pantoprazole
Brand: Protonix
Prototype: omeprazole
Drug Class: proton pump inhibitor
Drug Family: GI agent
Subclass: H+/K+-ATPase inhibitor
Organ Systems: gastrointestinal
Mechanism of Action
Benzimidazole PPI; least CYP2C19-dependent of older PPIs; preferred when clopidogrel co-administration required.
H+/K+-ATPase
Indications
- GERD
- erosive esophagitis
- PUD
- Zollinger-Ellison
- ICU stress ulcer prophylaxis (IV)
Contraindications
- rilpivirine
- atazanavir
Adverse Effects
Common
- headache
- diarrhea
- nausea
Serious
- hypomagnesemia
- C. diff
- fracture risk
Pharmacokinetics (ADME)
| Absorption | ~77% oral |
| Distribution | moderate |
| Metabolism | CYP2C19 (but less CYP2C19-dependent than omeprazole) |
| Excretion | renal 71% |
| Half-life | 1 hour |
| Onset | 1-3 hours |
| Peak | 2-4 hours |
| Duration | 24 hours |
| Protein Binding | 98% |
| Vd | 0.15 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| clopidogrel | minimal CYP2C19 inhibition — preferred PPI with clopidogrel | minor |
| methotrexate | reduces MTX clearance — high-dose MTX toxicity risk | major |
Nursing Considerations
- Preferred PPI when clopidogrel co-administration required (least CYP2C19 inhibition)
- IV formulation available for ICU stress ulcer prophylaxis and when oral not possible
- 30-60 min before meals
Clinical Pearls
- Preferred with clopidogrel: less CYP2C19 inhibition than omeprazole, lansoprazole, esomeprazole
- IV pantoprazole: useful in upper GI bleeding and NPO patients
Safety Profile
Pregnancy safe
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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