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INTRODUCTION

pantoprazole (pan-toe-pra-zole)

Image not available.Pantoloc, Protonix, Protonix IV

Classification

Therapeutic: antiulcer agents

Pharmacologic: proton-pump inhibitors

Indications

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.

Action

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.

Adverse Reactions/Side Effects

CNS: headache. GI: abdominal pain, diarrhea, eructation, flatulence. Endo: hyperglycemia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

  • 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.

Interventions

  • 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.

Patient/Client-Related Instruction

  • 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).

Pharmacokinetics

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

Distribution: Unknown.

Protein Binding: 98%.

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

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.

Contraindications/Precautions

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.

Use Cautiously in: Pedi: Safety not established.

Interactions

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).

Route/Dosage

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

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