pantoprazole sodium sesquihydrate: clinical use

Prescribing considerations

• Exclude malignancy or another important cause when alarm symptoms, suspected gastric ulcer or persistent symptoms are present.
• Review continuing need during long-term treatment.
• Oral H. pylori eradication requires appropriate antibiotics.
• Reserve intravenous treatment for situations where oral administration is inappropriate.
• Check excipients, as tablet formulations may differ.

Contraindications and cautions

• Hypersensitivity to pantoprazole, another substituted benzimidazole or a product excipient.
• Some lactose-containing tablets are unsuitable for specified rare hereditary disorders of galactose metabolism or absorption.

Monitoring

• Monitor liver enzymes in severe hepatic impairment.
• Consider magnesium measurement during prolonged therapy, particularly with digoxin, diuretics or other medicines that can lower magnesium.
• Assess vitamin B12, fracture risk and bone-health factors where relevant.
• Monitor INR or prothrombin time when clinically indicated with warfarin or phenprocoumon.

Clinical pharmacology

Pantoprazole is an acid-activated substituted benzimidazole that inhibits gastric parietal-cell hydrogen–potassium ATPase. It is metabolised mainly in the liver through CYP2C19, with CYP3A4 contributing.

Formulation and product differences

• Gastro-resistant tablets protect pantoprazole from stomach acid and must be swallowed intact.
• Powder for injection is reconstituted and administered intravenously by healthcare professionals.
• Selected oral products include use with antibiotics for H. pylori-associated ulcers; the selected intravenous product does not.

Gastro-resistant tablet

Route: Oral

Strengths: 20 mg, 40 mg

Injection

Route: Parenteral

Strengths: 40 mg