Pantpas, Pantra, Pantrol, Pantroz, Pantul, Pantune, Pantus, Panveda, Panvell, Panz, Panzat, Panzel, Panzilan, Panzilan, Panzol, Panzole, Panzor, Parastamic, Paz, Peblo, Penkool, Penlip, Pentalink, Pentastar, Pentowin, Pentoz, Pentozed, Peploc, Peptac, Peptazol, Peptazole, Pepticaid, Pepticool, Peptix, Peptoloc, Pepzol, Perloc, Pipanzin, Pozola, Praize, Pranza, Praz-Up, Prazobloc, Prazocid, Prazolacid, Prazolan, Prazole, Prazolpan, Prazopant, Pregel, Prevacid, Previfect, Previfect, Progen, Prolex, Promtec, Propanz, Protech, Protinum, Protium, Protocent, Protocid, Protofix, Protoloc, Proton, Proton-P, Protonex, Protonil, Protonix, Protopan, PTA, Pulcet, Pumpisel, Ranloc, Razon, Rcpan, Redacib, Refluxine, Refluxopan, rifun, Ripane, Roxitrol, Sedipanto, Segregam, Seltraz, Sipar, Sodac, Somac, Sozol, Stamic, Stomafor, Stripole, Sumipral, Supacid, Super OM, Suppi, Supracam, Supracid, Surmera, Tai Mei Ni Ke, Tecta, Tonval, Topazol, Topra, Topraz, Topzole, Toraflux, Tropaz, Trupan, Ulceron, Ulcoreks, Ulcotenal, Ulprix, Ulsepan, Ulstop, Ultop, Ultoz, Unigastrozol, Vencid, Ventro-Pant, Vomizole, Wei Di, Wei Ke An, Wonon, Xotepic, Yoevid, Zamotil, Zaprol, Zencopan, Zgaton, Zimpax, Zipant, Zipantol, Zipantola, Ziprol, Zolan, Zolemer, Zolpan, Zolpanz, Zolpra, Zoltex, Zoltum, Zontop, Zoprax, Zovanta, Zurcal, and Zurcazol.<ref name=brands>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

It was marketed as a combination drug with domperidone under the brand names Aciban-DSR, Acillect-DSR, Asoprazole-D, Buffet-DXR, Depam, Domelong P, Dycizol, Eracid-D, F-Pan DSR, Fulpan-D, Fulpan-DSR, Gerdom, Gi-Fri, Gopan-D, Gopan-DSR, GR8-OD, Kurepane-DSR, Latop-D, Monpan-D, Monpan-DSR, Nupenta-DSR, Odipan-DSR, Oritop-D, Oritop-DSR, P-Bit-D, P-Bit-DSR, P-Zole DSR, P-Zole-D, PAA-DSR, Palio-D, Pamtrazol-D, Pan-D, Pancrazio-DSR, Pandiff, Pandostal, Pandostal-OD, Panfast-DSR, Panopaz-D, Panor-D, Panpot-DSR, Pansa-D, Pantact-D, Pantin-D, Pantin-RD, Pantocar-D, Pantocom-D, Pantoflux, Pantojoy-DXR, Pantokool-D, Pantolex-DS, Pantopacid-D, Pantopacid-SR, Pantorica-D, Pantozol-D, Pantozol-DSR, Pantra-D, Pantune-D, Panveda-D, Panzo-D, Panzol Plus, Panzol-D, Paz-DN, Peblo-D, Peblo-DSR, Penkool-DSR, Penlip-D, Pentalink-D, Pentastar-D, Pentozed-D, Peptac D, Peptac DSR, Pepticool-DXR, Pintel-DSR, Pop-DSR, Praize-D, Praize-D Forte, Prazole Plus, Prazosan-DSR, Predom, Predom-OD, Prolex-DSR, Prolus-DSR, Protocent-DSR, Protopan-D, Protopan-H, Ripane-D, Ripane-DSR, Trazol-DSR, PTA-D, Ulcicap-PD, Ultop DSR, Ultoz-D, Wonon-D, Wonon-DSR, and Zovanta-D.<ref name=brands/>

It was marketed in combination with itopride under the brand names Ganaton Total, Kurepan-IT, Nupenta-ITR, P-Bit-ISR, Pepnil-ITO, Prolus-ISR, and Protopan-I.<ref name=brands/>

It was marketed in combination with clarithromycin and amoxicillin as Gastrocomb, Klacid Hp7, Panclamox, and ZacPac.<ref name=brands/>

It was marketed in combination with levosulpiride as Panlife-LS and in combination with naproxen as Arthopan.<ref name=brands/> Template:Collapse bottom

Veterinary useEdit

In veterinary medicine, pantoprazole appears to be safe to use in several large animal species.<ref>Template:Cite journal</ref> The pharmacokinetics of pantoprazole have been explored in several veterinary species, including calves, alpacas and foals with half lives reported as 2.81, 0.47, and 1.43 hours, respectively.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref name="Efficacy and pharmacokinetics of pa">Template:Cite journal</ref> Pantoprazole appears to be eliminated more quickly in goats when compared to calves, with goats having an elimination half-life of less than one hour.<ref>Template:Cite journal</ref>

Pantoprazole has been demonstrated to increase the 3rd compartment pH in alpacas.<ref name="Efficacy and pharmacokinetics of pa"/> It has been shown to be generally safe to use in cattle, sheep and goats.<ref>Template:Cite journal</ref> The subcutaneous bioavailability is greater than 100% in calves.<ref name=":3">Template:Cite journal</ref> In calves intravenous and subcutaneous administration has been shown to significantly elevate abomasal pH.<ref name=":3" />

ReferencesEdit

Template:Reflist

  1. REDIRECT Template:Drugs for peptic ulcer and GORD

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