Protonix

Pantoprazole contained in Protonix is a substituted benzimidazole which inhibits the secretion of hydrochloric acid in the stomach by specific blockade of the proton pumps of the parietal cells.

Pantoprazole is converted to its active form in the acidic environment of the parietal cell where it inhibits the H + / K + -ATPase enzyme, i.e. the final stage in the production of gastric acid. The inhibition is dose-dependent and affects both basal and stimulated acid secretion. In most patients, freedom from symptoms is achieved within 2 weeks. As with other proton pump inhibitors and H2 receptor inhibitors, treatment with pantoprazole reduces acidity in the stomach and thereby an increase in gastrin in proportion to the reduction in acidity. The increase in gastrin is reversible. Since pantoprazole binds to the enzyme distal to the cell receptor level, the substance can inhibit hydrochloric acid secretion independently of stimulation by other substances (acetylcholine, histamine, gastrin). The effect is the same whether given orally or intravenously.

The fasting gastrin values increase under pantoprazole. In the short-term treatment exceeds the normal upper limit. During long-term treatment doubled values as a rule, while the extreme increases in gastrin values are rare. A slight to moderate increase in the number of specific endocrine (ECL) cells in the stomach is observed in rare cases during long-term treatment (simple to adenomatoid hyperplasia). No case with the formation of carcinoid precursors (atypical hyperplasia) or carcinoid cells has been reported in human studies so far, unlike in animal studies.

In the treatment for longer than one year, the effect on thyroid function cannot be completely ruled out, based on animal studies.

The recommended dose is one gastro-resistant tablet Protonix daily. Symptom relief is usually within 2-4 weeks. Symptom relief normally after 4 weeks of treatment. When symptom relief is achieved, reoccurring symptoms can be controlled with a dose of 20mg once daily as needed. If a satisfactory symptom control cannot be achieved by treatment, if necessary, switching to continuous therapy may be considered.

For long-term management, a maintenance dose of one gastro-resistant tablet Generic Protonix daily. At relapse, the dose may be increased to pantoprazole 40mg daily. For this purpose, use Pantoprazole 40mg tablets. After healing of the relapse the dose can be reduced again to pantoprazole 20mg.

Hypersensitivity to the active substance, substituted benzimidazoles or to any of the excipients is a contraindication for the use of Protonix.

Use of Protonix as a preventive of gastroduodenal ulcers induced by non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should be restricted to patients who require continued NSAID treatment and have an increased risk of developing gastrointestinal complications. The increased risk should be assessed according to individual risk factors, e.g., advanced age (over 65 years), history of gastric or duodenal ulcer or upper gastrointestinal bleeding.

Co-administration of atazanavir with proton pump inhibitors is not recommended. If the combination of atazanavir with proton pump inhibitors is deemed unavoidable, close clinical monitoring (e.g. virus load) and that the dose of atazanavir increased to 400mg with 100mg of ritonavir. A daily dose of 20mg pantoprazole should not be exceeded.

In patients with Zollinger-Ellison syndrome and other pathological hypersecretory conditions requiring long-term treatment, pantoprazole, as all acid-blocking medicines, may reduce the absorption of vitamin B12 (cyanocobalamin) due hypo- or achlorhydria. This should be considered during long-term treatment of patients with reduced body stores or risk factors for reduced vitamin B12 absorption or similar clinical symptoms arise.