Oral Pantoprazole Research Articles

Carcinoids of the stomach and the duodenum with atrophic gastritis in a patient with

Background: A 27-year-old Caucasian male presented in 1977 with heartburn, indigestion and intermittent diarrhea. Treatment with cimetidine, ranitidine, and famotidine resulted in partial improvement, however, his symptoms persisted. Five years later, the patient underwent a parathyroid adenoma resection after hypercalcemia secondary to hyperparathyroidism.In 1986, multiple ulcers were found during an osophagogastroduodenoscopy (EGD), performed due to persistent epigastric discomfort. Two years later, he was diagnosed with Zollinger–Ellison syndrome (ZES) and MEN I Syndrome , however, despite treatment with famotidine, his symptoms persisted. In 1991, antisecretory treatment with the proton pump inhibitor, omeprazole, reduced the patient\'s basal acid output from 3–4 mEq/hr to 0.02–0.08 mEq/hr. In 1994, an EGD revealed multiple duodenal submucosal nodules. In 1997, treatment was switched to lansoprazole. The following year, a mucosal biopsy revealed atrophic gastric mucosa and multiple friable polyps with overlying ulcerations.Multifocal tumors were observed in the setting of endocrine cell hyperplasia and atrophic gastritis. Investigations:CT scan,MRI, somatostatin receptor scintigraphy, EGD, endoscopic ultrasonography and gastric analysis. Diagnosis: Carcinoids of the stomach and duodenum with atrophic gastritis and ZES accompanied by MEN I syndrome. Management:Histamine 2-receptor antagonists (cimetidine, ranitidine and famotidine) followed by proton pump inhibitor therapy (omeprazole, lansoprazole, and intravenous and oral pantoprazole). South African Gastroenterology Journal Vol. 6 (2) 2008: pp. 9-12

Effect of Increasing Esomeprazole and Pantoprazole Doses on Acid Control in Patients with Symptoms of Gastro-Oesophageal Reflux Disease

In patients with gastro-oesophageal reflux disease (GORD), dose escalation or drug switching may be considered in those with symptoms that persist despite standard-dose proton pump inhibitor (PPI) therapy. This study set out to assess whether increasing the dosage of oral esomeprazole and pantoprazole improves acid control in GORD patients, and to compare the pharmacodynamic efficacy of esomeprazole and pantoprazole administered at different dosages. This was an open-label, randomized, six-way crossover study that included Helicobacter pylori-negative GORD patients (aged 20-60 years) with <30% of time with intragastric pH>4. Patients were treated with oral once-daily esomeprazole 20 mg, 40 mg and 80 mg, and pantoprazole 20 mg, 40 mg and 80 mg, for 5 days. The main outcome measures were time with intragastric pH>4 over 24 hours, median pH over 24 hours and area under the hydrogen ion versus time curve on day 5 for each treatment period. Dose escalation with both PPIs improved acid control. The proportion of time with intragastric pH>4 (day 5) was 46.7% with esomeprazole 20 mg/day, 58.6% with esomeprazole 40 mg/day, and 65.8% with esomeprazole 80 mg/day; the corresponding percentages with pantoprazole were 28.6%, 36.9% and 44.9%, respectively. On a milligram-per-milligram basis, esomeprazole provided greater acid control than pantoprazole (p<0.001). Dose escalation with oral esomeprazole and pantoprazole improves acid control in patients with GORD, although esomeprazole provides significantly greater acid control on a milligram-per-milligram basis.

Oral pantoprazole and IV pantoprazole are comparable for the prevention of rebleeding in patients with nonvariceal upper gastrointestinal bleeding,

Oral pantoprazole and IV pantoprazole are comparable for the prevention of rebleeding in patients with nonvariceal upper gastrointestinal bleeding,

Oral pantoprazole in the form of granules or tablets are pharmacodynamically equivalent in suppressing acid output in patients with gastro‐oesophageal reflux disease and a history of erosive oesophagitis

To demonstrate the pharmacodynamic comparability between oral 40 mg pantoprazole delayed-release granules and tablets. This was a multicentre, randomized, open-label, 2-period, 2-sequence, 9-week crossover study in patients aged 18-65 years with gastro-oesophageal reflux disease and documented erosive oesophagitis. The primary endpoint was a comparison of the inhibition of pentagastrin-stimulated maximum acid output (MAO) at steady state after once daily dosing for 1 week and 23 h after the last dose of pantoprazole granules and tablets. Basal acid output was measured prior to MAO. Standard safety evaluations were performed. The one-sided t-test was used to test the null hypothesis that granules - 1.2 x tablet >/= 0 against the alternative hypothesis that this difference was <0 for both MAO and basal acid output values. Sixty patients completed the study. The mean MAO values were 7.11 +/- 4.98 and 7.29 +/- 4.77 mmol/h, while the mean basal acid output values were 0.74 +/- 0.91 and 0.58 +/- 0.63 mmol/h for the granules and tablets, respectively. The two formulations were shown statistically to be pharmacodynamically equivalent in suppressing MAO (P = 0.006), safe and well tolerated. Patients with gastro-oesophageal reflux disease who are unable to swallow the tablet may safely be prescribed the pantoprazole sodium granules.

Long-term management of gastroesophageal reflux disease with pantoprazole.

Gastroesophageal reflux disease (GERD) is a chronic, relapsing disease that can progress to major complications. Affected patients have poorer health-related quality of life than the general population. As GERD requires continued therapy to prevent relapse and complications, most patients with erosive esophagitis require long-term acid suppressive treatment. Thus GERD results in a significant cost burden and poor health-related quality of life. The effective treatment of GERD provides symptom resolution and high rates of remission in erosive esophagitis, lowers the incidence of GERD complications, improves health-related quality of life, and reduces the cost of this disease. Proton pump inhibitors are accepted as the most effective initial and maintenance treatment for GERD. Oral pantoprazole is a safe, well tolerated and effective initial and maintenance treatment for patients with nonerosive GERD or erosive esophagitis. Oral pantoprazole has greater efficacy than histamine H(2)-receptor antagonists and generally similar efficacy to other proton pump inhibitors for the initial and maintenance treatment of GERD. In addition, oral pantoprazole has been shown to improve the quality of life of patients with GERD and is associated with high levels of patient satisfaction with therapy. GERD appears to be more common and more severe in the elderly, and pantoprazole has shown to be an effective treatment for this at-risk population.

Validation of a New Endoscopic Technique to Assess Acid Output in Zollinger–Ellison Syndrome

To safely manage the hypersecretory state in patients with Zollinger-Ellison syndrome, both upper endoscopy and gastric analysis are required to titrate optimal medical therapy. Conventional gastric analysis requires more than 1 hour to perform and results in significant patient dissatisfaction. In this study, we have validated endoscopic gastric analysis as a novel technique that can effectively replace conventional gastric analysis. In a prospective, cross-over study, 12 patients with Zollinger-Ellison syndrome underwent gastric analysis, first by the conventional method and then by an endoscopic technique performed on the same day. Acid concentration was determined by titration, volume output was recorded, and acid output was calculated using standard methodologies and formulas. Agreement was assessed following the Bland-Altman method. To assess repeatability, both techniques were repeated on the same day in a subset of patients. Excellent agreement was reported between acid output (95% limits of agreement, -1.27 to 1.61 mEq/h) and acid concentration (95% limits of agreement, -0.01 to 0.01 mEq/mL), although poor agreement was observed between volume output measured. Endoscopic gastric analysis showed greater reproducibility regarding acid and volume output measured. We introduce a new, rapid, reproducible, and accurate endoscopic technique to measure acid output in patients with Zollinger-Ellison syndrome who require both annual endoscopy and gastric analysis. The data presented here suggest that endoscopic gastric analysis would be equally effective in determining acid output in other hypersecretory states. Additional analysis of cost effectiveness is needed to evaluate its use as a screening tool in select populations.

THE INCIDENCE OF THROMBOCYTOPENIA WITH CONTINUOUS PARENTERAL PANTOPRAZOLE INFUSION

PURPOSE: Proton pump inhibitor (PPI) continuous infusions are used in the treatment of acute upper gastrointestinal bleeds (GIB). PPIs are relatively safe however, in clinical practice, they have been supposedly linked to thrombocytopenia. Recent literature showed no increased incidence of thrombocytopenia with oral pantoprazole. However, data regarding the accurate incidence of thrombocytopenia with continuous infusion of PPIs is lacking and our study attempts to quantify this incidence.

Oral Rabeprazole 20 Mg Provides More Effective Acid Control Than IV Pantoprazole 40 Mg

Purpose: Intravenous (IV) proton-pump inhibitor therapy is used increasingly in hospitalized patients, even if, in many cases, they can take oral medication. Oral and IV pantoprazole produce equivalent acid suppression; oral rabeprazole produces greater acid suppression than oral pantoprazole. This study compares the antisecretory effects (time pH>3, 4, 5 & 6) produced by standard doses of oral rabeprazole and IV pantoprazole in healthy volunteers. Methods: Double-blind, randomized, two-way crossover study in 38 Helicobacter pylori-negative healthy volunteers. Subjects received oral rabeprazole 20 mg or IV pantoprazole 40 mg once daily for 3 days, with a 14-day (±3) washout period before the second 3-day drug administration period with the crossover drug regimen. Intragastric pH was recorded continuously for a 24-h period after dosing on days 1 and 3 of each treatment phase. Results: Over a 24-hour period, oral rabeprazole produced greater acid suppression than IV pantoprazole on day 1 [pH>3.0 (51.0%, 35.7%; p < 0.001), pH>4.0 (37.7%, 23.9%; p < 0.001), pH>5.0 (24.9%, 14.2%; p < 0.001), pH>6.0 (11.2%, 5.8%; p= 0.024)] and on day 3 [pH>3.0 (68.4%, 51.5%; p < 0.0001), pH>4.0 (54.4%, 37.7%; p < 0.001), pH>5.0 (38.1%, 24.8%; p <0.001), pH>6.0 (17.3%, 11.5%; p= 0.017)]. Over a 10-hour night-time period, oral rabeprazole produced greater acid suppression than IV pantoprazole on day 1 [pH>3.0 (42.8%, 27.8%; p < 0.010), pH>4.0 (30.2%, 18.2%; p= 0.017)] and on day 3 [pH>3 (56.2%, 37.0%; p < 0.001), pH>4 (43.4%, 26.2%; p= <0.002), pH>5 (29.8%, 18.8%; p= 0.024). Conclusions: In healthy subjects, oral rabeprazole provides greater intragastric acid suppression over 24 hours and during the 10-hour nocturnal period on day 1 and 3 than IV pantoprazole. Oral rabeprazole may be an appropriate substitute for IV pantoprazole in patients who can take oral medication. [figure 1]Figure 1

Comparison of Pentagastrin-Stimulated Maximum Acid Output in Patients with a History of Erosive Esophagitis Treated with 40 mg of Oral Pantoprazole Granules or Tablets

Comparison of Pentagastrin-Stimulated Maximum Acid Output in Patients with a History of Erosive Esophagitis Treated with 40 mg of Oral Pantoprazole Granules or Tablets

Intravenous Pantoprazole as Initial Treatment in Patients With Gastroesophageal Reflux Disease and a History of Erosive Esophagitis: A Randomized Clinical Trial

We sought to evaluate safety and efficacy of IV pantoprazole when used as initial therapy in patients with gastroesophageal reflux disease (GERD) and a history of erosive esophagitis (EE) in a double-blind, placebo-controlled, randomized, parallel-group study. Patients were randomized to 7 days of once-daily IV or oral pantoprazole (40 mg) or placebo. Efficacy variables included maximal acid output, basal acid output, and changes from baseline in frequency/severity of GERD symptoms, and frequency of antacid usage. Seventy-eight patients were randomized (n=26/27/25 [IV/oral/placebo]). Mean maximal acid output was 8.4, 6.3, and 20.9 mEq/h for IV or oral pantoprazole, and placebo, respectively. For pantoprazole versus placebo, maximal and basal acid output were significantly lower (P<.001) and there was a numerical trend toward improved GERD and antacid usage. Both treatments were well tolerated. In conclusion, IV/oral pantoprazole were similarly effective in suppressing basal and pentagastrin-stimulated gastric acid secretion in GERD patients with a history of EE.

Three‐year oral pantoprazole administration is effective for patients with Zollinger–Ellison syndrome and other hypersecretory conditions

Zollinger-Ellison syndrome and idiopathic hypersecretion are gastrointestinal hypersecretory conditions requiring long-term maintenance. The safety and efficacy data for short-term (6-month) treatment of Zollinger-Ellison syndrome and idiopathic hypersecretion with oral pantoprazole were previously published. This study extends the initial observations to 3 years. The primary efficacy end point for this report was the control of gastric acid secretion in the last hour before the next dose of oral pantoprazole (acid output of <10 mmol/h; <5 mmol/h in subjects with prior acid-reducing surgery). Dose titration was permitted to a maximum of 240 mg per 24 h. Twenty-four subjects completed the study. The acid output of 28 of 34 subjects was controlled at initial enrolment. The mean acid output rates were <10 mmol/h throughout the 36 months of treatment for 90-100% of the patients. The majority of the patients were controlled with b.d. doses of 40 or 80 mg pantoprazole at 36 months (acid output was controlled in 24 of 24 subjects). Pantoprazole was generally well tolerated with minimal adverse events reported. Maintenance oral pantoprazole therapy up to 3 years at dosages of 40-120 mg b.d. was effective and well tolerated in patients with Zollinger-Ellison syndrome and other hypersecretory conditions.

Intragastric Acid Control with Oral Esomeprazole or Pantoprazole after Intravenous Pantoprazole Administration in Healthy Adults

Purpose: After a prescribed course of intravenous proton pump inhibitor therapy, patients may require continued oral antisecretory therapy. The objective of this study was to compare intragastric acid control with oral esomeprazole 40 mg once daily with that of oral pantoprazole 40 mg once daily after 5 days of intravenous pantoprazole 40 mg once daily. Methods: In this randomized, open-label, comparative, 2-way crossover study (D9612L00066), healthy adults were randomized to 1 of 2 dosing sequences. Each 10-day dosing period included 5 days of daily injections over 2 minutes of intravenous pantoprazole followed by 5 days of once-daily oral doses of esomeprazole 40 mg or pantoprazole 40 mg. There was a 10–21-day washout period between dosing periods. All doses were administered, under observation at the investigator's site, 30 minutes before breakfast. Non–high-fat, non–high-calorie meals were provided to study subjects. On days 1 and 5 of oral dosing (before receiving the daily dose), a calibrated electrode was positioned 10 cm below the lower esophageal sphincter for 24-hour pH monitoring. The pH technicians and readers were blinded to subject treatment sequence. Only data from patients who had evaluable tracings from both day-5 tests were included. Results: All 38 subjects with evaluable data were H. pylori-negative and white, 63% were men, and the mean age was 25 years (range, 19 to 57 years). The mean number of evaluable hours of pH data for both treatment groups on both days was 24. Oral esomeprazole was significantly more effective for gastric acid suppression than oral pantoprazole on days 1 and 5 (steady state) of oral dosing (see table) immediately after a course of intravenous pantoprazole. The 16% difference between treatment means on day 5 is equivalent to 3.9 hours of pH > 4 during a 24-hour period.Table: Least-Squares Mean (SEM)% Time of 24 Hours Intragastric pH was >4 on Days 1 and 5 of Oral DosingConclusions: Switching from intravenous pantoprazole to oral esomeprazole 40 mg once daily more effectively suppressed intragastric acid than switching from intravenous pantoprazole to oral pantoprazole 40 mg once daily. Supported by AstraZeneca LP.

Routine application of the proton-pump inhibitor pantoprazole in patients with gastric lymphoma undergoing chemotherapy

Objective. The stomach is the most common site of origin for extranodal lymphomas. While resection has played a major part in the management of such patients in the past, in recent years there has been a change towards organ-conserving therapies. However, the risk of perforation and bleeding in patients undergoing organ-conserving therapy has been used as an argument against primary application of chemotherapy. In this article, we present our experience with the prophylactic use of oral pantoprazole. Material and methods. All patients undergoing chemotherapy for gastric lymphoma at our institution were prophylactically given oral pantoprazole (2×40 mg) for the duration of chemotherapy. Compliance with intake of the proton-pump inhibitor (PPI) was assessed at every visit for application of chemotherapy and at routine blood counts taken 10–14 days after each cycle of treatment by direct questioning of the patient. Results. A total of 82 patients (median age 69 years, range 33–93) received chemotherapy for gastric lymphoma: 51 had diffuse large B-cell lymphoma (DLBCL), 24 had mucosa-associated lymphoid tissue (MALT) lymphoma and 7 had DLBCL + MALT lymphoma. Compliance with intake of the PPI was excellent, as only two patients reported irregular intake and only one patient refused regular medication with pantoprazople. All patients responded to chemotherapy, with 74 (90%) achieving complete remission and 8 (10%) partial remission. After a median follow-up time of 50 months (range: 9–84 months) only one of these 82 patients (1.22%), the patient who discontinued intake of pantoprazole, died from gastric perforation, while none of the other patients had gastrointestinal bleeding or perforation. Conclusions. Judging from these data, continuous PPI intake is feasible and has a high rate of compliance. In the absence of randomized trials, routine application of oral pantoprazole in patients given chemotherapy for gastric lymphoma, especially DLBCL, appears to be a reasonable approach.

Pantoprazole reduces the size of postbanding ulcers after variceal band ligation

Elective esophageal variceal ligation (EVL) is performed to decrease the risk of variceal hemorrhage. Side effects of EVL include hemorrhage, chest pain, dysphagia, and odynophagia. Because gastric acid may exacerbate postbanding ulcers and delay healing, proton pump inhibition may decrease side effects associated with EVL. The aim of this study was to assess the efficacy of pantoprazole, a proton pump inhibitor, as an adjunct to elective EVL. We performed a double-blinded, randomized, placebo-controlled trial of pantoprazole after elective EVL. Subjects in the pantoprazole arm received 40 mg pantoprazole intravenously after EVL followed by 40 mg oral pantoprazole for 9 days. Control subjects received intravenous and oral placebo. Subjects underwent upper endoscopy 10 to 14 days after banding. Primary outcomes included the size and number of ulcers and the subjects' reports of dysphagia, chest pain, and heartburn. Forty-four subjects were randomized: 42 completed the protocol. At follow-up endoscopy, the mean number of ulcers was similar in the two groups. However, the ulcers in the pantoprazole group were on average half as large as in the placebo group (37 mm(2) vs. 82 mm(2), P < .01). Chest pain, dysphagia, and heartburn scores were not significantly different. Four subjects, all in the placebo group, had adverse outcomes, including 3 who bled from postbanding ulcers and 1 with sepsis. In conclusion, subjects receiving pantoprazole after elective EVL had significantly smaller postbanding ulcers on follow-up endoscopy than subjects receiving placebo. However, the total ulcer number and patient symptoms were not different between the groups.

Esomeprazole 40 mg i.v. provides faster and more effective intragastric acid control than pantoprazole 40 mg i.v.: results of a randomized study

Oral esomeprazole 40 mg provides greater acid control than oral pantoprazole 40 mg. To compare the effects on intragastric acid control of esomeprazole 40 mg administered intravenously with pantoprazole 40 mg intravenously. Healthy Helicobacter pylori-negative male and female subjects were enrolled into this single-centre, open, randomized, two-way crossover study. Esomeprazole 40 mg intravenously and pantoprazole 40 mg intravenously were administered as 15-min infusions once daily at 09:00 hours for 5 days. Continuous 24-h intragastric pH monitoring was carried out at baseline and on days 1 and 5. pH-data were available for all 25 subjects who completed the study. Esomeprazole 40 mg intravenously resulted in 8.3 and 13.9 h with an intragastric pH > 4 on days 1 and 5 compared with 5.3 and 9.0 h, respectively for pantoprazole 40 mg intravenously (day 1: P < 0.001, day 5: P < 0.0001). During the first 4 h of dosing on day 1 corresponding values were 1.7 and 0.6 h respectively (P < 0.0001). A mean median pH above 4 on day 5 was only attained with esomeprazole 40 mg intravenously. Once-daily dosing with esomeprazole 40 mg intravenously provides faster and more pronounced intragastric acid control than pantoprazole 40 mg intravenously.

INTRAVENOUS (IV) PANTOPRAZOLE DECREASES HEARTBURN AND ANTACID USE IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Purpose: To assess the effect of IV pantoprazole on GERD symptoms and antacid usage in patients with GERD who are not currently on acid suppres-sive therapy. Methods: In a multicenter, randomized, double blind, placebo-controlled, double dummy study, eligible patients were randomized to receive either IV pantoprazole 40 mg, oral pantoprazole tablets 40 mg, or placebo once daily for 7 days. Patients had to have a history of erosive esophagitis and recent symptoms of GERD and must have discontinued all acid suppressing medications (PPIs or H2RAs) for 10 days prior to the first day of dosing. Frequency and severity of heartburn and Gelusil usage were assessed twice daily by a telephone entry system. Severity was scored as none = 0, mild = 1, moderate = 2, or severe = 3. The mean values for the last 3 days before treatment (baseline) were compared with the mean for the last 3 days on treatment. As these were secondary endpoints in an acid output study no hypothesis testing was done and only descriptive statistics were conducted. Results: 74 patients were included in the intent-to-treat analysis for symptoms. Patients reported a mean of 3 episodes of heartburn per 24-hour period at baseline. The mean (± SE) change in heartburn and antacid use are shown in table 1.TableIn this study, IV pantoprazole was well tolerated with a safety profile comparable to those of oral pantoprazole and placebo. Conclusions: When used as initial therapy, IV pantoprazole, as well as oral pantoprazole reduced the frequency and severity of heartburn and antacid use. This study suggests that patients with a history of erosive GERD can be treated with IV pantoprazole to reduce GERD symptoms when the use of oral pantoprazole is not indicated.

PANTOPRAZOLE REDUCES THE SIZE OF POST-BANDING ULCERS AFTER ELECTIVE ENDOSCOPIC VARICEAL BAND LIGATION

Purpose: Elective esophageal variceal ligation (EVL) is a commonly performed procedure done to decrease the risk of variceal hemorrhage. Side effects of elective EVL include hemorrhage, chest pain, dysphagia and odynophagia. Because gastric acid may exacerbate the residual ulcers seen after EVL and delay healing, proton pump inhibition may decrease the side effects associated with EVL. The aim of this study was to assess the efficacy of pantoprazole, a proton pump inhibitor, as an adjunct to elective EVL. Methods: We performed a double-blinded randomized placebo controlled trial of pantoprazole in the setting of elective EVL. Subjects in the pantoprazole arm received pantoprazole 40 mg intravenously immediately after elective EVL and oral pantoprazole 40 mg for nine days following. Subjects in the control arm received identical-appearing intravenous and oral placebo medications. Subjects underwent repeat upper endoscopy 10–14 days after initial banding. Primary outcome variables included the size of the banding ulcers, number of ulcers present after controlling for the number of bands initially placed, and the subjects' reports of dysphagia, chest pain, and heartburn symptoms. Results: Forty-four subjects were randomized, and forty-two successfully completed the protocol. Four subjects, all in the placebo group, had adverse outcomes, including 3 who suffered variceal bleeding (2 after the initial banding session and 1 within 30 days following the second banding session), and one with sepsis. At 10 days post banding, the mean number of ulcers was similar in the pantoprazole and placebo groups. However, the ulcers in the pantoprazole group were on average half as large as those in the placebo group (3.7 mm vs 8.2 mm, p <0.01). Chest pain, dysphagia and heartburn scores were not different between the two groups. Conclusions: Subjects receiving pantoprazole therapy after elective EVL had significantly smaller post-banding ulcers on follow-up endoscopy than those receiving placebo. However, total ulcer number, as well as patient symptoms, were not different between the groups.

Lactic Acidosis during Propofol–Remifentanil Anesthesia in an Adult

Lactic Acidosis during Propofol–Remifentanil Anesthesia in an Adult

Intra-oesophageal pH profiles and pharmacokinetics of pantoprazole and esomeprazole

Aim To compare the effect of pantoprazole and esomeprazole on intra-oesophageal pH and investigate their pharmacokinetics in patients with symptomatic gastro-oesophageal reflux disease (GORD). Methods Double-blind, randomized, two-period crossover study. Caucasian men with symptomatic GORD (n= 48) were selected on the basis of clinical records of typical GORD symptoms, confirmed by a pathological reflux time (oesophageal pH < 4 for ≥ 6% of the time). They received oral pantoprazole 40 mg once daily (od) or esomeprazole 40 mg od for seven days. Continuous 24 h oesophageal pH-metry was performed at baseline and day 7. Evaluations included: pre- and post-treatment differences in the percentage of time with pH < 4.0 and < 3.0 between baseline and day 7; area under the curve (AUC), Cmax, and T½; point estimates and 90% confidence intervals (CI) on days 1 and 7, calculated for ratios of the AUC and Cmax. Results Both drugs decreased the mean total number of reflux episodes and reduced the percentage of reflux time within 24 h to < 3%. No pathological reflux was detectable after repeated administration of either drug. The 90% CI were within the predefined range at all time points; thus, equivalence of pantoprazole and esomeprazole was concluded. For pantoprazole, Cmax and AUC were unchanged on day 7 vs day 1, confirming its high and constant bioavailability. For esomeprazole, Cmax and AUC were increased on day 7 vs day 1 by 80% and 50%, respectively, indicating low initial bioavailability. No clinically relevant side effects were seen for either drug. Conclusion Pantoprazole and esomeprazole have equivalent effect on oesophageal pH, since no pathological reflux was detected after treatment with either drug. For esomeprazole, the Cmax and AUC increased after multiple dosing; for pantoprazole the pharmacokinetics were predictable and independent of the number of administered doses.

Three-year treatment with oral pantoprazole maintains effective long-term acid control in patients with zollinger-ellison syndrome (ZES) and idopathic hypersecretion

Three-year treatment with oral pantoprazole maintains effective long-term acid control in patients with zollinger-ellison syndrome (ZES) and idopathic hypersecretion