Panocid 40

Panocid 40 is a drug used in the treatment of ulcers and GERD. It is a proton pump inhibitor.

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Indications Panocida 40

Indicated for children aged 12 years and over and adults with gastroesophageal reflux.

For adults:

• eradication of Helicobacter pylori in individuals with associated gastric ulcers, as well as duodenal ulcers (in combination with other necessary antibiotics);
• treatment of gastric and intestinal (duodenal) ulcers;
• gastrinoma and other diseases associated with hypersecretion.

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Release form

The medicine is released in tablets, 10 pieces per blister. 1 or 3 blister plates are placed inside a separate package.

Pharmacodynamics

The drug slows down H ⁺ /K ⁺ -ATPase of parietal cells and prevents the transport of H2 ions from the parietal cell into the gastric lumen. It also blocks the final stage of hydrophilic secretion of hydrochloric acid. Reduces stimulated (regardless of the type of stimulus - histamine, acetylcholine or gastrin) and unstimulated secretion of hydrochloric acid.

During duodenal ulcer induced by the bacterium Helicobacter pylori, such weakening of the excretory function of the stomach increases the sensitivity of the pathogenic microbe to antibiotics. Pantoprazole has antimicrobial properties against Helicobacter pylori, which help develop the anti-Helicobacter effect of other drugs.

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Pharmacokinetics

After taking the tablet, the drug is completely and quickly absorbed. About 90-95% is synthesized with plasma protein. The drug reaches its peak serum level after 2.5 hours, with the effect lasting for the next 24 hours.

The metabolism of the substance pantoprazole occurs in the liver using the P450 hemoprotein enzyme system.

About 71% of the substance is excreted through the kidneys, and another 18% in the feces.

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Dosing and administration

To eliminate gastroesophageal reflux - adolescents over 12 years old and adults are prescribed 40 mg of the drug (1 tablet) once a day. Sometimes it is allowed to double the dosage (drink 2 tablets of 40 mg per day), especially if the use of other drugs did not bring the desired result.

Treatment of this disease often takes 1 month. If there is no result after this period, you can expect the problem to be resolved within the next 4 weeks.

People with gastric ulcers or ulcers in the duodenum, developing against the background of the presence of the Helicobacter pylori bacteria in the body, need to destroy the pathogenic microbe using combination therapy. Given the sensitivity of the bacteria, the following drug combinations can be prescribed to adults to destroy Helicobacter pylori:

• 40 mg of medicine (1 tablet) + amoxicillin in the amount of 1000 mg + clarithromycin in the amount of 500 mg; all medicines are taken twice a day;
• 40 mg of the drug (1 tablet) + metronidazole (400-500 mg) or tinidazole (500 mg) + clarithromycin (250-500 mg); all drugs should be taken twice a day;
• 40 mg Panocid 40 (1 tablet) + amoxicillin (1000 mg) + metronidazole (400-500 mg) or tinidazole (500 mg); each medicine should be taken twice a day.

In case of combined treatment to destroy the H. Pylori microbe, the second dose of Panocid 40 should be taken in the evening, before dinner (approximately 1 hour). The course duration is 1 week and can, if necessary, be extended for the same period, but its total duration should not exceed 2 weeks.

If subsequent therapy with pantoprazole is required during the treatment of ulcers, it is necessary to study the dosage recommendations proposed for the treatment of ulcerative pathologies of the duodenum and stomach.

In cases where combination therapy cannot be used (for example, in people who have not been diagnosed with Helicobacter pylori), it is necessary to take the drug in a dosage of 1 tablet once a day (monotherapy of gastric pathologies of the duodenum or stomach). If necessary, this dose is doubled (2 tablets per day) - this method is usually used if the use of other drugs has not yielded results.

In long-term treatment of gastrinoma and other diseases associated with increased secretory function, the initial daily dosage is 2 tablets (80 mg). This dosage can then be adjusted (lowered or increased), taking into account the level of secreted gastric acid. Daily dosages of more than 80 mg must be divided into 2 doses. It is allowed to temporarily increase the dosage to a level of more than 160 mg, but the period of such treatment should be limited exclusively to the time period required for adequate monitoring of acid secretion.

The duration of treatment for gastrinoma and other pathologies associated with hypersecretion does not have clear timeframes and depends on the clinical results.

Persons suffering from severe functional liver disorder are prohibited from exceeding the daily dose limit of 20 mg.

Treatment of duodenal ulcers usually takes 0.5 months. If a period of 2 weeks is not enough for healing, it is necessary to extend the course for another 2 weeks.

Elimination of gastroesophageal reflux and gastric ulcers usually occurs within 1 month. If the desired result is not achieved within the specified period, the therapy is extended for another 1 month.

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Use Panocida 40 during pregnancy

Information on the use of pantoprazole in pregnant women is limited. In studies of the reproductive system of animals, embryotoxicity was noted in the case of taking the drug at a dose of more than 5 mg/kg. The possibility of developing a negative reaction in humans has not been determined. Therefore, the use of Panocid 40 during pregnancy is permitted only in extreme cases.

There is information about the penetration of pantoprazole into breast milk, therefore it is allowed to prescribe it during this period only when it is known that the benefits of its use will outweigh the possible risks to the child.

Contraindications

Among the main contraindications of the drug:

• severe intolerance to the active component of the drug and its other components, as well as benzimidazole derivatives;
• It is prohibited to use in children under 12 years of age, because information about its properties and safety in this group of patients is limited.

Side effects Panocida 40

Taking the medicine may cause the following side effects:

• systemic disorders: fever, general and peripheral edema, as well as facial edema, development of candidiasis, asthenia and malaise, as well as the appearance of a hernia, cyst, abscess. In addition, heat stroke, chills, the occurrence of tumors, manifestations of allergies, photosensitivity, non-specific reactions, severe fatigue and changes in laboratory test values;
• cardiovascular system: development of arrhythmia, angina, chest pain and pain behind it, atrial fibrillation. In addition, changes in the cardiogram readings, bleeding, development of congestive heart failure, infarction or myocardial ischemia and palpitations, as well as a decrease/increase in blood pressure. Thrombosis, tachycardia, vasodilation, thrombophlebitis may occur, as well as fainting and problems with the retinal vessels;
• Gastrointestinal disorders: abdominal and epigastric pain (also a feeling of discomfort), diarrhea, bloating or constipation. The appearance of vomiting or nausea, as well as dry mouth. Development of anorexia, pancreatitis, colitis with stomatitis, dysphagia and cardiospasm, as well as duodenitis, esophagitis and enteritis. Esophageal hemorrhages, bleeding from the anus and inside the gastrointestinal tract may be observed, candidiasis in the gastrointestinal tract may occur and gastrointestinal cancer may develop. Glossitis with gingivitis, bad breath, melena, vomiting with blood also appear, appetite increases, stool disorders are observed, the color of the tongue changes. Ulcers appear on the oral mucosa, periodontitis, ulcerative colitis, periodontal abscess, gastric ulcers, as well as oral candidiasis develop;
• endocrine disorders: development of hyperglycemia or hyperlipoproteinemia, as well as goiter, diabetes mellitus and glucosuria, as well as mastodynia;
• organs of the hepatobiliary system: development of hepatocellular disorders (lead to the appearance of jaundice, accompanied or not accompanied by liver failure) damage to liver cells, an increase in liver enzymes (transaminases, as well as GGT) and triglycerides. In addition, the appearance of biliary pain, the development of cholecystitis, hyperbilirubinemia, cholelithiasis, intrahepatic cholestasis and hepatitis, as well as an increase in alkaline phosphatase, SGOT;
• lymph and hematopoietic system: development of thrombocytopenia, leukopenia or pancytopenia, eosinophilia, hypercholesterolemia or hyperlipoproteinemia, and in addition to this, anemia (also its hypochromic and iron deficiency forms), agranulocytosis with leukocytosis and the appearance of ecchymosis;
• metabolic disorders: development of hyperlipidemia (increased lipid values - cholesterol with triglycerides), gout, hypokalemia, hyponatremia, as well as hypocalcemia or hypomagnesemia. In addition, the appearance of a feeling of thirst and a decrease or increase in weight;
• organs of the immune system: development of anaphylaxis, Quincke's edema, as well as anaphylactic manifestations;
• connective tissue organs, as well as the musculoskeletal system: myalgia (disappears after stopping taking the drug), arthralgia, muscle spasms, arthrosis with arthritis, bone pain and bone tissue disorders are observed sporadically. Cramps, bursitis, tenosynovitis and stiffness of the neck muscles also develop. Problems with the functioning of joints and fractures (wrists, hips, spine) may occur;
• neurological problems: dizziness, phobias, tremors, headaches, paresthesia, nightmares and sleep problems, as well as confusion (this is especially true for people prone to such disorders; in their presence, these symptoms are exacerbated). Convulsions, emotional instability, a feeling of nervousness, drowsiness, the development of hypesthesia, dysarthria, hyperkinesia, neuropathy with neuritis and neuralgia, as well as a violation of taste perception are possible. Reflexes and libido may decrease;
• mental disorders: a state of depression that disappears after completion of the treatment course, a feeling of disorientation, a feeling of confusion, the appearance of hallucinations and a disorder of thinking;
• disorders of the respiratory system: nosebleeds, hiccups and asthma, pulmonary pathologies, laryngitis and pneumonia, as well as changes in the sound of the voice;
• subcutaneous layer and skin: allergic reactions in the form of rash and itching. Rarely, erythema multiforme, urticaria, photosensitivity, Stevens-Johnson syndrome, as well as Lyell's syndrome, acne and dermatitis (lichenoid, fungal, contact or exfoliative form) develop. In addition, alopecia, eczema, dry skin, maculopapular rash, hemorrhages, skin ulcers and other skin disorders, herpes simplex or herpes zoster and hyperhidrosis are observed;
• sense organs: blurred or impaired vision, development of glaucoma, cataracts, diplopia, extraocular paralysis or amblyopia. In addition, pain or noise in the ears, development of deafness or external otitis. Taste buds may also be affected;
• urinary system and kidneys: tubulointerstitial nephritis developed occasionally (renal failure may develop later), and in addition, albuminuria with hematuria, dysmenorrhea and cystitis, as well as urinary disorder, balanitis, kidney pain, epididymitis or nocturia. In addition, there may be a malfunction of the prostate, the appearance of kidney stones or urethral pain, urinary tract disorder, scrotal edema and the development of pyelonephritis, vaginitis or urethritis;
• mammary glands and reproductive organs: development of gynecomastia or impotence.

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Interactions with other drugs

The active substance of the drug - pantoprazole - can reduce the level of absorption of certain drugs. Among these are drugs whose bioavailability indicators depend on the level of acidity of the gastric juice produced (this includes certain antifungal drugs - itraconazole with ketoconazole and posaconazole, and other drugs, such as erlotinib).

When used simultaneously with proton pump inhibitors of drugs used for HIV (for example, atazanavir and other drugs whose absorption depends on the level of gastric acidity), a significant decrease in the level of bioavailability of these drugs, as well as a weakening of their effect, is possible. As a result, it is prohibited to take these substances in combination.

Although no drug interactions were observed when combined with warfarin and phenprocoumon, episodes of changes in INR values were occasionally recorded during clinical trials (during post-marketing studies). Therefore, individuals taking indirect anticoagulants should constantly monitor the PV/INR level throughout the entire period of pantoprazole use, as well as after its withdrawal (or in case of irregular use of Panocid).

There is evidence that the combination with methotrexate (in high doses, for example, 300 mg) can increase the levels of this substance in the blood of some patients. People who use methotrexate in high doses (for example, people with psoriasis or cancer) should stop using pantoprazole for the duration of treatment.

Most of the substance pantoprazole is metabolized in the liver (using the enzyme system of hemoprotein P450). The main route of this process is demethylation using the element 2C19. In addition, other metabolic processes occur, for example, oxidation using the enzyme CYP3A4. Testing of combinations with drugs that are metabolized in the same way (including diazepam with nifedipine, carbamazepine with glibenclamide, and also oral contraceptives containing the substances ethinyl estradiol with levonorgestrel) did not demonstrate significant drug interactions.

Information obtained after a series of tests of various interactions showed that the substance pantoprazole does not affect the processes of metabolism of active components, the metabolism of which is carried out with the participation of elements of CYP1A2 (this includes, for example, theophylline with caffeine) and CYP2C9 (for example, piroxicam with naproxen and diclofenac), as well as components of CYP2D6 (such as metoprolol) and CYP2E1 (for example, ethanol). It also does not affect p-glycoprotein associated with the absorption of the substance digoxin.

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Storage conditions

The tablets should be kept in a place out of reach of children. Temperature values should not exceed 30°C.

Shelf life

Panocid 40 can be used within 3 years from the date of manufacture of the drug.

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