Clinical experience with pantoprazole in gastroesophageal reflux disease

Interactions between selected over-the-counter drugs and food: clinical relevance and prevention

The use of medicines is associated with both therapeutic and adverse effects and interactions. In particular, interactions between drugs and food are common, and can either enhance the action of drugs or diminish their effect. Health professionals have a responsibility to screen for and educate patients about food-drug interactions, as well as to assist in decreasing their occurrence. The aim of this study was to identify any interactions present between food and selected over-the-counter (OTC) drugs. Sixty-five publications out of a potential 1112 found in the search were included in the study and among them 28 concerned painkillers, 6 - antihistamines, 4 - nasal decongestants, 10 were for proton pump inhibitors and for iron and 8 for sildenafil. Interactions between food and OTC drugs do exist. These drugs should not be taken regardless of the meal. Providing relevant information to the patient will increase drug safety and efficacy.

Bioequivalence Study of Pantoprazole Sodium-HPBCD and Conventional Pantoprazole Sodium Enteric-Coated Tablet Formulations

The objective of this study was to investigate the bioequivalence of two formulations of 40 mg pantoprazole sodium enteric-coated tablets: Tripepsa as the test and Pantocid as the reference. The two products were administered as a single oral dose according to a randomized two-phase crossover with a 1-month washout period in 25 healthy Indian volunteers. After drug administration, serial blood samples were collected over a period of 30 hours. Plasma pantoprazole concentrations were measured by high-performance liquid chromatography with UV detection. Pharmacokinetic parameters were analyzed based on noncompartmental analysis. The logarithmically transformed data of AUC0-∞ and Cmax were analyzed for 90% confidence intervals (CI) using ANOVA. The mean (90% CI) values for the ratio of AUC0-∞ and Cmax values of the test product over those of the reference product were 90.21 (83.69-97.24) and 108.68 (100.21-117.86), respectively (within the bioequivalence range of 80-125%). On the basis of pharmacokinetic parameters including AUC0-∞ , AUC0-t , and Cmax values, both the formulations were bioequivalent.

An update on the use of pantoprazole as a treatment for gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a chronic, recurrent disease that affects nearly 19 million people in the US. The mainstay of therapy for GERD is acid suppression. Proton pump inhibitors (PPIs) are the most effective medication for both initial treatment and maintenance therapy of GERD. Pantoprazole, a first-generation PPI, was approved by the FDA in 2000 for the treatment of erosive esophagitis associated with GERD. It has been used in more than 100 different countries worldwide. It is one of the few PPIs available in multiple forms: a delayed-release oral capsule, oral suspension, and intravenous. Pantoprazole been shown to improve acid reflux-related symptoms, heal esophagitis, and improve health-related quality of life more effectively than histamine-2 receptor antagonists. Evaluated in over 100 clinical trials, pantoprazole has an excellent safety profile, is as efficacious as other PPIs, and has a low incidence of drug interactions. It has also been shown to be safe and effective in special patient populations, such as the elderly and those with renal or moderate liver disease.

Sodium pantoprazole-loaded enteric microparticles prepared by spray drying: Effect of the scale of production and process validation

Pantoprazole is a prodrug used in the treatment of acid related disorders and Helicobacter pylori infections. It is activated inside gastric parietal cells binding irreversibly to the H(+)/K(+)-ATPase. In this way, pantoprazole must be absorbed intact in the intestinal tract, which indicates that enteric drug delivery systems are required for its oral administration. The purpose of this study was to investigate the physical characteristics of enteric pantoprazole-loaded microparticles prepared by spray drying using a blend of Eudragit S100 and HPMC. The microparticles were produced in different spray dryers and operational conditions at laboratory and pilot scales. Microparticles produced with two fluid nozzle atomizer and air pressure of 196 kPa presented satisfactory encapsulation efficiency and gastro-resistance. Microparticles produced with the same atomizer but using 49 kPa of air pressure presented strings in the powder. The microparticles produced in mixed flow presented very high polydispersity and the ones produced with rotating disc atomizer presented drug crystals adsorbed on the particle surfaces. The microparticles produced with two fluid nozzle atomizer and 196 kPa were prepared in three consecutive days for the process validation. The powders showed reproducible diameter, polydispersity, densities, encapsulation efficiency and gastro-resistance profile.

Role of pantoprazole in the treatment of gastro-oesophageal reflux disease

The diagnosis and treatment of gastro-oesophageal reflux disease (GERD) presents many problems, despite the fact that significant advances have been made in recent years in the understanding of its pathogenesis and symptomatology. GERD affects many people and has a significant negative impact on patient quality of life. Heartburn is the most common symptom of GERD which occurs with and without oesophagitis. The predominant causative factor for symptoms is prolonged contact of oesophageal mucosa with refluxed acid and pepsin. Proton pump inhibitors (PPIs) are the most effective treatment for GERD: overall proportions of patients with healing and complete heartburn relief are markedly higher with PPIs than with alternative treatment strategies. Furthermore, the speed of healing and heartburn relief with PPIs is almost twice as rapid as with any other form of therapy. The present review focuses on the effectiveness and safety of the PPI, pantoprazole. The data show that the compound is highly effective in GERD patients with and without oesophagitis. Pantoprazole has an excellent safety record and shows only minor interaction with other drugs.

Preparation, characterization, and in vivo anti-ulcer evaluation of pantoprazole-loaded microparticles

Pantoprazole is an important drug in the treatment of acid-related disorders. This work concerns the preparation and characterization of gastro-resistant pantoprazole-loaded microparticles prepared using an O/O emulsification/solvent evaporation technique. The in vivo activity of the pantoprazole-loaded Eudragit S100 microparticles was carried out in rats. Furthermore, tablets containing the microparticles were also investigated. Microparticles presented spherical and smooth morphologies (SEM) and they remained intact in the inner surface of tablets. DSC and IR analyses showed that pantoprazole was physically and molecularly dispersed in the polymer. In vivo anti-ulcer evaluation showed that the microparticles were able to protect rat stomachs against ulcer formation, while the drug aqueous solution did not present activity. Drug dissolution profiles from tablets demonstrated slower release than untabletted microparticles. Weibull equation was the best model for describing the drug release profiles from microparticles and tablets. As regards the acid protection, tablets showed a satisfactory drug protection in acid medium (61.05 +/- 8.09% after 30 min).

Pantoprazole provides rapid and sustained symptomatic relief in patients treated for erosive oesophagitis

BACKGROUND

Effective symptom control is a primary concern of most heartburn suffers.

AIM

To compare the safety and efficacy of pantoprazole, placebo and the H2 antagonist nizatidine in relieving symptoms in patients with erosive oesophagitis.

METHODS

Data from two randomized, double-blind studies were pooled. Patients received pantoprazole 10, 20 or 40 mg, or placebo daily (study 1, n = 603), or pantoprazole 20 or 40 mg daily or 150-mg nizatidine b.d. (study 2, n = 243) for either 4 or 8 weeks. Endoscopy was performed at baseline, week 4 and week 8. Persistent absence of symptoms was defined as the first day that no symptoms were reported by the patient on that day or any subsequent study day.

RESULTS

A significantly higher percentage (P < 0.05) of pantoprazole patients reported elimination of all symptoms by week 8. Daytime heartburn, night-time heartburn and regurgitation were significantly better controlled with pantoprazole (with a dose-response at most time-points). Absence of symptoms was a powerful predictor of healing; presence of symptoms correlated poorly.

CONCLUSION

Pantoprazole is more effective than placebo or nizatidine for controlling heartburn and acid regurgitation in patients with erosive oesophagitis. Relief of GERD symptoms is highly predictive of healing of erosive oesophagitis at 4 and 8 weeks.

Dyspepsia: initial evaluation and treatment

OBJECTIVE

To provide recommendations for the initial evaluation and management of dyspepsia.

DATA SOURCES

Articles identified through a MEDLINE search for human studies published in English between 1966 and June 2001, using the primary search term dyspepsia and the secondary search terms diagnosis, complications, and treatment; textbooks with information on the diagnosis and management of gastrointestinal (GI) disorders; and bibliographies of retrieved publications and textbooks.

STUDY SELECTION

Articles that focused on dyspepsia as well as factors suggestive of more complicated GI disorders that would require pharmacists to refer patients to a physician.

DATA EXTRACTION

Performed by the author manually.

DATA SYNTHESIS

Functional dyspepsia (i.e., upset stomach or indigestion with no identifiable lesion) is a common complaint that may be relieved by medications, including antacids, histamine2-receptor antagonists, proton pump inhibitors, and promotility agents. However, therapy should not mask important warning signs and symptoms of more complicated diseases, as that could delay both diagnosis and more definitive treatment. Peptic ulcer disease and gastroesophageal reflux disease each account for about 20% of patients presenting with dyspepsia. Gastric cancer is an important disease to consider in the differential diagnosis of dyspepsia in patients older than 45 years, especially elderly patients (65 years and older).

CONCLUSION

Nonprescription medications can relieve functional dyspepsia, but pharmacists must be aware of common features of diseases that require patient referral to a physician for further evaluation.