Meyerpanzol 40mg Meyer - BPC Treatment of reflux esophagitis (3 blisters x 10 tablets)

Stomach and duodenum ulcer .

Pharmacy

pantoprazol is a structured proton pump inhibitor and similar effect to Omeprazol. As a benzimidazol that has attached the group, pantoprazol is proton turned into a form of activity in the acid secretary tubes of the cell into the stomach, where the enzyme inhibitors H+/K+/ATPase are also called proton pump, the final stage of gastric acid secretion.

After drinking, the anti -secreting effect of Pantoprazol lasts more than 24 hours. Within 2.5 hours after giving healthy people 40mg pantoprazol, the acid excretion of the stomach is inhibited about 51%. If you take 40mg once a day in 7 days, this inhibitor is up to 85%. Excreting stomach acid back to normal within 1 week after stopping pantoprazol and there is no increase in secretion.

Pantoprazol can inhibit Helicobacler Pylori in patients with peptic ulcer or reflux esophagitis infected with this bacterium. Coordinate to treat pantoprazol with antibiotics (such as clarithromycin, amoxicillin) can be exposed to H. pylori accompanied by an ulcer and remission for long term disease.

Dynamic pharmacy

Pantoprazole absorbs fast because of the highest plasma concentration after drinking about 2 - 2.5 hours. The drug is less metabolized in the liver, oral use is about 77%. About 98% Pantoprazol attached to plasma proteins, the distribution volume is about 0.17i/kg.

Pantoprazole metabolizes mainly in the liver thanks to the cytochrom P450 isoenzyme isoenzyme to form Desmethylpantoprazol. A small part is metabolized by CYP3A4, CYP2D6 and CYP2C9. The metabolic substances are excreted mainly through urine (80%), the rest through the bile into the feces. Half -life excretion of pantoprazol is about 1 hour, and lasts in the liver failure, half -life eliminated in people with cirrhosis is 3 - 6 hours.

Nervous system disorders: headache, dizziness.

Gastrointestinal disorders: diarrhea, nausea/vomiting, flatulence, constipation, dry mouth , abdominal pain and discomfort.

Liver disorders (Transaminase, Y -GT).

Hypersensitivity to Benzimidazol's derivative.

Precautions when using

liver failure

In patients with severe liver failure, regular monitoring of liver enzymes should be monitored during treatment with pantoprazol, especially when used for a long time. In case of increased liver enzymes, drug should be stopped.

Coordination

In each case of coordination treatment, depending on the characteristics of the corresponding drug product, consider.

Malignant stomach disease

Meet symptoms with pantoprazol can hide symptoms of malignant stomach disease and can hinder diagnosis. When there is any alarm symptoms (such as significant weight loss, recurrent vomiting, difficulty swallowing, vomiting of blood, anemia or black stool) and when stomach ulcers suspected or appear, malignant diseases should be excluded.

Unsuitable pantoprazol with HIV protease inhibitors that depend on acidic lip pH such as Atazanavir, due to their significant reduction of bioavailability.

affect the absorption of vitamin B12

In patients with Zollinger - Ellison syndrome and other excretory stimulus conditions that need long -term treatment, pantoprazole as well as all acid inhibitors, can reduce the absorption of vitamin B12 due to reduction or deficiency of hydrochloride.

In long -term treatment, especially when the treatment time exceeds 1 year, patients should be monitored regularly.

Gastrointestinal infections caused by bacteria: Treatment with Pantoprazol may slightly increase the risk of gastrointestinal tract infections caused by bacteria such as Salmonella and Campylobacter or C. Difficile.

Severe maggesi bloodstream has been reported in patients treated with PPIS such as Pantoprazol for at least three months and in most cases after one year of treatment. The serious manifestations of the blood magnesi such as fatigue, muscle spasms, delirium, convulsions, dizziness and ventricular arrhyths may appear but may start silently and not noticed. In most affected patients, lowering blood magnesia is improved after supplementing magnesi and stopping ppi.

For patients expected to treat or use PPIS with Digoxin or drugs that can cause blood magusi (such as diuretics), should consider monitoring Magnesi levels before starting PPI treatment and periodically during treatment.

fracture

Proton pump inhibitors, especially if high doses and for a long time (> 1 year), may increase the risk of a fracture of hip, wrist and spine fractures, mainly in the elderly or other risk factors. Observatory studies show that proton pump inhibitors may increase the risk of fractures by 10-40%.

One of these may be due to other risk factors. Patients at risk of osteoporosis should be carefully cared for under the current clinical instructions and provides adequate vitamin D and calcium.

Selling red skin lupus (SCLE)

Proton pump inhibitors are very rare for SCLE cases. If the damage occurs, especially in the skin exposed to the sun and if accompanied by joint pain, patients need to quickly come to medical assistance and should stop using Pantoprazol.

Testing

Increased chromographin A (CGA) level can hinder the study of endocrine nerve tumors. To avoid this hindrance, pantoprazol should be stopped at least 5 days before CGA measurement. If CGA and Gastrin concentrations do not return to the reference scope after the initial measurement, the exam must be repeated 14 days after stopping the treatment of Proton pump inhibitors.

Ingredients have not lactose. Patients with rare diseases: Galactose intolerance, Lapp Lactase deficiency, Glucose absorption disorders - Galactose should not use this drug.

Be cautious with the Tartrazin Yellow excipient ingredient of the drug can cause allergic reactions.

Be cautious with the ingredient of the drug propylene glycol of the drug can cause skin irritation.

The ability to drive and operate machines

pantoprazol does not have or affect the ability to drive and use machinery. The adverse drug reactions such as dizziness and visual disorders may occur. If affected, patients should not drive or operate machinery.

Pregnancy

Data on pregnant women (about 300 - 1000 pregnancy results) shows that there is no toxicity that causes fetal defects/babies of Pantoprazol. Animal studies have shown reproductive toxicity. Should avoid using pantoprazol during pregnancy.

Breastfeeding period

Animal studies show that there is a pantoprazol secretion in breast milk. The risk for infants/young children cannot exclude. Therefore, deciding to stop breastfeeding or stop treatment with pantoprazol should consider the benefits of breastfeeding and the benefits of Pantoprazol for women.

Reproductive ability

There is no evidence of fertility impairment after using Pantoprazol in animal studies.

Drug interaction

drugs with pharmacokinetic absorption depending on the pH

Due to the prolonged and completely prolonged stomach acid secretion, Pantoprazol can hinder the absorption of other drugs with stomach pH is an important factor that determines oral efficiency such as ketoconazol, otraconazole, posaconazole and erlotinib.

HIV protease inhibitors

Not simultaneously pantoprazol with HIV protease inhibitors that depend on pH environment such as Atazanavir, due to significantly reducing the bioavailability of the drug. If the combination of HIV protease inhibitors with a proton pump inhibitor (PPIS) is necessary, it is necessary to closely monitor clinical monitoring. Do not exceed the dose of Pantoprazol 20mg daily and the dose of HIV protease inhibitors may need adjustment.

Coumarin anticoagulant (phenprocoumon or warfarin )

Simultaneous use of pantoprazol with warfarin or phenprocoumon does not affect the pharmacokinetics or Inr of warfarin, phenprocoumon. However, there has been a report on the increase in Inr and the prothrombin time in patients using simultaneously PPIS with Warfarin or Phenprocoumon. Inrendet and prothrombin time can lead to abnormal bleeding and even death. Need to monitor the increase of Inr and prothrombin time in these patients.

methotrexate

Concomitance the use of methotrexat (300mg) and proton pump inhibitors have been reported to increase methotrexate levels in some patients. Therefore, in high -dose methotrexate diseases such as cancer and psoriasis, it is necessary to consider pantoprazol suspension.

Other interactions

Pantoprazol is metabolized in the liver through the cytochrom P450 enzyme system. The process of changing the substance is mainly demethylation by CYP2C19 and other processes include oxidation by CYP3A4.

Interactive research with drugs also metabolizes these lines such as Carbamazepin, Diazepam, Glibenclamid, Nifedipine and oral contraceptives containing levonorgestrel and ethinyl oestradiol does not show clinical significance.

Interaction of Pantoprazol with other drugs or compounds that are metabolized and an enzyme system is not excluded.

Results from a series of interactive studies show that Pantoprazol does not affect the metabolism of active ingredients metabolized by CYP1A2 (Cafein, Theophylllin), CYP2G9 (Piroxicam, diclofenac , Naproxen), CYP2D6 (Metoprolol), CYP2E1 (ETHANOL) or not obstructing the absorption Digoxin is related to P - lycoprotein.

There is no interaction when used simultaneously with antacids.

There is no clinical interaction when using Pantoprazol simultaneously with corresponding antibiotics ( clarithromycin , metronidazol, amoxicilin).

CYP2C19 inhibitors or touch products: CYP2C19 inhibitors such as fluvoxamine can increase the body contact of Pantoprazol. Dosage reduction may be considered for patients with long -dose pantoprazol or people with liver failure.

Touch enzyme CYP2C19 and CYP3A4 such as Rifampicin and St John's Wort (Hypericum Perforatum) can reduce PPI levels in plasma.