Pantoprazole- Special Warnings And Drug Interactions

Pantoprazole- Special Warnings And Drug Interactions Pantoprazole 40 mg is indicated for the use in Adults and adolescents 12 years of age and above for reflux oesophagitis Pantoprazole is indicated for use in Adults for- Eradication of Helicobacter pylori (H. pylori) in combination with appropriate antibiotic therapy in patients with H. pylori-associated ulcers. Gastric and duodenal ulcer. Zollinger-Ellison-Syndrome and other pathological hypersecretory conditions. SPECIAL WARNINGS Hepatic Impairment- Monitor the liver enzymes regularly in patients with severe liver impairment for long-term pantoprazole use. Discontinue the use if there is a rise of the liver enzymes. Gastric malignancy- Symptomatic response to pantoprazole may mask the symptoms of gastric malignancy and may delay diagnosis. In cases of significant unintentional weight loss, recurrent vomiting, dysphagia, hematemesis, anemia, or melena, and when gastric ulcer is suspected or present, malignancy should be excluded. Consider further investigation if symptoms persist despite adequate treatment. Influence on vitamin B12 absorption- In patients with Zollinger-Ellison syndrome pantoprazole may reduce the absorption of vitamin B12 due to hypo- or achlorhydria. Consider this in patients with reduced body stores or risk factors for reduced vitamin B12 absorption on long-term therapy or if respective clinical symptoms are observed. Long term treatment- In long-term treatment, especially when exceeding a treatment period of 1 year, patients should be kept under regular surveillance. GI infections- Pantoprazole may cause a slightly increased risk of GI infections caused by bacteria such as Salmonella and Campylobacter and C. difficile. Hypomagnesemia- PPIs like pantoprazole when used for at least three months or a year may cause hypomagnesemia. In most affected patients, hypomagnesemia improved after magnesium replacement and discontinuation of the PPI. Consider measuring magnesium levels before starting PPI treatment and periodically during treatment. Bone fractures- PPIs, if used in high doses and over long durations (>1 year), may increase the risk of hip, wrist and spine fracture, predominantly in older people. Patients at risk of osteoporosis should have an adequate intake of vitamin D and calcium. Subacute cutaneous lupus erythematosus (SCLE)- PPIs are associated with very infrequent cases of SCLE. If lesions occur, especially in sun-exposed areas of the skin, and if accompanied by arthralgia, consider stopping Pantoprazole. Interference with laboratory tests- Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumors. To avoid this interference, Pantoprazole treatment should be stopped for at least 5 days before CgA measurements

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