Pantoprazole Eg (Pantoprazole Sodium Sesquihydrate)

Pantoprazole Eg is a proton pump inhibitor that acts on the gastric acid secretion pathway. It is indicated for several acid‑related conditions:

• Gastro‑oesophageal reflux disease (GERD): provides symptomatic relief and promotes healing of erosive esophagitis.
• Erosive peptic ulcer disease: accelerates ulcer healing and reduces risk of recurrence.
• Zollinger‑Ellison syndrome: controls excessive gastric acid secretion associated with this rare neuroendocrine tumor.
• Prevention of NSAID‑induced gastric ulcers: lowers incidence of ulcer formation in patients requiring chronic NSAID therapy.

• Pantoprazole 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 acidity, allowing mucosal healing and symptom control.

Pantoprazole is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Headache: mild to moderate intensity.
• Diarrhoea: usually transient.
• Nausea or abdominal discomfort.
• Flatulence or bloating.
• Constipation: occasional.
• Dry mouth.

Serious or Rare Side Effects

• Acute interstitial nephritis: may present with renal impairment.
• Severe hypersensitivity reactions: including rash, angioedema or anaphylaxis.
• Clostridioides difficile‑associated colitis: risk increases with prolonged use.
• Osteoporotic fractures: reported with long‑term therapy.
• Low magnesium (hypomagnesemia): can cause muscle cramps or cardiac arrhythmia.
• Vitamin B12 deficiency: may develop with extended treatment.

When prescribing Pantoprazole, clinicians should consider several safety aspects:

• Assess renal and hepatic function: dose adjustment may be required in severe impairment.
• Review concomitant medications: potential for drug‑drug interactions.
• Evaluate need for long‑term therapy: monitor for bone health and electrolyte disturbances.
• Use caution in pregnancy and lactation: weigh benefits against potential risks.
• Discontinue before elective surgery involving the gastrointestinal tract if acid suppression may interfere with healing.
• Store at ambient temperature: keep below 25 °C, retain in original packaging and protect from moisture.

Pantoprazole can affect the pharmacokinetics of several medicines. Awareness of the interaction potential helps optimise therapy.

Major Interactions (Avoid)

• Antifungal agents such as ketoconazole or itraconazole: reduced absorption may lead to therapeutic failure.
• HIV protease inhibitors (e.g., atazanavir, nelfinavir): markedly decreased plasma concentrations.
• Clopidogrel: diminished antiplatelet effect, increasing cardiovascular risk.

Moderate Interactions (Monitor Closely)

• Warfarin: possible alteration of INR, requiring more frequent monitoring.
• Methotrexate (high‑dose): reduced renal clearance may raise toxicity risk.
• Digoxin: slight increase in serum levels, especially in the elderly.