Panto (Pantoprazole Sodium Sesquihydrate)

Pantoprazole is a proton pump inhibitor used to manage conditions associated with excess gastric acid production.

• Gastro‑oesophageal reflux disease (GERD): provides symptomatic relief and promotes healing of the oesophageal lining.
• Erosive oesophagitis: facilitates ulcer healing and prevents recurrence.
• Peptic ulcer disease: promotes ulcer closure and reduces risk of complications.
• Zollinger‑Ellison syndrome: controls hyper‑secretion of gastric acid in this rare endocrine disorder.

• Pantoprazole sodium sesquihydrate selectively and irreversibly binds to the H+/K+‑ATPase enzyme (the gastric proton pump) on the secretory surface of parietal cells. By inhibiting this final step of acid production, it markedly reduces both basal and stimulated gastric acid secretion, leading to increased gastric pH and allowing damaged mucosa to heal.

Pantoprazole may be associated with a range of adverse reactions, most of which are dose‑independent and reversible.

Common Side Effects

• Headache: mild to moderate intensity.
• Diarrhoea: usually transient.
• Nausea: occasional and self‑limiting.
• Abdominal pain: mild discomfort.
• Flatulence: increased intestinal gas.
• Constipation: occasional bowel habit change.

Serious or Rare Side Effects

• Severe hypersensitivity reactions: including rash, angioedema, or anaphylaxis.
• Clostridioides difficile infection: may present with severe diarrhoea.
• Acute interstitial nephritis: renal inflammation requiring monitoring.
• Hepatic dysfunction: elevated transaminases.
• Osteoporotic fractures: long‑term use may affect bone density.
• Vitamin B12 deficiency: prolonged therapy may impair absorption.

Before initiating therapy, consider the following precautions:

• Assess renal function: dose adjustment may be required in severe impairment.
• Evaluate hepatic status: use with caution in patients with liver disease.
• Review concomitant medications: potential for drug‑drug interactions.
• Monitor for infection: prolonged acid suppression can increase risk of gastrointestinal infections.
• Pregnancy and lactation: use only if clearly needed after risk‑benefit assessment.
• Store at ambient temperature: keep below 25 °C, protect from moisture and keep in the original packaging.

Pantoprazole can affect the pharmacokinetics of several co‑administered drugs.

Major Interactions (Avoid)

• Antiretroviral protease inhibitors (e.g., atazanavir): markedly reduced absorption.
• Certain antifungal agents (e.g., ketoconazole, itraconazole): decreased efficacy due to reduced gastric acidity.

Moderate Interactions (Monitor Closely)

• Warfarin: may enhance anticoagulant effect, monitor INR.
• Methotrexate (high dose): increased serum levels, monitor renal function.
• Digoxin: possible increase in serum concentration, observe for toxicity.
• Clopidogrel: reduced activation, consider alternative antiplatelet therapy.
• Iron supplements: decreased absorption, separate dosing by at least 2 hours.