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EC caplet: PANTOPUMP 40 mg caplets should not be chewed or crushed, and should be swallowed whole with water 1 hour before breakfast. In combination therapy for eradication of Helicobacter pylori infection, the second PANTOPUMP 40 mg caplet should be taken before the evening meal. The combination therapy is implemented for 7 days in general and can be prolonged to up to two weeks maximum. If to ensure healing of the ulcers, further treatment with Pantoprazole is indicated, the dosage recommendations for duodenal and gastric ulcers should be considered.
A duodenal ulcers generally heals within 2 weeks. If a 2-week period of treatment is not sufficient, healing will be achieved in almost all cases within a further 2 weeks.
A 4-week period is usually required for the treatment of gastric ulcers and reflux esophagitis. If this is not sufficient, healing will usually be achieved within a further 4 weeks.
Recommended dosage: In Helicobacter pylori positive patients with gastric and duodenal ulcers, eradication of the germ by a combination therapy should be achieved. Depending upon the resistance pattern, the following combinations can be recommended for the eradication of Helicobacter pylori.
a. 2 x 1 PANTOPUMP 40 mg gastro-resistant caplet/day
+ 2 x 1000 mg amoxycillin/day
+ 2 x 500 mg clarithromycin/day.
b. 2 x 1 PANTOPUMP 40 mg gastro-resistant caplet/day
+ 2 x 500 mg metronidazole/day
+ 2 x 500 mg clarithromycin/day.
c. 2 x 1 PANTOPUMP 40 mg gastro-resistant caplet/day
+ 2 x 1000 mg amoxycillin/day
+ 2 x 500 mg metronidazole/day.
If combination therapy is not an option, e.g. if the patient has tested negative for Helicobacter pylori, the following dosage guidelines apply for PANTOPUMP 40 mg monotherapy: For the treatment of gastric and duodenal ulcer and reflux esophagitis: One caplet of PANTOPUMP 40 mg gastro-resistant caplet per day.
In individual cases the dose may be doubled (increase to 2 PANTOPUMP 40 mg gastro-resistant caplets daily) especially when there has been no response to other treatment.
For the long-term management of Zollinger-Ellison-Syndrome and other pathological hypersecretory conditions: Patients should start their treatment with a daily dose of 80 mg (2 caplets of PANTOPUMP 40 mg). Thereafter, the dosage can be titrated up or down as needed using measurements of gastric acid secretion to guide. With doses above 80 mg daily, the dose should be divided and given twice daily. A temporary increase of the dosage above 160 mg Pantoprazole is possible but should not be applied longer than required for adequate acid control.
Treatment duration in Zollinger-Ellison-Syndrome and other pathological hypersecretory conditions is not limited and should be adapted according to clinical needs.
In patients with severe liver impairment the dose has to be reduced to 1 caplet (40 mg Pantoprazole) every other day.
Furthermore, in these patients the liver enzymes should be monitored during PANTOPUMP 40 mg therapy. In the case of a rise of the liver enzymes, PANTOPUMP 40 mg should be discontinued.
The daily dose of 40 mg Pantoprazole should not be exceeded in elderly patients or in patients with impaired renal function. An exception is combination therapy for eradication of Helicobacter pylori, where also elderly patients should receive the usual Pantoprazole dose (2 x 40 mg per day) during 1-week treatment.
In the case of a rise of the liver enzymes, PANTOPUMP 40 mg should be discontinued.
Powd for inj: Gastric and duodenal ulcers, reflux esophagitis: 40 mg intravenously daily.
Zollinger-Ellison syndrome and other pathological hypersecretory conditions: Initially 80 mg intravenously. May be titrated up or down as needed. Doses more than 80 mg should be given twice daily.
