pantoprazole and domperidone

Action and Spectrum

Actions and spectrum: 

pantoprazole: 

• Action: pantoprazole works by reducing the production of stomach acid. Specifically, it inhibits the proton pump in the stomach lining, which is responsible for acid secretion. By reducing acid levels, it helps treat conditions like gastroesophageal reflux disease (GERD), peptic ulcers, and Zollinger-Ellison syndrome. 
• Spectrum: pantoprazole is primarily used to treat conditions related to excessive stomach acid production, including GERD, erosive esophagitis, and peptic ulcers. 

domperidone: 

• Action: domperidone works by blocking dopamine receptors in the digestive system and increasing the movement of the stomach and intestines. This helps to reduce nausea and vomiting and improve gastric motility.  
• Spectrum: domperidone is commonly used to treat conditions involving gastrointestinal motility disorders, such as gastroparesis (delayed stomach emptying) and nausea and vomiting due to various causes, including chemotherapy and postoperative recovery. 

The combination of pantoprazole and domperidone may be prescribed when a patient has conditions involving both excess stomach acid production and gastrointestinal motility issues. pantoprazole addresses the acid-related problem, while domperidone helps with motility and related symptoms. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Diarrhoea 

pruritus 

GIT infections 

Angioedema 

dyspnoea 

gastroenteritis 

jaundice 

anterior ischaemia 

speech disorder 

Headache 

dizziness 

skin rashes 

anaphylaxis 

chest pain 

erythema multiforme 

hyperglycaemia 

optic neuropathy 

pancreatitis 

Insomnia 

dizziness 

lethargy 

GI disturbances 

mastalgia 

gynaecomastia 

Rash 

urticaria 

Conjunctivitis 

dysuria 

palpitations 

Asthaenia 

Nervousness 

thirst 

irritability 

hot flushes 

Galactorrhoea 

menstrual irregularities 

pruritus 

Stomatitis 

urinary frequency 

Oedema 

leg cramps 

drug intolerance 

Black Box Warning

Black Box Warning: 

A black box warning for the pantoprazole and domperidone combination may highlight the risk of cardiac arrhythmias, particularly in patients with underlying heart conditions or when used at higher doses. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: Patients who have a known hypersensitivity or allergy to pantoprazole, domperidone, or any of its components should avoid this combination. 
• History of Cardiac Issues: It is typically contraindicated in patients with a history of cardiac arrhythmias, particularly ventricular arrhythmias, as both medications can affect cardiac function. 
• Gastrointestinal Bleeding: In cases of gastrointestinal bleeding, this combination should be avoided as it might mask symptoms or delay diagnosis.

Caution: 

• Renal Impairment: In individuals with renal impairment, dose adjustments may be necessary, particularly for pantoprazole, as it is primarily eliminated through the kidneys. 
• Liver Dysfunction: Patients with severe liver dysfunction should be monitored closely when taking this combination, as both medications can affect liver function. 
• Neurological Disorders: domperidone can affect the central nervous system, and caution is required when prescribing to patients with neurological disorders or a history of seizures. 
• Drug Interactions: pantoprazole and domperidone can interact with other medications. Healthcare professionals should be aware of potential drug interactions when prescribing this combination.

Comorbidities: 

• Cardiovascular Disease: Patients with cardiovascular conditions like hypertension or arrhythmias may be prescribed pantoprazole and domperidone, but caution is necessary due to the potential for cardiac side effects associated with domperidone. 
• Neurological Disorders: Patients with neurological disorders like Parkinson’s disease might experience gastrointestinal symptoms that could benefit from domperidone. However, domperidone can affect the central nervous system, so caution is needed. 
• Pregnancy: Pregnant individuals with acid reflux or gastrointestinal issues may be prescribed pantoprazole and domperidone, but this should be done with careful consideration and under medical supervision. 

Pregnancy / Lactation

Pregnancy consideration: US FDA pregnancy category: Not assigned 

Lactation: Excreted into human milk: Yes  

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

pantoprazole works by irreversibly inhibiting the proton pump (H+/K+ ATPase) in the stomach’s parietal cells. This reduces gastric acid production, leading to decreased acidity in the stomach. 

domperidone acts on dopamine receptors in the gastrointestinal tract, blocking their activity. This leads to increased motility in the upper digestive system and enhanced gastric emptying, helping to relieve symptoms like nausea and reflux. 

pantoprazole and domperidone are often combined to provide dual action in managing gastrointestinal disorders. Pantoprazole reduces gastric acid secretion, which can help heal conditions like gastritis and peptic ulcers. Simultaneously, domperidone helps relieve symptoms of delayed gastric emptying, such as nausea and heartburn. 

Pharmacodynamics: 

pantoprazole works by irreversibly inhibiting the proton pump (H+/K+ ATPase) in the stomach’s parietal cells. This inhibition reduces the production of gastric acid by these cells, leading to decreased acidity in the stomach. pantoprazole helps heal conditions like gastritis, peptic ulcers, and gastroesophageal reflux disease (GERD) by reducing the amount of acid in the stomach, thus alleviating symptoms, and promoting the healing of the esophagus and stomach lining. 

domperidone acts on dopamine receptors in the gastrointestinal tract, blocking their activity. By blocking dopamine receptors, domperidone increases motility in the upper digestive system and enhances gastric emptying. This helps relieve symptoms of delayed gastric emptying, such as nausea, heartburn, and reflux. The combination of pantoprazole and domperidone offers a comprehensive approach to managing gastrointestinal disorders. pantoprazole reduces gastric acid production, addressing the underlying causes of conditions like gastritis and peptic ulcers. 

Pharmacokinetics: 

Absorption 

• pantoprazole: pantoprazole is usually administered orally and is absorbed in the small intestine. It is best absorbed when taken before meals due to the pH-dependent activation of the drug. 
• domperidone: domperidone is also administered orally and is absorbed in the small intestine. It should be taken before meals for optimal absorption. 

Distribution 

• Both drugs are distributed throughout the body after absorption. They can cross the blood-brain barrier, but their primary sites of action are in the gastrointestinal tract. 

Metabolism 

• pantoprazole: pantoprazole undergoes hepatic metabolism primarily via the cytochrome P450 enzyme system, CYP2C19 and CYP3A4. 
• domperidone: domperidone undergoes extensive hepatic metabolism, particularly via CYP3A4 and CYP3A5 enzymes in the liver. 

Elimination and excretion 

• pantoprazole: The metabolites of pantoprazole are primarily excreted in the urine, with a small portion eliminated in the feces. 
• domperidone: domperidone and its metabolites are excreted in the feces, with minimal urinary excretion. 

Adminstartion

Administration: 

• Dosage: The specific dosage and regimen of pantoprazole and domperidone will depend on the individual patient’s condition and the prescribing physician’s recommendations. 
• Oral Administration: pantoprazole is typically taken orally, usually once daily before a meal. The tablet should be swallowed whole with a glass of water, and it is often recommended to take it at the same time each day. domperidone is also administered orally. It is typically taken before meals. The timing and dosage will be determined by the prescribing healthcare professional. 
• Duration: The duration of treatment with pantoprazole and domperidone combination therapy will vary depending on the underlying medical condition. It is important to complete the full course of treatment as prescribed, even if symptoms improve. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: pantoprazole and domperidone 

Pronounced: (Pan-toe-PRAZ-ole and dom-PEH-ri-done)  

Why do we use pantoprazole and domperidone? 

• Gastroesophageal Reflux Disease (GERD): This combination is used to treat GERD, where stomach acid frequently flows back into esophagus, causing heartburn and regurgitation. pantoprazole helps reduce stomach acid production, while domperidone can aid in relieving symptoms. 
• Peptic Ulcers: It may be prescribed for the treatment of peptic ulcers, including gastric and duodenal ulcers. pantoprazole helps heal and prevent the recurrence of ulcers. 
• Zollinger-Ellison Syndrome: In rare cases, this combination is used to manage Zollinger-Ellison syndrome, a condition characterized by excessive stomach acid production. 
• Dyspepsia: For individuals with non-ulcer dyspepsia or functional dyspepsia, pantoprazole and domperidone can help alleviate symptoms like bloating, discomfort, and early satiety.