Pantoprazole
A proton pump inhibitor, given by mouth or into a vein, for erosive reflux disease, stomach ulcers and Zollinger-Ellison syndrome.
Drug card
- How it works
- Blocking the stomach's proton pump (H+/K+ ATPase) to stop acid secretion
- Used for
- Erosive esophagitis from reflux disease
- Stomach ulcers
- Zollinger-Ellison syndrome
- Known for
- C. difficile diarrhea
- Fractures with long-term use
- Low magnesium with long-term use
- Its name
- -prazole means a proton pump inhibitor
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does pantoprazole work?
A lipophilic weak base that gathers in the acidic canaliculus of the parietal cell, is protonated there to an active sulfenamide and binds covalently to two sites on the H+/K+ ATPase, so acid suppression lasts beyond 24 hours. Unlike omeprazole, it has no clinically important effect on the activation of clopidogrel.
Like other proton pump inhibitors: PPIs are prodrugs. They collect in the acidic canaliculi of gastric parietal cells, where acid turns them into an active sulfenamide that binds the H+/K+ ATPase (the proton pump) through covalent disulfide bonds. This shuts off the last step of acid secretion, basal and stimulated alike, and because the bond is irreversible the effect outlasts the drug's short stay in the blood.
Uses
What is pantoprazole used for?
- Erosive esophagitis from reflux disease
- Stomach ulcers
- Zollinger-Ellison syndrome
Side effects
Side effects of pantoprazole
- C. difficile diarrheaKnown forSerious
- Fractures with long-term useKnown forSerious
- Low magnesium with long-term useKnown forSerious
- Headache
- Diarrhea
- Nausea and vomiting
- Abdominal pain
- Flatulence
- Dizziness
- Joint pain
- Acute interstitial nephritisSerious
- Vein inflammation at the injection site
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated with rilpivirine; avoid with nelfinavir.
- Monitor INR with warfarin, and consider pausing it during high-dose methotrexate.
- Symptom relief does not rule out stomach cancer; investigate a poor response.
- The injection contains edetate, which can worsen zinc deficiency.
Good to know: Its label finds no clinically important effect on clopidogrel, whereas the omeprazole and esomeprazole labels advise avoiding that combination.
Remember it
A way to remember it
CLIMB
- C
- C. difficile diarrhea
- L
- Lupus erythematosus, cutaneous or systemic
- I
- Interstitial nephritis
- M
- Magnesium falls (hypomagnesemia)
- B
- B12 deficiency
Five less common but serious PPI risks to remember, alongside fractures with long-term use.
Written for biofideX
Its name
-prazole means proton pump inhibitor
Omeprazole, esomeprazole, lansoprazole and pantoprazole block the H+/K+ ATPase of parietal cells. Aripiprazole, an antipsychotic, ends in -piprazole, which WHO now discourages.
- Every drug name stem
Its class
Proton pump inhibitors
Other proton pump inhibitors with a card:
Easily mixed up with H2 receptor antagonists.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Pantoprazole sodium delayed-release tablets: label (DailyMed)
- Pantoprazole sodium for injection: label (DailyMed)
- Pantoprazole (NCI Thesaurus)
- About pantoprazole (NHS)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Stomach and gut
Pantoprazole is one of 15 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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