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pantoprazole (pan-toe-pra-zole)

imagePantoloc, Protonix, Protonix IV


Therapeutic: antiulcer agents

Pharmacologic: proton-pump inhibitors


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.


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.


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.


  • 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).


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)

PO 2.5 hr unknown 1 wk
IV 15–30 min 2 hr unknown

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


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.


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).


PO (Adults): GERD—40 mg once daily; ...

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