Pantoprazole + Ondansetron Pharmacology
Pantoprazole + Ondansetron
Pantoprazole
(H+ K+ATPase) and inhibits the exchange of extracellular K+ for intracellular H+ ion. Pantoprazole irreversibly inhibits proton pumps activity and decreases gastric acid secretion. Pantoprazole is more acid stable and its activity is lowered in higher pH. It is the only proton pump inhibitor which is available as parenteral form.
Distribution: It is widely distributed in the body in protein bound form.
Metabolism: Pantoprazole is extensively metabolised in the liver.
Excretion: It is excreted mainly in the urine and small amount in faeces.
2. Nausea
3. Vomiting
4. Headache
5. Flatulence
6. Abdominal pain
7. Pruritis
8. Dizziness
9. Rash
2. Monitor liver function
3. Avoid prolonged use
Below 12 years : Contraindicated
2. Benign Gastric ulcer
3. Zollinger- Ellison syndrome
4. Gastroesophageal reflux disease
Oral contraceptives : Does not appear to compromise hormonal contraceptive efficacy as no interaction with a low dose combined oral contraceptive has been seen.
Adult: 20-40mg / day before breakfast.
Duodenal ulcer: 40mg / day to be taken before breakfast for 2 - 4 weeks.
Benign Gastric ulcer: 40mg / day to be taken before breakfast for 1 - 2months.
Zollinger- Ellison syndrome: 80 mg / day in 2 divided doses increase the dose to 240 mg/ day if needed.
Gastroesophageal reflux disease: 20 - 40 mg / day to be taken before breakfast for 1 month and continue the treatment for 1 more month if needed.
Parenteral: 40 mg once daily as IV injection over 15 minutes.
Children below 12 years : Not recommended
Ondansetron
Cytotoxic chemotherapy is associated with release of Serotonin from Enterochromaffin cells in the small intestine. Serotonin triggers vomiting through 5HT3 vagal receptor that activates the vomiting reflex. Since Ondansetron is a 5HT3 receptor antagonist, it is indicated for the prevention of nausea and vomiting associated in chemotherapy.
Anaesthetic adjuncts: It is used preoperatively in order to reduce the post operative vomiting.
Distribution: It is distributed in protein bound form.
Metabolism: Ondansetron is extensively metabolised in the liver.
Excretion: It is excreted mainly in urine.
2. Dizziness
3. Constipation
4. Musculoskeletal pain
5. Chills
6. Allergic reactions
7. Agitation
8. Chest pain
9. Malaise
10. Urinary retention
11. Elevation in hepatic enzymes
12. Hypotension
2. Intestinal obstruction
Below 6 months : Contraindicated
2. Post operative nausea and vomiting
Oral :
Nausea and vomiting associated with cytotoxic chemotherapy or radiotherapy:8 mg should be given 1 - 2 hour before chemotherapy or radiotherapy and repeat the same dose after the procedure every 12 hours for 1 - 2 days.
Post operative nausea and vomiting: 16 mg should be given 1 hour before anesthesia or soon after operation
IV Injection :
Nausea and vomiting associated with cytotoxic chemotherapy or radiotherapy: 0.15 mg / kg IV infusion over 15 minutes should be given half an hour before starting treatment and repeat the same dose 4th and 8th hour after first dose or a single dose of 32 mg IV infusion over 15 minutes should be given half an hour before starting the treatment.
Post operative nausea and vomiting: 4 mg IV should be given immediately before anesthesia or soon after operation
Children :
Oral :
Nausea and vomiting associated with cytotoxic chemotherapy or radiotherapy:8 mg should be given 1 - 2 hour before chemotherapy or radiotherapy and repeat the same dose after the procedure every 12 hours for 1 - 2 days
Injection:
Nausea and vomiting associated with cytotoxic chemotherapy or radiotherapy:0.15 mg / kg IV infusion over 15 minutes should be given half an hour before starting treatment and repeat the same dose 4th and 8th hour after first dose
Children below 2 years: 0.1 mg / kg body weight as IV infusion
Maximum dose: 4 mg
If you missed a dose and feel nauseated then take the missed dose as soon as possible.
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