Panocid 40

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

[1]

Indications of the the Panocide 40

It is shown to children from 12 years old and adults with gastroesophageal reflux.

For adults:

• destruction of Helicobacter pylori in individuals with associated gastric ulcers, and in addition ulcers of the 12-colon (in combination with other necessary antibiotics);
• treatment of gastric and intestinal (duodenal ulcers) ulcers;
• gastrinoma and other diseases associated with hypersecretion.

[2], [3], [4], [5],

Release form

Release of the medicine is carried out in tablets, on the first blister for 10 pieces. Inside a separate package, put 1 or 3 blister plates.

Pharmacodynamics

The drug slows down the H ⁺ / K ⁺ -ATPase of the lining cells and prevents the transport of H2 ions from the lining to the gastric lumen. It is also the blocker of the final stage of the hydrophilic release of hydrochloric acid. Reduces stimulated (regardless of the type of stimulus - substances histamine, acetylcholine or gastrin) and unstimulated release of hydrochloric acid.

During the ulcer of the 12-colon induced by the bacterium with Helicobacter pylori, a similar weakening of the excretory function of the stomach increases the sensitivity of the pathogenic microbe to antibiotics. Pantoprazole has antimicrobial properties with respect to Helicobacter pylori, which help the development of anti-Helicobacter pylori action of other drugs.

[6], [7]

Pharmacokinetics

After taking the pill, the medicine is absorbed completely and quickly. About 90-95% is synthesized with a plasma protein. Peak serum level of the drug reaches 2.5 hours later, with the effect remaining for the next 24 hours.

Metabolism of the substance pantoprazole occurs inside the liver with the help of the enzyme system of hemoprotein P450.

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

[8], [9], [10]

Dosing and administration

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

The treatment of this disease often takes 1 month. If there is no result after this period, you can expect the problem to be fixed in the next 4 weeks.

People with a gastric ulcer or ulcer in the 12-colon area developing against the background of the presence of the Helicobacter pylori bacterium in the body are required to destroy the pathogenic microbe using combined treatment. Taking into account the sensitivity of bacteria, the following medicinal combinations can be prescribed for adults to kill Helicobacter pylori:

• 40 mg of a drug (1 tablet) + amoxyllicin at a rate of 1000 mg + clarithromycin at a rate 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 medicines should be consumed twice a day;
• 40 mg of Panocid 40 (1 tablet) + amoxyllicin (1000 mg) + metronidazole (400-500 mg) or tinidazole (500 mg); take each medicine twice a day.

If combined treatment is used to kill the H. Pylori microbe, a second dose of Panocid 40 should be consumed in the evening, before dinner (about 1 hour). The duration of the course is equal to the first week and can, if necessary, be extended for the same period, but its total duration should not exceed 2 weeks.

If, in the treatment of ulcers, subsequent therapy with pantoprazole is required, it is necessary to study the recommendations regarding the dosages proposed for the treatment of ulcerative duodenal pathologies, as well as the stomach.

In cases when combined therapy can not be used (for example, people who did not have Helicobacter pylori), it is required to take the medicine in a dosage of 1 tablet once a day (monotherapy of stomach 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 produced a result.

With prolonged treatment of gastrinoma and other diseases associated with an increase in secretory function, the initial daily dosage is equal to 2 tablets (80 mg). Further, this dose can be adjusted (reduced or increased), given the level of secreted stomach acid. Daily dosages of more than 80 mg should be divided into 2 uses. It is permissible for a while to increase the dose to a level of more than 160 mg, but the period of such treatment should be limited solely to the time interval required to adequately monitor the release of acid.

The duration of treatment of gastrinoma and other pathologies associated with hypersecretion does not have a clear timeline and is dependent on clinical results.

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

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

Elimination of gastroesophageal reflux, as well as gastric ulcers usually occurs within 1 month. If there is no required result in the specified period, the therapy is prolonged for another month.

[14], [15],

Use of the the Panocide 40 during pregnancy

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

There is information about the penetration of pantoprazole into the mother's milk, so it is only possible to prescribe it during this period if it is known that the benefit from its use will exceed the possible risks for the child.

Contraindications

Among the main contraindications of drugs:

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

Side effects of the the Panocide 40

Taking medication can cause the following side effects:

• systemic disorders: the state of fever, general and peripheral puffiness, as well as puffiness on the face, the development of candidiasis, asthenia and malaise, and in addition the appearance of a hernia, cysts, abscess. In addition, heat stroke, chills, the appearance of tumors, allergy, photosensitivity, nonspecific reactions, severe fatigue and changes in the values of laboratory tests;
• organs of the cardiovascular system: the development of arrhythmia, stenocardia, pain in the sternum and behind it, atrial fibrillation. In addition, changes in the indications of the cardiogram, the appearance of bleeding, the development of heart failure in a stagnant form, myocardial infarction or ischemia and palpitation, as well as a decrease / increase in blood pressure. Possible the appearance of thrombosis, tachycardia, vasodilation, thrombophlebitis, and also fainting and problems with the vessels of the retina;
• disorders in the digestive tract: abdominal and epigastric pain (also a sense of discomfort), diarrhea, bloating or constipation. Occurrence of vomiting or nausea, and also dryness of the oral mucosa. The development of anorexia, pancreatitis, colitis with stomatitis, dysphagia and cardiospasm, as well as duodenitis, esophagitis and enteritis. There may be esophageal hemorrhages, bleeding from the anus and inside the gastrointestinal tract, candidiasis appears in the digestive tract, and gastrointestinal cancer develops. Also there is a glossitis with gingivitis, bad breath, melena, vomiting with blood, an increase in appetite, there are disorders of the stool, the color of the tongue changes. On oral mucosa there are ulcers, periodontitis develops, ulcerative colitis, periodontal abscess, gastric ulcers, as well as oral candidiasis;
• endocrine disorders: the development of hyperglycemia or hyperlipoproteinemia, and in addition to goitre, diabetes and glucosuria, as well as mastodinia;
• organs of the hepatobiliary system: the 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 occurrence of biliary pain, the development of cholecystitis, hyperbilirubinemia, cholelithiasis, intrahepatic cholestasis and hepatitis, as well as an increase in the parameters of alkaline phosphatase, SGOT;
• lymph and hematopoietic system: development of thrombocyto-, leuko- or pancytopenia, eosinophilia, hypercholesterolemia or hyperlipoproteinemia, and besides this anemia (also its hypochromic and iron deficiency forms), agranulocytosis with leukocytosis and the appearance of ecchymosis;
• metabolic disorders: the development of hyperlipidemia (increased lipid values - cholesterol with triglycerides), gout, hypokalemia, hyponatremia, as well as hypocalcemia or hypomagnesemia. Besides this, the appearance of a sense of thirst and a decrease or increase in weight;
• organs of the immune system: the development of anaphylaxis, Quincke edema, as well as anaphylactic manifestations;
• organs of the connective system, as well as ODA: there is a single myalgia (disappears after the end of medicine reception), arthralgia, muscle spasms, arthrosis with arthritis, bone pains and disorders in bone tissues. Also convulsions, bursitis, tenosynovitis and rigidity of the neck muscles develop. Possible problems with the functioning of joints and fractures (wrists, thighs, spine);
• neurological problems: dizziness, phobia, tremor, headaches, paresthesia, nightmares and sleep problems, as well as confusion (this particularly applies to people prone to such violations, and if they occur, these manifestations become more acute). There may be seizures, emotional instability, nervousness, drowsiness, development of hypoesthesia, dysarthria, hyperkinesia, neuropathy with neuritis and neuralgia, as well as a violation of taste perception. Reflexes and libido may decrease;
• mental disorders: the state of depression, disappearing after the completion of the treatment course, a sense of disorientation, a sense of embarrassment, the appearance of hallucinations and a disorder of thinking;
• disturbances in 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: manifestations of allergy in the form of rash and itching. Occasionally, erythema multiforme develops, hives, photosensitivity, Stevens-Johnson syndromes, as well as Lyell, acne and dermatitis (lichenoid, fungal, contact or exfoliative form). In addition, alopecia, eczema, dry skin, maculopapular rash, hemorrhagia, skin ulcer and other skin disorders, simple or surrounding herpes and hyperhidrosis;
• sensory organs: blurred vision, development of glaucoma, cataract, diplopia, extraocular paralysis or amblyopia. In addition to this, pain or noise in the ears, the development of deafness or external otitis media. There may also be a disorder of taste buds;
• urinary system and kidneys: tubulointerstitial nephritis (renal insufficiency may occur in the future), and in addition albuminuria with hematuria, dysmenorrhea and cystitis, as well as urination disorder, balanitis, kidney pain, epididymitis, or nocturia. In addition, there may be a violation in the work of the prostate, the appearance of concrements in the kidney or urethral pain, a disorder of the urinary ducts, edema of the scrotum and the development of pyelonephritis, vaginitis or urethritis;
• breast and reproductive organs: development of gynecomastia or impotence.

[11], [12], [13]

Interactions with other drugs

The active substance of the drug - pantoprazole - can reduce the level of absorption of individual drugs. Among such medicines, the bioavailability indicators of which depend on the acidity level of the gastric juice produced (this includes individual antimycotic drugs - itraconazole with ketoconazole and posaconazole, and other drugs, eg erlotinib).

When used simultaneously with HIV proton pump inhibitors (for example, atazanavir and other drugs whose absorption depends on the level of acidity of the gastric juice), a significant reduction in the bioavailability of these drugs and the weakening of their effect are possible. Therefore, it is forbidden to take these substances in combination.

Although there was no drug interaction when combined with warfarin and fenprocumone, during the clinical tests episodes of the change in the PSI indices were recorded (in postmarketing studies). Therefore, persons taking anticoagulants of indirect action need to constantly monitor the level of MI / MNI during the entire period of using pantoprazole, and after its abolition (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 indices of this substance in the blood of individual patients. People who use methotrexate in large doses (for example, people with psoriasis or cancer) need to cancel the use of pantoprazole for the duration of treatment.

Most of the substance pantoprazole passes the metabolism inside the liver (using the enzyme system of hemoprotein P450). The main way of this process is demethylation using element 2C19. In addition, other metabolic processes occur, for example, oxidation with the enzyme CYPZA4. Testing of combinations with drugs metabolized in the same way (among such diazepam with nifedipine, carbamazepine with glibenclamide, and in addition oral contraceptives containing ethinylestradiol substances with levonorgestrel) did not demonstrate significant drug interaction.

The information obtained after a series of tests of various interactions showed that the substance of pantoprazole does not affect the metabolism of active components metabolized 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 (eg, ethanol). It also does not affect the p-glycoprotein associated with the absorption of the digoxin substance.

[16], [17], [18], [19]

Storage conditions

Keep the tablets in a place that is closed from children's access. Temperature values - no more than 30 ° С.

[20]

Shelf life

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

[21],