Pantoprazole

Proton Pump Inhibitor·Gastrointestinal - Acid Suppression

GORD, Peptic Ulcer Disease (PUD), GI bleed, stress ulcer prophylaxis in ICU

PBSPPISomac, Salpraz20 mg EC tabletS4+1

Max Dose

80 mg/day

Half-life

1-2 h

Plavix Interaction

SAFE

C. Diff Risk

MODERATE

Rapid Summary

Overview

Irreversible Proton Pump Inhibitor (PPI). Effectively shuts down gastric acid secretion. The preferred PPI on cardiovascular wards due to its safety profile with antiplatelets.

Maximum Dose

Max 80 mg/day (used BD for severe bleeding ulcers or Zollinger-Ellison).

Clinical Focus

Provides optimal cover for NSAID/Aspirin-induced ulcer prophylaxis.

Bottom Line

Pantoprazole is a widely used PPI for GORD, peptic ulcers, and stress ulcer prophylaxis with IV availability, but long-term use increases risk of hypomagnesaemia, fractures, and C. difficile.

Formulation & Access

Brand Names

Somac, Salpraz

Oral Routes

Do not crush

Enteric-coated tablets (20 mg, 40 mg). Do not crush.

Parenteral

Ampoule (40 mg powder) for IV use.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

GORD, Peptic Ulcer Disease (PUD), GI bleed, stress ulcer prophylaxis in ICU.

Clinical Place

The safest PPI to prescribe alongside Clopidogrel.

Quick reference

Class & Role

Proton Pump Inhibitor — Irreversible Proton Pump Inhibitor (PPI).

Route / Formulation

Enteric-coated tablets (20 mg, 40 mg). Do not crush. (Somac, Salpraz)

Usual Dose & Max

PO 20-40 mg OD (30 mins before breakfast). Max 80 mg/day (used BD for severe bleeding ulcers or Zollinger-Ellison).

Key Indication Doses

GORD / PUD Prophylaxis: PO 20-40 mg OD (30 mins before breakfast). Active Bleeding Ulcer: IV 80 mg STAT bolus, followed by 8 mg/hr infusion for 72 hours. H. Pylori Eradication: PO 40 mg BD (with antibiotics).

Best Uses

Pantoprazole is a widely used PPI for GORD, peptic ulcers, and stress ulcer prophylaxis with IV availability, but long-term use increases risk of hypomagnesaemia, fractures, and C. difficile.

Avoid / Cautions

Co-administration with rilpivirine/atazanavir (HIV meds require acid to absorb). Pregnancy Category B3 (Omeprazole is Category B3 but has more safety data).

Key Risks

Gastrointestinal: Enteric infections (C. difficile, Salmonella) due to loss of acid barrier. Microscopic colitis. Metabolic: Hypomagnesemia, Vitamin B12 deficiency, Iron deficiency (with chronic use > 1 year). Musculoskeletal: Increased risk of osteoporotic fractures with prolonged, high-dose use.

Key Interactions

Unlike Omeprazole, Pantoprazole does NOT significantly inhibit CYP2C19. It is completely safe to use with Clopidogrel. Drugs requiring acidic pH for absorption (e.g., Ketoconazole, Itraconazole, Iron) will fail to absorb.

Monitoring

Check U&E (magnesium) and B12 levels if the patient has been on a PPI for years. Review the medication chart constantly. Cease the PPI if there is no longer a strict indication to prevent chronic toxicity.

Clinical Pearl

PPIs only bind to ACTIVE proton pumps. Pumps are activated by eating. Therefore, taking a PPI 30 mins *before* breakfast ensures the drug peaks in the blood exactly when the most pumps are turned on. Taking it at night or without food wastes the drug.

Access

Somac, Salpraz20 mg EC tablet

Brand: Somac, Salpraz
Formulation: Enteric-coated tablets (20 mg, 40 mg)

Pantoprazole

Proton Pump Inhibitor·Gastrointestinal - Acid Suppression

GORD, Peptic Ulcer Disease (PUD), GI bleed, stress ulcer prophylaxis in ICU

PBSPPISomac, Salpraz20 mg EC tabletS4+1

Max Dose

80 mg/day

Half-life

1-2 h

Plavix Interaction

SAFE

C. Diff Risk

MODERATE

Rapid Summary

Overview

Irreversible Proton Pump Inhibitor (PPI). Effectively shuts down gastric acid secretion. The preferred PPI on cardiovascular wards due to its safety profile with antiplatelets.

Maximum Dose

Max 80 mg/day (used BD for severe bleeding ulcers or Zollinger-Ellison).

Clinical Focus

Provides optimal cover for NSAID/Aspirin-induced ulcer prophylaxis.

Bottom Line

Pantoprazole is a widely used PPI for GORD, peptic ulcers, and stress ulcer prophylaxis with IV availability, but long-term use increases risk of hypomagnesaemia, fractures, and C. difficile.

Formulation & Access

Brand Names

Somac, Salpraz

Oral Routes

Do not crush

Enteric-coated tablets (20 mg, 40 mg). Do not crush.

Parenteral

Ampoule (40 mg powder) for IV use.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

GORD, Peptic Ulcer Disease (PUD), GI bleed, stress ulcer prophylaxis in ICU.

Clinical Place

The safest PPI to prescribe alongside Clopidogrel.

Quick reference

Class & Role

Proton Pump Inhibitor — Irreversible Proton Pump Inhibitor (PPI).

Route / Formulation

Enteric-coated tablets (20 mg, 40 mg). Do not crush. (Somac, Salpraz)

Usual Dose & Max

PO 20-40 mg OD (30 mins before breakfast). Max 80 mg/day (used BD for severe bleeding ulcers or Zollinger-Ellison).

Key Indication Doses

Best Uses

Pantoprazole is a widely used PPI for GORD, peptic ulcers, and stress ulcer prophylaxis with IV availability, but long-term use increases risk of hypomagnesaemia, fractures, and C. difficile.

Avoid / Cautions

Co-administration with rilpivirine/atazanavir (HIV meds require acid to absorb). Pregnancy Category B3 (Omeprazole is Category B3 but has more safety data).

Key Risks

Key Interactions

Monitoring

Clinical Pearl

Access

Somac, Salpraz20 mg EC tablet

Brand: Somac, Salpraz
Formulation: Enteric-coated tablets (20 mg, 40 mg)