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pantoprazole

✓ Approved

Nanodaru · ATP4A · Small Molecule

What is pantoprazole?

pantoprazole is a small molecule developed by Nanodaru. It is approved for therapeutic indications via injectable (others) or intravenous (iv).

Drug Profile

CompanyNanodaru
Drug ClassSmall Molecule
Molecular TargetATP4A
RouteInjectable (Others), Intravenous (IV)
StatusApproved
Sources: ClinicalTrials.gov, Nanodaru

Mechanism of Action

Molecular Targets

pantoprazole acts on 1 molecular target:

ATP4AATPase H+/K+ transporting subunit alpha (ATP6A)
Want deeper analysis?Noah AI can explain complex mechanisms and compare to similar drugs.

Therapeutic Indications

pantoprazole is developed for 4 unique indications across 2 therapeutic areas.

Therapeutic AreaConditionPhase
Gastrointestinal disordersDuodenal ulcer✓ Approved
Gastrointestinal disordersGastric ulcer✓ Approved
Neoplasms benign, malignant and unspecified (incl cysts and polyps)Gastrinoma✓ Approved
Gastrointestinal disordersGastrooesophageal reflux disease✓ Approved

Related Research Articles

PubMedClinical pharmacology and therapeutics2026-10-15

Reprocessing Mass Spectra from Therapeutic Drug Monitoring to Unveil Proton Pump Inhibitor Use and Quantify Phenoconversion of Escitalopram Metabolism in CYP2C19-Genotyped Patients.

Hole Kristine K, Wollmann Birgit M BM, Stingl Julia Carolin JC, Molden Espen E

Escitalopram is a frequently prescribed antidepressant drug. CYP2C19 genotype is a major determinant of escitalopram metabolism and treatment outcome. However, real-life studies show a high degree of genotype-phenotype mismatch in escitalopram metabolism. The present study aimed to identify comedication with proton pump inhibitors (PPIs) and quantify phenoconversion of escitalopram metabolism in CYP2C19-genotyped patients by reprocessing high-resolution mass spectra from therapeutic drug monitoring (TDM) analyses. Patients were included from a combined TDM/pharmacogenetics (PGx) laboratory facility in Oslo, Norway. TDM profiles of escitalopram and CYP2C19 genotypes were available in the laboratory database. Reprocessing of high-resolution mass spectra by exact mass and fragment detection identified possible comedication with pantoprazole, esomeprazole/omeprazole or lansoprazole using mzCloud reference library. Patients were grouped as normal metabolizers (NMs), intermediate metabolizers (IMs), poor metabolizers (PMs), rapid metabolizers (RM), or ultrarapid metabolizers (UM). Primary outcome measure was N-desmethylescitalopram-to-escitalopram metabolic ratio (MR; CYP2C19 biomarker) in UMs vs. PMs. 2818 patients were included, constituting 2373 without and 445 (15.8%) with PPIs. Most patients were females (64.2%). Regarding CYP2C19 phenotype distribution, the cohort comprised 39.3% NMs, 29.3% IMs, 2.6% PMs, 24.6% RMs, and 4.2% UMs. Escitalopram MR was 4.5-fold higher in CYP2C19 UMs vs. PMs without PPIs (P < 0.001), while this difference was 2.8-fold in pantoprazole users (P < 0.001), and 1.8-fold in esomeprazole/omeprazole users (P = 0.2). In conclusion, PPIs show significant phenoconversion of CYP2C19-mediated escitalopram metabolism with esomeprazole/omeprazole exhibiting a stronger effect than pantoprazole. The novel method for identification of interacting comedications in TDM samples illustrates the innovative potential of high-resolution mass spectrometry in precision medicine.

PMID 42876187
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PubMedFrontiers in cardiovascular medicine2026-10-14

Pantoprazole-induced anaphylactic asthma and Type I Kounis syndrome: a case report and literature review.

Huang Ailing A, Li Songyun S, Sattar Haseeb H, Qin Yalu Y et al.

Proton pump inhibitors (PPIs) are among the most frequently prescribed medications and are generally considered to have a favourable safety profile. Nevertheless, immediate hypersensitivity reactions may occur and, in exceptional circumstances, can precipitate Kounis syndrome (KS), an acute coronary syndrome resulting from the activation of inflammatory pathways. We describe an elderly patient who developed severe anaphylaxis with Type I KS shortly after intravenous pantoprazole administration in the presence of an unsuspected myocardial bridge, and discuss the potential clinical implications. An 85-year-old woman with a 30-year history of well-controlled bronchial asthma was admitted with community-acquired pneumonia. During hospitalization, she received intravenous pantoprazole (40 mg) for acid reflux. Within five minutes of the infusion, she developed a widespread erythematous rash, severe bronchospasm, profound hypotension (74/56 mmHg), and ST-segment elevation of approximately 0.3 mV in leads I, aVL, and V₁ to V₄. Emergency coronary angiography demonstrated no obstructive coronary artery disease but identified a myocardial bridge involving the mid-left anterior descending artery, producing nearly 90% systolic compression. Serial cardiac troponin and NT-proBNP concentrations remained within the normal range. Assessment using the Naranjo Adverse Drug Reaction Probability Scale yielded a score of six, indicating a probable causal relationship between pantoprazole and the adverse event. The patient was treated with methylprednisolone (80 mg). The recovery occurred within 2 h. This case highlights that intravenous pantoprazole may rarely trigger life-threatening Type I Kounis syndrome. It also raises the possibility that a pre-existing myocardial bridge can accentuate coronary vasospasm during severe allergic reactions, thereby contributing to the clinical presentation. Based on this experience and the available literature, we propose a practical management algorithm to facilitate timely diagnosis and treatment in similar clinical settings.

PMID 42871088
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PubMedInternational journal of emergency medicine2026-10-09

Severe symptomatic hypocalcemia with neuromuscular hyperexcitability associated with long-term pantoprazole use: a case report.

Khaneghahi Arshia A, Zamani Saber S, Akbari Mohammad M, Akbari Ali A et al.

Hypocalcemia is a common electrolyte abnormality; however, severe symptomatic hypocalcemia presenting with neuromuscular hyperexcitability and cardiac manifestations is an uncommon clinical condition requiring prompt recognition and management. Long-term proton pump inhibitor (PPI) therapy has been associated with disturbances in mineral metabolism, particularly hypomagnesemia, which may contribute to impaired calcium homeostasis. A 54-year-old woman from a remote rural area was referred to our hospital after developing progressive weakness, paresthesia, and painful involuntary muscle contractions. Neurological examination revealed bilateral carpopedal spasms with positive Trousseau's and Chvostek's signs. Electrocardiography demonstrated QTc prolongation. Laboratory evaluation showed severe hypocalcemia with a total calcium level of 5.2 mg/dL and ionized calcium of 0.74 mmol/L, accompanied by mild hypomagnesemia, vitamin D insufficiency, and an inappropriately low parathyroid hormone (PTH) response. The patient had been self-administering pantoprazole 40 mg daily for approximately four years without regular reassessment. Pantoprazole was discontinued because of its potential contribution to impaired calcium and magnesium homeostasis. She was treated with intravenous calcium gluconate under cardiac monitoring, followed by magnesium and vitamin D supplementation and transition to oral calcium therapy. Her clinical symptoms resolved during hospitalization. At the one-month follow-up, she remained asymptomatic, with sustained normalization of serum calcium and magnesium levels and no recurrence of electrolyte imbalance. This case highlights the importance of considering severe symptomatic hypocalcemia in patients receiving long-term pantoprazole therapy, particularly when neuromuscular and cardiac manifestations are present. Although a direct causal relationship cannot be definitively established, the coexistence of prolonged PPI exposure, mild hypomagnesemia, vitamin D insufficiency, and impaired PTH response suggests a multifactorial mechanism. Early recognition, comprehensive evaluation of calcium homeostasis, and appropriate correction of electrolyte abnormalities are essential to prevent serious complications.

PMID 42850585
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PubMedEuropean geriatric medicine2026-10-09

Prevalence and appropriateness of solid oral dosage form manipulation in long-term care facilities.

Malara Alba A, Zucchelli Alberto A, Trevisan Caterina C, Borselli Gilda G et al.

Medication administration in long-term care facilities (LTCFs) is complicated by multimorbidity, frailty, cognitive impairment, polypharmacy, and dysphagia. Solid oral dosage form (SODF) manipulation is common but may compromise medication safety. We aimed to determine the prevalence of SODF manipulation and evaluate its appropriateness in Italian LTCFs. We conducted a national multicenter point-prevalence study (Prescription-Day LTCFs 2024) in 82 Italian LTCFs. Of the 3400 enrolled residents, 3174 were included after excluding residents with acute conditions and facilities enrolling fewer than five residents. The study population had a mean age of 84.8 years, of which 74.1% were women, with high multimorbidity, dementia (47.9%), polypharmacy (mean 7.3 medications), and dysphagia (14.7%). SODF manipulation included tablet crushing or splitting, capsule opening, and mixing medications with food or liquids. Appropriateness was evaluated using a hierarchical framework integrating the SIFO Handbook, the Friuli Venezia Giulia "Do Not Crush" list, the TRC 2025 update, the Summary of Product Characteristics, and expert review. Among 20,290 oral prescriptions (15,214 tablets and 802 capsules), 4655 SODFs (23.0%) were modified. Of these, 27.9% were inappropriate and 10.8% likely inappropriate. Overall, 1006 residents (31.7%) received at least one inappropriate or likely inappropriate modification, and 11.9% received three or more. Inappropriate manipulation was more frequent for capsules than tablets (68.8% vs 37.7%). Frequently involved medications included pantoprazole, trazodone, and amlodipine. Residents exposed to inappropriate manipulation were more likely to be frail and to have dementia or dysphagia. SODF manipulation is highly prevalent in Italian LTCFs, with more than one-third of modifications being potentially inappropriate. The frequency of manipulation exceeded the prevalence of dysphagia, suggesting organizational and behavioral drivers. Standardized guidance and greater prescriber and pharmacist involvement are needed to improve medication safety.

PMID 42850398
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PubMedGastroenterologia y hepatologia2026-10-07

Marcos Maika Aragunde MA, Ezquerra Alberto A, Moreira Leticia L, Barba Elizabeth E

Functional dyspepsia is a disorder of gut-brain interaction that significantly affects quality of life and has a limited therapeutic response. This systematic review, conducted according to PRISMA 2020, analyzed randomized clinical trials published over the past ten years in adults meeting Rome III/IV criteria. Prokinetics showed no consistent benefit, except in some patients with overlapping subtypes. In postprandial distress syndrome, a low-FODMAP diet was not superior to conventional dietary advice, except, in a subgroup analysis, in patients with abdominal distension, while mirtazapine showed signals of benefit in patients with weight loss or early satiety. In epigastric pain syndrome, low-dose amitriptyline was superior to pantoprazole. Herbal therapies, electroacupuncture, transcutaneous auricular vagus nerve stimulation, and multidisciplinary care showed signals of benefit, mostly derived from single trials, whereas cannabidiol was ineffective. Overall, the evidence supports a personalized, stepwise, and biopsychosocial approach to treatment.

PMID 42843625
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PubMedAlimentary pharmacology & therapeutics2026-10-04

The TOP-GERD Trial: Comparative Efficacy of Tegoprazan Versus Pantoprazole in the Treatment of Erosive Oesophagitis in a Non-Asian Population.

Remes-Troche José M JM, Valdovinos-García Luis Raúl LR, Gyawali C Prakash CP, Vargas-Basurto José Luis JL et al.

Potassium-competitive acid blockers provide rapid and sustained acid suppression, but tegoprazan has not been studied in non-Asian populations. To compare the efficacy and safety of tegoprazan 50 mg once daily with pantoprazole 40 mg once daily for healing erosive oesophagitis and improving reflux symptoms. In this multicentre, randomized, double-blind, active-controlled trial, Mexican adults with Los Angeles grade B-D erosive oesophagitis received tegoprazan or pantoprazole for 4 weeks. The primary outcome was superior endoscopic healing at week 4. Secondary outcomes included early symptom response, complete symptom resolution, changes in symptom severity, health-related quality of life, and adverse events. Seventy participants were randomized and 64 completed treatments. In the intention-to-treat population, endoscopic healing occurred in 88.9% receiving tegoprazan and 79.4% receiving pantoprazole (p = 0.33). In the per-protocol population, healing occurred in 100% and 84.4%, respectively (p = 0.053). Among participants with Los Angeles grade C or D oesophagitis, per-protocol healing rates were 100% with tegoprazan and 68.8% with pantoprazole (p = 0.04). During the first treatment week, at least 50% symptom improvement occurred in 84.4% and 31.3%, respectively (p < 0.001), and complete symptom resolution was more frequent with tegoprazan from day 1. Symptom severity and health-related quality of life improved in both groups. Adverse events were infrequent, mild, and unrelated to treatment. There was a nonsignificant 9.5% difference in the primary intention-to-treat 4-week healing endpoint between tegoprazan and pantoprazole. Tegoprazan provided faster symptom improvement, while the per-protocol findings and the higher healing rate observed in the exploratory severe oesophagitis subgroup were encouraging and warrant further investigation. (ClinicalTrials.gov Identifier: NCT06991348).

PMID 42829447
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