Drug reference

Pantoprazole + Domperidone

Proton Pump Inhibitor · Antiulcerant, Gastroprokinetic, Antiemetic

Also known as Pan-D, Pantocid-D, Panto-D, Pantakind-D, Sompraz-D

Proton Pump InhibitorAntiulcerant, Gastroprokinetic, AntiemeticATC A02BC02 (Pantoprazole), A03FA03 (Domperidone)

CDSCO approvedSchedule HATC A02BC02 (Pantoprazole), A03FA03 (Domperidone)

Pharmacokineticsplasma · t hours

ONSET: 2.5h · Pantoprazole: ~2.5 hours for significant acid suppression; Domperidone: ~30 minutes for prokinetic effects.
PEAK: 2.3h · Pantoprazole: 2-2.5 hours (plasma concentration); Domperidone: 1 hour (plasma concentration).
t½: 8h · Pantoprazole: Terminal half-life ~1 hour (though acid suppression effect lasts much longer); Domperidone: 7-9 hours (prolonged in renal/hepatic impairment).
DURATION: 7h · Pantoprazole: >24 hours (acid suppression); Domperidone: 6-8 hours (prokinetic effect).

EXCRETION

—

not curated

INTERACTIONS

4 major

incl. contraindicated

PREGNANCY

Pantoprazole: B; Domperidone: C. Overall combination is considered Pregnancy Category C; use only if the potential benefit justifies the potential risk to the fetus.

FDA category + note

Top interactionssee all 12 →

AtazanavirContraindicatedTextbookG&G 14e · p1245-1266
LedipasvirSevereTextbookG&G 14e · p1238, p1242
RilpivirineSevereTextbookG&G 14e · p1245-1266
VelpatasvirSevereTextbookG&G 14e · p1239, p1242

Mechanism

Pantoprazole selectively inhibits the H+/K+-ATPase proton pump in gastric parietal cells, irreversibly blocking the final step in acid production, thereby reducing gastric acid secretion. Domperidone is a peripheral dopamine D2 receptor antagonist that increases esophageal and gastric motility and tone, facilitating gastric emptying and reducing gastroesophageal reflux. It also acts as an antiemetic by blocking D2 receptors in the chemoreceptor trigger zone. The combination aims to suppress acid secretion and concurrently improve gastric emptying and alleviate symptoms of nausea and reflux. Combination rationale: This FDC combines a potent gastric acid suppressor (pantoprazole) with a prokinetic agent (domperidone) to address multifactorial gastrointestinal disorders. Pantoprazole effectively reduces acid production, providing relief from heartburn and promoting healing in acid-related conditions. Domperidone enhances upper gastrointestinal motility, helping to alleviate symptoms such as bloating, fullness, and nausea, which are often co-present with acid reflux or dyspepsia, thereby offering comprehensive symptomatic management.

Indications

Gastroesophageal Reflux Disease (GERD) unresponsive to pantoprazole aloneDyspepsia with reflux symptomsErosive esophagitisSymptomatic treatment of nausea and vomiting associated with acid-related disorders

Dosing

Adult: Pantoprazole 40 mg + Domperidone 10 mg, orally once daily, typically 30 minutes before breakfast. Some formulations may be Pantoprazole 20 mg + Domperidone 10 mg.
Pediatric: Not generally recommended for children below 12 years due to safety concerns with domperidone. Limited data available for children above 12 years; if used, Pantoprazole 20mg + Domperidone 10mg once daily under strict medical supervision and only when benefits outweigh risks.
Hepatic adjustment: Contraindicated in moderate to severe hepatic impairment due to domperidone. For mild hepatic impairment, caution is advised; dose reduction or extended dosing intervals may be needed for pantoprazole, and domperidone should be avoided.
Geriatric: Use with caution due to increased risk of cardiac arrhythmias with domperidone. Lower doses or alternative agents should be considered, especially in those with underlying cardiac conditions or polypharmacy.
Max dose: Generally, Pantoprazole 40 mg + Domperidone 10 mg once daily. The maximum recommended daily dose of domperidone, especially when considering cardiac risks, is 30 mg/day (often in divided doses if not an FDC).

Pharmacokinetics

Onset

Pantoprazole: ~2.5 hours for significant acid suppression; Domperidone: ~30 minutes for prokinetic effects.

Peak effect

Pantoprazole: 2-2.5 hours (plasma concentration); Domperidone: 1 hour (plasma concentration).

Duration

Pantoprazole: >24 hours (acid suppression); Domperidone: 6-8 hours (prokinetic effect).

Half-life

Pantoprazole: Terminal half-life ~1 hour (though acid suppression effect lasts much longer); Domperidone: 7-9 hours (prolonged in renal/hepatic impairment).

Bioavailability

Pantoprazole: Approximately 77%; Domperidone: Approximately 15% (due to extensive first-pass metabolism).

Protein binding

Pantoprazole: ~98%; Domperidone: 91-93%.

Metabolism

Pantoprazole: Primarily hepatic via CYP2C19 and CYP3A4, followed by sulfate conjugation. Domperidone: Extensive hepatic metabolism via CYP3A4.

Excretion

Pantoprazole: Approximately 80% renal, 20% fecal; Domperidone: Approximately 66% fecal, 33% renal.

Contraindications

Hypersensitivity to pantoprazole, domperidone, or excipients
Moderate to severe hepatic impairment
Known QT prolongation or significant cardiac disease (e.g., congestive heart failure, bradycardia)
Concomitant use with potent CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, clarithromycin)
Prolactinoma
Gastrointestinal hemorrhage, mechanical obstruction, or perforation

Side effects

Common

HeadacheDizzinessNauseaVomitingAbdominal painDiarrheaConstipationFlatulenceDry mouthRash

Serious

Torsades de Pointes
QT prolongation
Ventricular arrhythmias (domperidone)
Sudden cardiac death (domperidone, especially with high doses or cardiac risk factors)
Clostridium difficile-associated diarrhea (long-term PPI use)
Acute interstitial nephritis (PPIs)
Bone fractures (long-term PPI use)
Hypomagnesemia (long-term PPI use)
Severe allergic reactions (anaphylaxis, angioedema)
Extrapyramidal symptoms (rare, domperidone)

Pregnancy & lactation

Pregnancy

Pantoprazole: B; Domperidone: C. Overall combination is considered Pregnancy Category C; use only if the potential benefit justifies the potential risk to the fetus.

Lactation

Pantoprazole is excreted into breast milk in very low amounts; considered generally safe. Domperidone is excreted into breast milk and can potentially cause cardiac effects in breastfed infants, particularly with higher doses or prolonged use. Therefore, its use is generally not recommended during lactation.

Drug interactions

Atazanavir

Contraindicated

Textbook

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

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

Source: G&G 14e · p1245-1266

Ledipasvir

Severe

Textbook

Reduced ledipasvir concentrations, potentially leading to treatment failure/relapse.

If PPIs must be used, their doses should not exceed the equivalent of 20 mg omeprazole once daily. Omeprazole must be administered simultaneously with LDV/SOF in the fasted state.

Source: G&G 14e · p1238, p1242

Rilpivirine

Severe

Textbook

Reduced absorption and plasma concentrations of rilpivirine, potentially leading to loss of efficacy.

Should not be given with proton pump inhibitors.

Source: G&G 14e · p1245-1266

Velpatasvir

Severe

Textbook

Reduced velpatasvir concentrations, potentially leading to treatment failure.

PPI doses should not exceed the equivalent of 20 mg omeprazole daily. SOF/VEL should be taken with food 4 hours prior to a PPI dose. Velpatasvir requires acidic gastric pH.

Source: G&G 14e · p1239, p1242

Aceclofenac + Paracetamol

Moderate

Textbook

Increased risk of small intestine damage, despite reducing duodenal and gastric ulceration.

Consider the overall GI risk, including small intestine, when coadministering.

Source: G&G 14e · p834

Aceclofenac

Moderate

Textbook

Increased risk of small intestine damage, despite reducing duodenal and gastric ulceration.

Consider the overall GI risk, including small intestine, when coadministering.