Drug reference

Pantoprazole

Proton Pump Inhibitor · Antiulcer

Also known as Pantoprazole Sodium, Panto, Pan

START

40 mg PO once daily, 30 min before breakfast

TYPICAL MAX

240 mg/day (Zollinger-Ellison)

STOP IF

Hypersensitivity

WATCH

Mg²⁺ · B12 · C. difficile risk on long use

CDSCO approvedSchedule HJan AushadhiNPPA price-controlledATC A02BC02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1h · acid suppression begins
PEAK: 2.5h · Cmax
t½: 1h · plasma t½ (effect outlasts)
DURATION: 1d · irreversible H⁺/K⁺ ATPase block

EXCRETION

CYP2C19 → renal metabolites · less CYP than omeprazole

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Category B — preferred PPI in pregnancy

FDA category + note

Top interactionssee all 12 →

AcalabrutinibSevereDatabaseDDInter
AtazanavirSevereDatabaseDDInter
DacomitinibSevereDatabaseDDInter
DasatinibSevereDatabaseDDInter

Available in India

2,759 branded formulations and 3,525 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Pantoprazole is a selective and irreversible proton pump inhibitor. It binds covalently to the H+/K+-ATPase enzyme (proton pump) in the secretory canaliculi of parietal cells in the stomach, thereby inhibiting the final step in gastric acid production. This leads to a dose-dependent inhibition of both basal and stimulated acid secretion.

Indications

Erosive esophagitis associated with gastroesophageal reflux disease (GERD)Maintenance of healing of erosive esophagitisPathological hypersecretory conditions, including Zollinger-Ellison syndromeDuodenal ulcersGastric ulcersHelicobacter pylori eradication (in combination therapy)NSAID-associated ulcers (prevention and treatment) (off-label)Stress ulcer prophylaxis in critically ill patients (off-label)Erosive esophagitisGastroesophageal reflux diseaseHelicobacter pylori eradicationZollinger-Ellison syndromePathological hypersecretory conditionsReducing the risk of duodenal ulcer recurrence associated with H. pylori infectionsTreatment and prevention of recurrence of NSAID-associated gastric ulcersTreatment of acute bleeding ulcers (off-label use)Bleeding peptic ulcerProphylaxis of acute stress ulcersPeptic ulcerGastroesophageal reflux disease (GERD)H. pylori eradication therapy

Dosing

Adult: GERD/Erosive Esophagitis: 40 mg orally once daily for up to 8 weeks. Maintenance: 20-40 mg orally once daily. Zollinger-Ellison Syndrome: Initial 40 mg orally twice daily. Adjust dose as needed, some patients may require up to 240 mg/day. H. pylori eradication: 40 mg orally twice daily (in combination with antibiotics) for 7-14 days. NSAID-associated ulcer prevention: 20 mg orally once daily.
Pediatric: Adolescents (>=12 years) for Erosive Esophagitis associated with GERD: 40 mg orally once daily for up to 8 weeks.
Renal adjustment: No dose adjustment generally needed for renal impairment.
Hepatic adjustment: Severe hepatic impairment (Child-Pugh C): Max 20 mg once daily. No adjustment for mild to moderate impairment.
Geriatric: No specific dose adjustment solely based on age. Use with caution due to increased risk of side effects like bone fractures with long-term use.
Max dose: Generally 240 mg/day for pathological hypersecretory conditions. For standard indications, usually 40 mg once daily.

Pharmacokinetics

Onset

Within 2.5 hours

Peak effect

2-2.5 hours (oral)

Duration

Up to 24 hours (due to irreversible binding)

Half-life

Approximately 1 hour

Bioavailability

~77% (oral)

Protein binding

~98%

Metabolism

Primarily hepatic, extensively metabolized by cytochrome P450 (CYP) enzymes, mainly CYP2C19 and CYP3A4.

Excretion

Mainly renal (approximately 80%) and biliary/fecal (approximately 18%)

Contraindications

Hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation
Concomitant use with rilpivirine-containing products
Known history of severe hepatic impairment

Side effects

Common

HeadacheDiarrheaNauseaAbdominal painFlatulenceDizzinessVomitingDry mouthRashConstipation

Serious

Clostridium difficile-associated diarrhea
Acute interstitial nephritis
Bone fracture (with long-term high-dose use)
Hypomagnesemia (with long-term use)
Vitamin B12 deficiency (with long-term use)
Severe skin reactions (e.g., SJS, TEN)
Lupus erythematosus (cutaneous and systemic)
Fundic gland polyps (with long-term use)
Pancreatitis (rare)
Subacute myopathy
Arthralgias
Interstitial nephritis
Pharyngitis
Skin rashes
Increased risk of bone fracture
Increased susceptibility to hospital-acquired pneumonia
Increased susceptibility to community-acquired Clostridium difficile infection
Increased susceptibility to spontaneous bacterial peritonitis (in patients with ascites)
Hypomagnesemia
Vitamin B12 (cobalamin) deficiency (with long-term use, >3 years)
Hypergastrinemia leading to ECL hyperplasia and fundic gland polyposis
Atrophic gastritis

Pregnancy & lactation

Pregnancy

Category B — preferred PPI in pregnancy

Lactation

Excreted in human milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Minimal data suggests low levels in breastmilk.

Drug interactions

Acalabrutinib

Severe

Database

Drug interaction classified as: absorption

Source: DDInter

Atazanavir

Severe

Database

Substantially reduced atazanavir concentrations, leading to loss of antiviral effectiveness.

Proton pump inhibitors should be avoided in patients receiving atazanavir without ritonavir.

Source: DDInter

Dacomitinib

Severe

Database

Clinical effect not specified

Source: DDInter

Dasatinib

Severe

Database

Reduced plasma concentrations of dasatinib, potentially leading to decreased anti-cancer efficacy.

Avoid concomitant use if possible. If co-administration is necessary, consider alternative acid suppression or monitor for therapeutic response.

Source: DDInter

Erlotinib

Severe

Database

Reduced plasma levels and potentially reduced efficacy of erlotinib.

Avoid concomitant use if possible. If co-administration is necessary, consider administering erlotinib at least 10 hours after the last dose of pantoprazole and at least 2 hours before the next dose. Monitor for therapeutic response.

Source: DDInter

Methotrexate

Severe

Database

Increased methotrexate levels, potentially leading to toxicity.

Not specified, but typical management involves monitoring methotrexate levels.

Source: DDInter

Nelfinavir

Severe

Database

Significantly reduced plasma concentrations of nelfinavir, leading to loss of antiviral efficacy and potential development of drug resistance

CONTRAINDICATED. Avoid concomitant use. If an acid-reducing agent is required, consider H2 blockers or antacids with careful timing, or an alternative antiretroviral regimen.

Source: DDInter

Neratinib

Severe

Database

Clinical effect not specified

Source: DDInter

Pazopanib

Severe

Database

Clinical effect not specified

Source: DDInter

Pexidartinib