Pantoprazole Sodium for Gastroesophageal Reflux Disease

Pantoprazole Sodium is a medication that belongs to the class of proton pump inhibitors (PPIs). It works by inhibiting the proton pump in the stomach lining, which is responsible for the secretion of gastric acid. This action helps to decrease the amount of acid produced in the stomach, providing relief from acid-related conditions.

High Dose Pantoprazole Sodium for Gastroesophageal Reflux Disease

Proton pump inhibitors (PPIs) have remained the cornerstone of GERD treatment because of their significant and reliable ability to suppress acid. The PPIs function by irreversibly inhibiting the H+–K+ ATPase (proton pump) found in the gastric parietal cells. As compared with H2 receptor antagonists (H2RA), PPIs provide significantly faster healing rates (12%/week vs 6%/week) and faster and more complete relief from heartburn (11.5%/week vs 6.4%/week). Out of all the PPIs available in the Indian market, Pantoprazole sodium is the most prescribed drug owing to its efficacy and least interaction with other drugs. When taken orally, pantoprazole is swiftly absorbed with an absolute oral bioavailability of 77%. The presence of antacids does not affect its absorption, although food can delay it. However, neither food nor antacids alter the extent of pantoprazole absorption. Furthermore, increasing the dose results in a proportional increase in both the peak plasma concentration and the area under the plasma concentration–time curve (AUC). Pantoprazole sodium also exhibits difference in properties as compared with other PPIs. It binds only to cysteine residues 813 and 822 and these residues are believed to be specific for inhibition of acid secretion by the proton pump. It is also much slowly activated at a moderately acidic pH thus, preventing unwanted effect on other tissues or cell organelles that express proton pumps.[1]

In overweight or obese patients with reflux esophagitis of Los Angeles Grade A and B, a total of 200 participants were evenly randomized into two groups: One group receiving pantoprazole sodium 40 mg twice daily, and the other getting pantoprazole 40 mg in the morning and one placebo at night. On the basis of intent-to-treat (ITT) and per protocol (PP) analysis, the sustained systematic response was significantly higher in the double dose group than in the single dose group from week 4 (ITT: 62 vs 41%, p = 0.005; PP: 63.9 vs 42.3%, p = 0.004) until week 8 (ITT: 86 vs 70%, p = 0.01; PP: 90.5 vs 72.9%, p = 0.01).Higher dose of pantoprazole sodium is used in patients of GERD with severe symptoms, EE, co-morbidities where NSAID is used, obesity, or in cases of atypical symptoms of GERD like laryngitis, chronic cough, and non-cardiac chest pain. It has shown positive response in terms of symptomatic relief and better quality of life. Dual release formulation of pantoprazole sodium 80 mg ensures that the drug is present in the plasma for longer duration thus, improving the acid suppression and the patient compliance. Additional studies are warranted to comprehensively grasp the long-term impacts and potential adverse effects associated with its usage.

Pantoprazole sodium in the treatment of patients with gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common condition that develops when gastroesophageal reflux causes troublesome symptoms or complications. According to the Montreal definition, the diagnosis is established upon the presence of characteristic symptoms that the patient finds disturbing, regardless of their duration. State-of-the-art treatment involves proton pump inhibitors (PPI), which rapidly and successfully suppress the production of gastric acid, resulting in rapid symptom relief and high rates of oesophageal healing. The present meta-analysis of three clinical studies with similar protocols (all under the same name PAN-STAR), hereafter called PAN-STAR studies, aims to further assess pantoprazole sodium (Nolpaza®) in clinical practice. The primary goal of the PAN-STAR studies (Efficacy and safety of pantoprazole in the treatment and Symptom relief in patients with gAstRoesophageal reflux disease (GERD)) was to establish the efficacy of treatment with 40 mg of pantoprazole sodium and the effect of treatment duration on symptom control in patients with erosive reflux disease (ERD) and in those with non-erosive reflux disease (NERD). The secondary goal was to establish the effect of this treatment on the quality of life of patients with ERD and in patients with NERD. Additionally, analysis of adverse events due to pantoprazole treatment was performed.[2]

The results of the present meta-analysis of the PAN-STAR clinical studies show that pantoprazole sodium 40 mg was associated with complete relief of GERD related symptoms in the majority of patients with ERD and NERD. In patients without complete relief of symptoms the severity of symptoms was significantly reduced. Furthermore, pantoprazole 40 mg significantly improved the quality of life of treated patients and was very well tolerated throughout the whole study. Therefore, this meta-analysis suggests that pantoprazole sodium 40 mg once daily is an effective and well tolerated choice for providing symptom relief of patients with GERD.

References

[1]Upadhyay R, Soni NK, Kotamkar AA, Naseem A, Phadke A, Nayar S, Pallewar S, Shetty P, Mungantiwar A, Jaiswal S, Qamra A. High Dose Pantoprazole for Gastroesophageal Reflux Disease: Need, Evidence, Guidelines and Our Experience. Euroasian J Hepatogastroenterol. 2024 Jan-Jun;14(1):86-91. doi: 10.5005/jp-journals-10018-1426. PMID: 39022196; PMCID: PMC11249892.

[2]Dabrowski A, Štabuc B, Lazebnik L. Meta-analysis of the efficacy and safety of pantoprazole in the treatment and symptom relief of patients with gastroesophageal reflux disease - PAN-STAR. Prz Gastroenterol. 2018;13(1):6-15. doi: 10.5114/pg.2018.74556. Epub 2018 Mar 26. PMID: 29657605; PMCID: PMC5894447.

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