PANTOMAX 40/MG TAB 15/TAB

Indications

Approved Uses

GERD including short‑term treatment and maintenance of healing of erosive esophagitis; and pathological hypersecretory conditions including Zollinger-Ellison syndrome.

Off-Label Uses

H. pylori eradication as part of combination therapy; prevention/treatment of NSAID-associated ulcers; stress-ulcer prophylaxis in critically ill patients; functional dyspepsia; laryngopharyngeal reflux; Barrett’s esophagus symptom control (not cancer prevention).

Dosage & Administration

Dosing by Condition

Erosive esophagitis/GERD (treatment): 40 mg orally once daily for up to 8 weeks; may extend to an additional 8 weeks if needed.
Erosive esophagitis (maintenance of healing): 40 mg orally once daily (use the lowest effective dose).
Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome): Initial 40 mg orally twice daily; titrate to acid control; doses up to 240 mg/day have been used.

Initial Dose

40mg orally once daily.

Maintenance Dose

20-40mg once daily

Maximum Dose

240mg/day (Zollinger-Ellison syndrome); 80mg/day for standard indications

Children's Dosage

Children ≥5 years (≥15kg) for GERD: 20mg once daily (15-40kg); 40mg once daily (>40kg) for up to 8 weeks. Not approved for children under 5 years

How to Take

Swallow the 40 mg gastro‑resistant (enteric‑coated) tablet whole with water; do not crush, chew, or split. Take preferably 30-60 minutes before a meal (commonly before breakfast).

Side Effects

Common Side Effects

Headache, diarrhea, nausea, abdominal pain, flatulence, constipation, vomiting, dizziness

Side Effect Frequency

Common (≥1% to <10%): headache, diarrhea, nausea/vomiting, abdominal pain, flatulence; dizziness is typically uncommon; arthralgia is typically uncommon.

Safety & Warnings

Age Restriction

Not approved/recommended for children <5 years for this 40 mg gastro‑resistant tablet; pediatric use is generally ≥5 years (age/weight-based dosing) depending on indication.

Driving Warning

Safe

Drug Interactions

Drug Interactions

Key interactions: avoid/contraindicated with rilpivirine; avoid with atazanavir and nelfinavir (reduced absorption); reduces absorption of pH-dependent drugs (e.g., ketoconazole/itraconazole, iron salts); high-dose methotrexate (may increase levels-hold PPI); warfarin (monitor INR); clopidogrel interaction is less clinically significant with pantoprazole than omeprazole but monitor if high risk; mycophenolate exposure may be reduced.

Food Interaction

May be taken with or without food, but taking 30-60 minutes before a meal is preferred for maximal effect; food can delay absorption without meaningfully reducing overall exposure.

Special Populations

Breastfeeding

Caution

Children

Children ≥5 years (≥15kg) for GERD: 20mg once daily (15-40kg); 40mg once daily (>40kg) for up to 8 weeks. Not approved for children under 5 years

Elderly

Standard adult dosing; no routine dose adjustment required. Use with caution in elderly patients on long-term therapy due to increased risk of fractures and hypomagnesemia

Kidney Impairment

No renal dose adjustment needed, including in severe renal impairment and in patients on hemodialysis.

Liver Impairment

Mild-moderate hepatic impairment: no adjustment; severe impairment: use with caution and consider a maximum of 20 mg once daily with periodic liver enzyme monitoring.

Storage & Patient Advice

Missed Dose

Take as soon as remembered; skip if it is almost time for the next dose. Do not take two doses at one time.

Overdose

Symptoms are usually non-specific and consistent with known adverse effects (e.g., nausea, vomiting, abdominal pain, diarrhea, dizziness, headache); management is supportive/symptomatic, and pantoprazole is not meaningfully removed by hemodialysis-seek urgent medical care/poison center advice.

Patient Counseling

Swallow the enteric‑coated tablet whole with water; do not crush/chew/split. Take preferably 30-60 minutes before a meal and use as prescribed (symptom relief may take 1-3 days). Seek care for severe/persistent diarrhea, rash, or signs of low magnesium (muscle cramps, palpitations, seizures) with long-term use; discuss long-term risks (B12 deficiency, fractures) if prolonged therapy; tell clinicians about warfarin, methotrexate, and HIV meds (rilpivirine/atazanavir).

Pharmacology

Mechanism of Action

Proton pump inhibitor that irreversibly inhibits the gastric parietal cell H+/K+-ATPase, suppressing the final step of acid secretion (basal and stimulated).

Onset of Action

Onset begins within a few hours (about 2-3 hours), but maximal symptom/acid suppression typically requires 2-3 days of daily dosing.

Duration of Effect

Approximately 24 hours of acid suppression per dose, with greater suppression after several consecutive daily doses.

Half-Life

Approximately 1 hour (range about 0.9-1.9 hours)

Bioavailability

Approximately 77%.

Metabolism

Extensively metabolized hepatically, primarily via CYP2C19 and to a lesser extent via CYP3A4 (with significant first-pass metabolism).

Product Information

Available Dosage Forms

For this PRODUCT: gastro‑resistant (enteric‑coated) oral tablet, 40 mg (blister pack of 15).

Generic Availability

Yes

Gi Condition

Acid Reflux/GERD, Ulcer

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