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INTRODUCTION

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pantoprazole (pan-toe-pra-zole)

Image not available.Pantoloc, Protonix, Protonix IV

Classification

Therapeutic: antiulcer agents

Pharmacologic: proton-pump inhibitors

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Indications
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Erosive esophagitis associated with gastroesophageal reflux disease (GERD). Decrease relapse rates of daytime and nighttime heartburn symptoms on patients with GERD. Pathologic gastric hypersecretory conditions. Unlabeled Use: Adjunctive treatment of duodenal ulcers associated with Helicobacter pylori.

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Action
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Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic Effects: Diminished accumulation of acid in the gastric lumen, with lessened acid reflux. Healing of duodenal ulcers and esophagitis. Decreased acid secretion in hypersecretory conditions.

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Adverse Reactions/Side Effects
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CNS: headache. GI: abdominal pain, diarrhea, eructation, flatulence. Endo: hyperglycemia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor improvements in GI symptoms (gastritis, heartburn, and so forth) to help determine if drug therapy is successful.

  • Monitor signs of hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

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Interventions
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  • In cases of NSAID-induced gastritis, implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for aspirin and other NSAIDs.

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Patient/Client-Related Instruction
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  • Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

  • Instruct patient to report bothersome or prolonged side effects, including headache or GI effects (diarrhea, flatulence, belching, abdominal pain).

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Pharmacokinetics
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Absorption: Tablet is enteric coated; absorption occurs only after tablet leaves the stomach.

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Distribution: Unknown.

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Protein Binding: 98%.

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Metabolism and Excretion: Mostly metabolized by the liver via the cytochrome P450 (CYP) system; inactive metabolites are excreted in urine (71%) and feces (18%).

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Half-life: 1 hr.

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TIME/ACTION PROFILE (effect on acid secretion)

ROUTE ONSET* PEAK DURATION*
PO 2.5 hr unknown 1 wk
IV 15–30 min 2 hr unknown

*Onset = 51% inhibition; duration = return to normal following discontinuation.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; OB: Should be used during pregnancy only if clearly needed. Lactation: Discontinue breast-feeding due to potential for serious adverse reactions in infants.

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Use Cautiously in: Pedi: Safety not established.

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Interactions
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Drug-Drug: May ↓ absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavir, ampicillin esters, iron salts, and digoxin. May ↑ risk of bleeding with warfarin (monitor INR/PT).

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Route/Dosage
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PO (Adults): GERD—40 mg once daily; Gastric hypersecretory conditions—40 mg bid, up to 120 mg ...

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