PANTOPRAZOLE SODIUM- pantoprazole sodium tablet, delayed release

Jungtinės Valstijos - anglų - NLM (National Library of Medicine)

Nusipirk tai dabar

Pakuotės lapelis Pakuotės lapelis (PIL)

10-09-2019

Prekės savybės Prekės savybės (SPC)

10-09-2019

Veiklioji medžiaga:
PANTOPRAZOLE SODIUM (UNII: 6871619Q5X) (PANTOPRAZOLE - UNII:D8TST4O562)
Prieinama:
McKesson Corporation dba SKY Packaging
INN (Tarptautinis Pavadinimas):
PANTOPRAZOLE SODIUM
Sudėtis:
PANTOPRAZOLE 40 mg
Vartojimo būdas:
ORAL
Recepto tipas:
PRESCRIPTION DRUG
Terapinės indikacijos:
Pantoprazole Sodium Delayed-Release Tablets, USP are indicated for: Pantoprazole is indicated in adults and pediatric patients five years of age and older for the short-term treatment (up to 8 weeks) in the healing and symptomatic relief of erosive esophagitis (EE). For those adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of Pantoprazole may be considered. Safety of treatment beyond 8 weeks in pediatric patients has not been established. Pantoprazole is indicated for maintenance of healing of EE and reduction in relapse rates of daytime and nighttime heartburn symptoms in adult patients with GERD. Controlled studies did not extend beyond 12 months. Pantoprazole is indicated for the long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison (ZE) Syndrome. - Pantoprazole is contraindicated in patients with known hypersensitivity to any component of the formulation or any substituted benzimidazole. Hypersensitivity reactions may includ
Produkto santrauka:
Product: 63739-564 NDC: 63739-564-10 10 TABLET, DELAYED RELEASE in a BLISTER PACK / 10 in a BOX, UNIT-DOSE
Autorizacija statusas:
Abbreviated New Drug Application
Registracijos numeris:
63739-564-10

PANTOPRAZOLE SODIUM- pantoprazole sodium tablet, delayed release

McKesson Corporation dba SKY Packaging

----------

MEDICATION GUIDE

Pantoprazole (pan-TOE-pruh-zole) Sodium Delayed-Release Tablets, USP

CIA77568N Rev. 05/2019

What is the most important information I should know about Pantoprazole?

You should take Pantoprazole exactly as prescribed, at the lowest dose possible and for the shortest time

needed.

Pantoprazole may help your acid-related symptoms, but you could still have serious stomach problems. Talk

with your doctor.

Pantoprazole can cause serious side effects, including:

A type of kidney problem (acute interstitial nephritis) . Some people who take proton pump inhibitor

(PPI) medicines, including Pantoprazole, may develop a kidney problem called acute interstitial

nephritis that can happen at any time during treatment with Pantoprazole. Call your doctor right away

if you have a decrease in the amount that you urinate or if you have blood in your urine.

Diarrhea caused by an infection ( Clostridium difficile ) in your intestines. Call your doctor right

away if you have watery stools or stomach pain that does not go away. You may or may not have a

fever.

Bone fractures (hip, wrist, or spine). Bone fractures in the hip, wrist, or spine may happen in people

who take multiple daily doses of PPI medicines for a long period of time (a year or longer). Tell your

doctor if you have a bone fracture, especially in the hip, wrist, or spine.

Certain types of lupus erythematosus. Lupus erythematosus is an autoimmune disorder (the body’s

immune cells attack other cells or organs in the body). Some people who take PPI medicines,

including Pantoprazole, may develop certain types of lupus erythematosus or have worsening of the

lupus they already have. Call your doctor right away if you have new or worsening joint pain or a

rash on your cheeks or arms that gets worse in the sun.

Talk to your doctor about your risk of these serious side effects.

Pantoprazole can have other serious side effects. See “ What are the possible side effects of Pantoprazole?”

What is Pantoprazole?

A prescription medicine called a proton pump inhibitor (PPI) used to reduce the amount of acid in your

stomach.

In adults, Pantoprazole is used for:

up to 8 weeks for the healing and symptom relief of acid-related damage to the lining of the

esophagus (called erosive esophagitis or EE). Your doctor may prescribe another 8 weeks of

Pantoprazole in patients whose EE does not heal.

maintaining healing of EE and to help prevent the return of heartburn symptoms caused by GERD. It

is not known if Pantoprazole is safe and effective when used longer than 12 months for this purpose.

the long-term treatment of conditions where your stomach makes too much acid. This includes a rare

condition called Zollinger-Ellison Syndrome.

In children 5 years of age and older, Pantoprazole is used for:

up to 8 weeks for the healing and symptom relief of EE.

It is not known if Pantoprazole is safe if used longer than 8 weeks in children.

Pantoprazole is not for use in children under 5 years of age.

It is not known if Pantoprazole is safe and effective in children for treatement other than EE.

Do not take Pantoprazole if you are:

allergic to pantoprazole sodium, any other PPI medicine, or any of the ingredients in Pantoprazole.

See the end of this Medication Guide for a complete list of ingredients.

taking a medicine that contains rilpivirine (EDURANT, COMPLERA, ODEFSEY, JULUCA) used

to treat HIV-1 (Human Immunodeficiency Virus).

Before taking Pantoprazole, tell your doctor about all of your medical conditions, including if you:

have low magnesium levels in your blood.

are pregnant or plan to become pregnant. Pantoprazole may harm your unborn baby. Tell your doctor

if you become pregnant or think you may be pregnant during treatment with Pantoprazole.

are breastfeeding or plan to breastfeed. Pantoprazole can pass into your breast milk. Talk with your

doctor about the best way to feed your baby if you take Pantoprazole.

Tell your doctor about all of the medicines you take, including prescription and over-the-counter medicines,

vitamins and herbal supplements. Especially tell your doctor if you take methotrexate (Otrexup, Rasuvo,

Trexall, XATMEP), digoxin (LANOXIN), or a water pill (diuretic).

How should I take Pantoprazole?

Take Pantoprazole exactly as prescribed by your doctor.

Pantoprazole delayed-release tablets (Pantoprazole tablets):

Do not split, chew, or crush Pantoprazole tablets.

Swallow Pantoprazole tablets whole, with or without food.

Tell your doctor if you are not able to swallow your Pantoprazole tablet.

You may use antacids while taking Pantoprazole tablets.

If you miss a dose of Pantoprazole, take it as soon as possible. If it is almost time for your next dose,

do not take the missed dose. Take the next dose at your regular time. Do not take 2 doses at the same

time.

If you take too much Pantoprazole, call your doctor or your poison control center at 1-800-222-1222

right away or go to the nearest emergency room.

What are the possible side effects of Pantoprazole?

Pantoprazole can cause serious side effects, including:

See “ What is the most important information I should know about Pantoprazole ?”

Low vitamin B-12 levels in your body can happen in people who have taken Pantoprazole for a long

time (more than 3 years). Tell your doctor if you have symptoms of low vitamin B-12 levels,

including shortness of breath, lightheadedness, irregular heartbeat, muscle weakness, pale skin,

feeling tired, mood changes, and tingling or numbness in the arms and legs.

Low magnesium levels in your body can happen in people who have taken Pantoprazole for at least 3

months. Tell your doctor if you have symptoms of low magnesium levels, including seizures,

dizziness, irregular heartbeat, jitteriness, muscle aches or weakness, and spasms of hands, feet or

voice.

Stomach growths (fundic gland polyps). People who take PPI medicines for a long time have an

increased risk of developing a certain type of stomach growths called fundic gland polyps, especially

after taking PPI medicines for more than 1 year.

The most common side effects of Pantoprazole in adults include: headache, diarrhea, nausea, stomach-area

(abdominal) pain, vomiting, gas, dizziness, and joint pain.

The most common side effects of Pantoprazole in children include: upper respiratory infection, headache,

fever, diarrhea, vomiting, rash, and stomach-area (abdominal) pain.

These are not all the possible side effects of Pantoprazole. Call your doctor for medical advice about side

effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store Pantoprazole?

Store Pantoprazole at room temperature between 59° to 86°F (15° to 30°C).

Keep Pantoprazole and all medicines out of the reach of children.

General information about the safe and effective use of Pantoprazole.

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use

Pantoprazole for a condition for which it was not prescribed. Do not give Pantoprazole to other people, even

if they have the same symptoms that you have. It may harm them. You can ask your doctor or pharmacist for

information about Pantoprazole that is written for health professionals.

What are the ingredients in Pantoprazole?

Active ingredient: pantoprazole sodium sesquihydrate

Inactive ingredients in Pantoprazole Sodium Delayed-Release Tablets: crospovidone, glyceryl dibehenate,

hypromellose, lactose monohydrate, methacrylic acid copolymer dispersion, talc, titanium dioxide, and

triethyl citrate. The 20 mg tablets also contains black iron oxide, isopropyl alcohol, and propylene glycol.

For more information, call 1-844-834-0530.

This Medication Guide has been approved by the U.S. Food and Drug Administration.

This product's label may have been updated. For more information, call 1-844-834-0530.

Distributed by:

Lannett Company, Inc.

Philadelphia, PA 19136

CIA77568N

Rev. 05/2019

All brand names are the trademarks of their respective owners.

Revised: 9/2019

Document Id: 826ca157-470d-43f1-a6b2-0b3e2d53b302

34391-3

Set id: a0141135-3f83-49ba-b50c-31f353bf42f4

Version: 12

Effective Time: 20190910

McKesson Corporation dba SKY Packaging

PANTOPRAZOLE SODIUM- pantoprazole sodium tablet, delayed release

McKesson Corporation dba SKY Packaging

----------

HIGHLIGHTS OF PRESCRIBING INFORMATION

These highlights do not include all the information needed to use PANTOPRAZOLE SODIUM DELAYED-

RELEASE TABLETS safely and effectively. See full prescribing information for PANTOPRAZOLE SODIUM

DELAYED-RELEASE TABLETS.

PANTOPRAZOLE sodium delayed-release tablets, for oral use

Initial U.S. Approval: 2000

RECENT MAJOR CHANGES

Warnings and Precautions, Fundic Gland Polyps (5.9)

06/2018

INDICATIONS AND USAGE

Pantoprazole is a proton pump inhibitor (PPI) indicated for the following:

Short-Term Treatment of Erosive Esophagitis Associated with Gastroesophageal Reflux Disease (GERD) (1.1)

Maintenance of Healing of Erosive Esophagitis (1.2)

Pathological Hypersecretory Conditions Including Zollinger-Ellison (ZE) Syndrome (1.3)

DOSAGE AND ADMINISTRATION

Indic atio n

Do se

Frequency

Short-Term Treatment of Erosive Esophagitis Associated With GERD (2.1)

Adults

40 mg

Once Daily for up to 8 wks

Children (5 years and older)

≥ 15 kg to < 40 kg

20 mg

Once Daily for up to 8 wks

≥ 40 kg

40 mg

Maintenance of Healing of Erosive Esophagitis (2.1)

Adults

40 mg

Once Daily

Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome (2.1)

Adults

40 mg

Twice Daily

See full prescribing information for administration instructions

DOSAGE FORMS AND STRENGTHS

Delayed-Release Tablets: 20 mg and 40 mg (3)

CONTRAINDICATIONS

Patients with known hypersensitivity to any component of the formulation or to substituted benzimidazoles (4)

Patients receiving rilpivirine-containing products (4, 7)

WARNINGS AND PRECAUTIONS

Gastric Malignancy: In adults, symptomatic response does not preclude presence of gastric malignancy. Consider

additional follow-up and diagnostic testing. (5.1)

Acute Interstitial Nephritis: Observed in patients taking PPIs. (5.2)

Clostridium difficile-Associated Diarrhea: PPI therapy may be associated with increased risk of Clostridium difficile-

associated diarrhea. (5.3)

Bone Fracture: Long-term and multiple daily dose PPI therapy may be associated with an increased risk for

osteoporosis-related fractures of the hip, wrist or spine. (5.4)

Cutaneous and Systemic Lupus Erythematosus: Mostly cutaneous; new onset or exacerbation of existing disease;

discontinue Pantoprazole and refer to specialist for evaluation. (5.5)

Cyanocobalamin (Vitamin B-12) Deficiency: Daily long-term use (e.g., longer than 3 years) may lead to malabsorption

or a deficiency of cyanocobalamin. (5.6)

Hypomagnesemia: Reported rarely with prolonged treatment with PPIs. (5.7)

Fundic Gland Polyps: Risk increases with long-term use, especially beyond one year. Use the shortest duration of

Controlled studies did not extend beyond 12 months

therapy. (5.9)

ADVERSE REACTIONS

Most common adverse reactions are:

For adult use (>2%): headache, diarrhea, nausea, abdominal pain, vomiting, flatulence, dizziness, and arthralgia. (6.1)

For pediatric use (>4%): URI, headache, fever, diarrhea, vomiting, rash, and abdominal pain. (6.1)

To report SUSPECTED ADVERSE REACTIONS, contact Lannett Company, Inc. at 1-844-834-0530 or FDA at 1-

800-FDA-1088 or www.fda.gov/medwatch.

DRUG INTERACTIONS

See full prescribing information for a list of clinically important drug interactions (7)

USE IN SPECIFIC POPULATIONS

Pregnancy: Based on animal data, may cause fetal harm. (8.1)

See 17 for PATIENT COUNSELING INFORMATION and Medication Guide.

Revised: 9/2019

FULL PRESCRIBING INFORMATION: CONTENTS*

RECENT MAJOR CHANGES

1 INDICATIONS AND USAGE

1.1 Short-Term Treatment of Erosive Esophagitis Associated With Gastroesophageal Reflux

Disease (GERD)

1.2 Maintenance of Healing of Erosive Esophagitis

1.3 Pathological Hypersecretory Conditions Including Zollinger-Ellison (ZE) Syndrome

2 DOSAGE AND ADMINISTRATION

2.1 Recommended Dosing Schedule

2.2 Administration Instructions

3 DOSAGE FORMS AND STRENGTHS

4 CONTRAINDICATIONS

5 WARNINGS AND PRECAUTIONS

5.1 Presence of Gastric Malignancy

5.2 Acute Interstitial Nephritis

5.3 Clostridium difficile-Associated Diarrhea

5.4 Bone Fracture

5.5 Cutaneous and Systemic Lupus Erythematosus

5.6 Cyanocobalamin (Vitamin B-12) Deficiency

5.7 Hypomagnesemia

5.8 Tumorigenicity

5.9 Fundic Gland Polyps

5.10 Interference with Investigations for Neuroendocrine Tumors

5.11 Interference with Urine Screen for THC

5.12 Concomitant Use of Pantoprazole with Methotrexate

6 ADVERSE REACTIONS

6.1 Clinical Trials Experience

6.2 Postmarketing Experience

7 DRUG INTERACTIONS

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

8.2 Lactation

8.4 Pediatric Use

8.5 Geriatric Use

10 OVERDOSAGE

11 DESCRIPTION

11 DESCRIPTION

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

12.2 Pharmacodynamics

12.3 Pharmacokinetics

12.5 Pharmacogenomics

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

14 CLINICAL STUDIES

14.1 Erosive Esophagitis (EE) Associated with Gastroesophageal Reflux Disease (GERD)

14.2 Long-Term Maintenance of Healing of Erosive Esophagitis

14.3 Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome

16 HOW SUPPLIED/STORAGE AND HANDLING

17 PATIENT COUNSELING INFORMATION

FULL PRESCRIBING INFORMATION

1 INDICATIONS AND USAGE

Pantoprazole Sodium Delayed-Release Tablets, USP are indicated for:

1.1 Short-Term Treatment of Erosive Esophagitis Associated With Gastroesophageal Reflux

Disease (GERD)

Pantoprazole is indicated in adults and pediatric patients five years of age and older for the short-term

treatment (up to 8 weeks) in the healing and symptomatic relief of erosive esophagitis (EE). For those

adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of

Pantoprazole may be considered. Safety of treatment beyond 8 weeks in pediatric patients has not been

established.

1.2 Maintenance of Healing of Erosive Esophagitis

Pantoprazole is indicated for maintenance of healing of EE and reduction in relapse rates of daytime and

nighttime heartburn symptoms in adult patients with GERD. Controlled studies did not extend beyond 12

months.

1.3 Pathological Hypersecretory Conditions Including Zollinger-Ellison (ZE) Syndrome

Pantoprazole is indicated for the long-term treatment of pathological hypersecretory conditions,

including Zollinger-Ellison (ZE) Syndrome.

2 DOSAGE AND ADMINISTRATION

2.1 Recommended Dosing Schedule

Pantoprazole is supplied as delayed-release tablets. The recommended dosages are outlined in Table 1.

Table 1: Recommended Dosing Schedule for Pantoprazole

Indication

Dos e

Frequency

Short-Term Treatment of Erosive Esophagitis Associated With GERD

Adults

40 mg

Once daily for up to 8 weeks

Sections or subsections omitted from the full prescribing information are not listed.

Children (5 years and older)

≥ 15 kg to < 40 kg

20 mg

Once daily for up to 8 weeks

≥ 40 kg

40 mg

Maintenance of Healing of Erosive Esophagitis

Adults

40 mg

Once daily

Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome

Adults

40 mg

Twice daily

2.2 Administration Instructions

Directions for method of administration for each dosage form are presented in Table 2.

Table 2: Administration Instructions

Formulation

Route

Ins tructions

Delayed-Release Tablets Oral

Swallowed whole, with or without food

Take a missed dose as soon as possible. If it is almost time for the next dose, skip the missed dose and

take the next dose at the regular scheduled time. Do not take 2 doses at the same time.

Pantoprazole Sodium Delayed-Release Tablets

Swallow Pantoprazole Sodium Delayed-Release Tablets whole, with or without food in the stomach.

For patients unable to swallow a 40 mg tablet, two 20 mg tablets may be taken. Concomitant

administration of antacids does not affect the absorption of Pantoprazole Sodium Delayed-Release

T ablets.

3 DOSAGE FORMS AND STRENGTHS

Delayed-Release Tablets:

40 mg, white oval biconvex tablets debossed with "17" on one side

20 mg, white oval biconvex tablets imprinted in black ink with "KU" on one side and "180" on the

other side

4 CONTRAINDICATIONS

Pantoprazole is contraindicated in patients with known hypersensitivity to any component of the

formulation or any substituted benzimidazole. Hypersensitivity reactions may include anaphylaxis,

anaphylactic shock, angioedema, bronchospasm, acute interstitial nephritis, and urticaria [see Adverse

Reactions (6)].

Proton pump inhibitors (PPIs), including Pantoprazole, are contraindicated with rilpivirine-

containing products [see Drug Interactions (7)].

5 WARNINGS AND PRECAUTIONS

5.1 Presence of Gastric Malignancy

For adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of Pantoprazole

may be considered.

Controlled studies did not extend beyond 12 months

Dosage regimens should be adjusted to individual patient needs and should continue for as long as clinically

indicated. Doses up to 24 0 mg daily have been administered.

*

Do not split, chew, or crush Pantoprazole Sodium Delayed-Release Tablets.

In adults, symptomatic response to therapy with Pantoprazole does not preclude the presence of gastric

malignancy. Consider additional follow-up and diagnostic testing in adult patients who have a

suboptimal response or an early symptomatic relapse after completing treatment with a PPI. In older

patients, also consider an endoscopy.

5.2 Acute Interstitial Nephritis

Acute interstitial nephritis has been observed in patients taking PPIs including Pantoprazole. Acute

interstitial nephritis may occur at any point during PPI therapy and is generally attributed to an idiopathic

hypersensitivity reaction. Discontinue Pantoprazole if acute interstitial nephritis develops [see

Contraindications (4)].

5.3 Clostridium difficile-Associated Diarrhea

Published observational studies suggest that PPI therapy like Pantoprazole may be associated with an

increased risk of Clostridium difficile associated diarrhea, especially in hospitalized patients. This

diagnosis should be considered for diarrhea that does not improve [see Adverse Reactions (6.2)].

Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition

being treated.

5.4 Bone Fracture

Several published observational studies suggest that PPI therapy may be associated with an increased

risk for osteoporosis-related fractures of the hip, wrist, or spine. The risk of fracture was increased in

patients who received high-dose, defined as multiple daily doses, and long-term PPI therapy (a year or

longer). Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the

condition being treated. Patients at risk for osteoporosis-related fractures should be managed according

to established treatment guidelines [see Dosage and Administration (2), Adverse Reactions (6.2)].

5.5 Cutaneous and Systemic Lupus Erythematosus

Cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE) have been reported in

patients taking PPIs, including pantoprazole sodium. These events have occurred as both new onset and

an exacerbation of existing autoimmune disease. The majority of PPI-induced lupus erythematous cases

were CLE.

The most common form of CLE reported in patients treated with PPIs was subacute CLE (SCLE) and

occurred within weeks to years after continuous drug therapy in patients ranging from infants to the

elderly. Generally, histological findings were observed without organ involvement.

Systemic lupus erythematosus (SLE) is less commonly reported than CLE in patients receiving PPIs. PPI

associated SLE is usually milder than non-drug induced SLE. Onset of SLE typically occurred within

days to years after initiating treatment primarily in patients ranging from young adults to the elderly. The

majority of patients presented with rash; however, arthralgia and cytopenia were also reported.

Avoid administration of PPIs for longer than medically indicated. If signs or symptoms consistent with

CLE or SLE are noted in patients receiving Pantoprazole, discontinue the drug and refer the patient to

the appropriate specialist for evaluation. Most patients improve with discontinuation of the PPI alone in

4 to 12 weeks. Serological testing (e.g. ANA) may be positive and elevated serological test results may

take longer to resolve than clinical manifestations.

5.6 Cyanocobalamin (Vitamin B-12) Deficiency

Generally, daily treatment with any acid-suppressing medications over a long period of time (e.g.,

longer than 3 years) may lead to malabsorption of cyanocobalamin (Vitamin B-12) caused by hypo- or

achlorhydria. Rare reports of cyanocobalamin deficiency occurring with acid-suppressing therapy have

been reported in the literature. This diagnosis should be considered if clinical symptoms consistent

with cyanocobalamin deficiency are observed.

5.7 Hypomagnesemia

Hypomagnesemia, symptomatic and asymptomatic, has been reported rarely in patients treated with PPIs

for at least three months, in most cases after a year of therapy. Serious adverse events include tetany,

arrhythmias, and seizures. In most patients, treatment of hypomagnesemia required magnesium

replacement and discontinuation of the PPI.

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin

or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider

monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions

(6.2)].

5.8 Tumorigenicity

Due to the chronic nature of GERD, there may be a potential for prolonged administration of

Pantoprazole. In long-term rodent studies, pantoprazole was carcinogenic and caused rare types of

gastrointestinal tumors. The relevance of these findings to tumor development in humans is unknown

[see Nonclinical Toxicology (13.1)].

5.9 Fundic Gland Polyps

PPI use is associated with an increased risk of fundic gland polyps that increases with long-term use,

especially beyond one year. Most PPI users who developed fundic gland polyps were asymptomatic and

fundic gland polyps were identified incidentally on endoscopy. Use the shortest duration of PPI therapy

appropriate to the condition being treated.

5.10 Interference with Investigations for Neuroendocrine Tumors

Serum chromogranin A (CgA) levels increase secondary to drug-induced decreases in gastric acidity.

The increased CgA level may cause false positive results in diagnostic investigations for

neuroendocrine tumors. Healthcare providers should temporarily stop Pantoprazole treatment at least 14

days before assessing CgA levels and consider repeating the test if initial CgA levels are high. If serial

tests are performed (e.g. for monitoring), the same commercial laboratory should be used for testing, as

reference ranges between tests may vary [see Clinical Pharmacology (12.2)].

5.11 Interference with Urine Screen for THC

There have been reports of false-positive urine screening tests for tetrahydrocannabinol (THC) in

patients receiving PPIs, including Pantoprazole [see Drug Interactions (7)].

5.12 Concomitant Use of Pantoprazole with Methotrexate

Literature suggests that concomitant use of PPIs with methotrexate (primarily at high dose; see

methotrexate prescribing information) may elevate and prolong serum levels of methotrexate and/or its

metabolite, possibly leading to methotrexate toxicities. In high-dose methotrexate administration, a

temporary withdrawal of the PPI may be considered in some patients [see Drug Interactions (7)].

6 ADVERSE REACTIONS

The following serious adverse reactions are described below and elsewhere in labeling:

Acute Interstitial Nephritis [see Warnings and Precautions (5.2)]

Clostridium difficile-Associated Diarrhea [see Warnings and Precautions (5.3)]

Bone Fracture [see Warnings and Precautions (5.4)]

Cutaneous and Systemic Lupus Erythematosus [see Warnings and Precautions (5.5)]

Cyanocobalamin (Vitamin B-12) Deficiency [see Warnings and Precautions (5.6)]

Hypomagnesemia [see Warnings and Precautions (5.7)]

Fundic Gland Polyps [see Warnings and Precautions (5.9)]

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed

in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug

and may not reflect the rates observed in clinical practice.

Adults

Safety in nine randomized comparative US clinical trials in patients with GERD included 1,473 patients

on oral Pantoprazole (20 mg or 40 mg), 299 patients on an H -receptor antagonist, 46 patients on

another PPI, and 82 patients on placebo. The most frequently occurring adverse reactions are listed in

Table 3.

Table 3: Adverse Reactions Reported in Clinical Trials of Adult Patients with GERD at a

Frequency of > 2%

Pantoprazole

(n=1473)

Comparators

(n=345)

Placebo

(n=82)

Headache

12.2

12.8

Diarrhea

Nausea

Abdominal pain

Vomiting

Flatulence

Dizziness

Arthralgia

Additional adverse reactions that were reported for Pantoprazole in clinical trials with a frequency of ≤

2% are listed below by body system:

Body as a Whole: allergic reaction, pyrexia, photosensitivity reaction, facial edema

Gastrointestinal: constipation, dry mouth, hepatitis

Hematologic: leukopenia, thrombocytopenia

Metabolic/Nutritional: elevated CK (creatine kinase), generalized edema, elevated triglycerides, liver

enzymes elevated

Musculoskeletal: myalgia

Nervous: depression, vertigo

Skin and Appendages: urticaria, rash, pruritus

Special Senses: blurred vision

Pediatric Patients

Safety of Pantoprazole in the treatment of EE associated with GERD was evaluated in pediatric patients

ages 1 year through 16 years in three clinical trials. Safety trials involved pediatric patients with EE;

however, as EE is uncommon in the pediatric population, 249 pediatric patients with endoscopically-

proven or symptomatic GERD were also evaluated. All adult adverse reactions to Pantoprazole are

considered relevant to pediatric patients. In patients ages 1 year through 16 years, the most commonly

reported (> 4%) adverse reactions include: URI, headache, fever, diarrhea, vomiting, rash, and

abdominal pain.

For safety information in patients less than 1 year of age see Use in Specific Populations (8.4).

Additional adverse reactions that were reported for Pantoprazole in pediatric patients in clinical trials

with a frequency of ≤ 4% are listed below by body system:

Body as a Whole: allergic reaction, facial edema

Gastrointestinal: constipation, flatulence, nausea

Metabolic/Nutritional: elevated triglycerides, elevated liver enzymes, elevated CK (creatine kinase)

Musculoskeletal: arthralgia, myalgia

Nervous: dizziness, vertigo

Skin and Appendages: urticaria

The following adverse reactions seen in adults in clinical trials were not reported in pediatric patients

in clinical trials, but are considered relevant to pediatric patients: photosensitivity reaction, dry mouth,

hepatitis, thrombocytopenia, generalized edema, depression, pruritus, leukopenia, and blurred vision.

Zollinger-Ellison (ZE) Syndrome

In clinical studies of ZE Syndrome, adverse reactions reported in 35 patients taking Pantoprazole 80

mg/day to 240 mg/day for up to 2 years were similar to those reported in adult patients with GERD.

6.2 Postmarketing Experience

The following adverse reactions have been identified during postapproval use of Pantoprazole.

Because these reactions are reported voluntarily from a population of uncertain size, it is not always

possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

These adverse reactions are listed below by body system:

Gastrointestinal Disorders: fundic gland polyps

General Disorders and Administration Conditions: asthenia, fatigue, malaise

Hematologic: pancytopenia, agranulocytosis

Hepatobiliary Disorders: hepatocellular damage leading to jaundice and hepatic failure

Immune System Disorders: anaphylaxis (including anaphylactic shock), systemic lupus erythematosus

Infections and Infestations: Clostridium difficile associated diarrhea

Investigations: weight changes

Metabolism and Nutritional Disorders: hyponatremia, hypomagnesemia

Musculoskeletal Disorders: rhabdomyolysis, bone fracture

Nervous: ageusia, dysgeusia

Psychiatric Disorders: hallucination, confusion, insomnia, somnolence

Renal and Urinary Disorders: interstitial nephritis

Skin and Subcutaneous Tissue Disorders: severe dermatologic reactions (some fatal), including erythema

multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN, some fatal), angioedema

(Quincke’s edema) and cutaneous lupus erythematosus

7 DRUG INTERACTIONS

Table 4 includes drugs with clinically important drug interactions and interaction with diagnostics when

administered concomitantly with Pantoprazole and instructions for preventing or managing them.

Consult the labeling of concomitantly used drugs to obtain further information about interactions with

PPIs.

PPIs.

Table 4: Clinically Relevant Interactions Affecting Drugs Co-Administered with Pantoprazole and

Interactions with Diagnostics

Antiretrovirals

Clinical Impact:

The effect of PPIs on antiretroviral drugs is variable. The

clinical importance and the mechanisms behind these

interactions are not always known.

Decreased exposure of some antiretroviral drugs (e.g.,

rilpivirine atazanavir, and nelfinavir) when used

concomitantly with pantoprazole may reduce antiviral

effect and promote the development of drug resistance.

Increased exposure of other antiretroviral drugs (e.g.,

saquinavir) when used concomitantly with pantoprazole may

increase toxicity of the antiretroviral drugs.

There are other antiretroviral drugs which do not result in

clinically relevant interactions with pantoprazole.

Intervention:

Rilpivirine-containing products: Concomitant use with

Pantoprazole is contraindicated [see Contraindications (4)]. See

prescribing information.

Atazanavir: See prescribing information for atazanavir for

dosing information.

Nelfinavir: Avoid concomitant use with Pantoprazole. See

prescribing information for nelfinavir.

Saquinavir: See the prescribing information for saquinavir and

monitor for potential saquinavir toxicities.

Other antiretrovirals: See prescribing information.

Warfarin

Clinical Impact:

Increased INR and prothrombin time in patients receiving PPIs,

including pantoprazole, and warfarin concomitantly. Increases

in INR and prothrombin time may lead to abnormal bleeding and

even death.

Intervention:

Monitor INR and prothrombin time. Dose adjustment of

warfarin may be needed to maintain target INR range. See

prescribing information for warfarin.

Clopidogrel

Clinical Impact:

Concomitant administration of pantoprazole and clopidogrel in

healthy subjects had no clinically important effect on exposure

to the active metabolite of clopidogrel or clopidogrel-induced

platelet inhibition [see Clinical Pharmacology (12.3)].

Intervention:

No dose adjustment of clopidogrel is necessary when

administered with an approved dose of Pantoprazole.

Methotrexate

Clinical Impact:

Concomitant use of PPIs with methotrexate (primarily at high

dose) may elevate and prolong serum concentrations of

methotrexate and/or its metabolite hydroxymethotrexate,

possibly leading to methotrexate toxicities. No formal drug

interaction studies of high-dose methotrexate with PPIs have

been conducted [see Warnings and Precautions (5.12)].

Intervention:

A temporary withdrawal of Pantoprazole may be considered in

some patients receiving high-dose methotrexate.

Drugs Dependent on Gastric pH for

Absorption (e.g., iron salts, erlotinib,

dasatinib, nilotinib, mycophenolate

mofetil, ketoconazole/itraconazole)

Clinical Impact:

Pantoprazole can reduce the absorption of other drugs due to

its effect on reducing intragastric acidity.

Intervention:

Mycophenolate mofetil (MMF): Co-administration of

pantoprazole sodium in healthy subjects and in transplant

patients receiving MMF has been reported to reduce the

exposure to the active metabolite, mycophenolic acid (MPA),

possibly due to a decrease in MMF solubility at an increased

gastric pH [see Clinical Pharmacology (12.3)]. The clinical

relevance of reduced MPA exposure on organ rejection has

not been established in transplant patients receiving

Pantoprazole and MMF. Use Pantoprazole with caution in

transplant patients receiving MMF.

See the prescribing information for other drugs dependent on

gastric pH for absorption.

Interactions with Investigations of

Neuroendocrine Tumors

Clinical Impact:

CgA levels increase secondary to PPI-induced decreases in

gastric acidity. The increased CgA level may cause false

positive results in diagnostic investigations for

neuroendocrine tumors [see Warnings and Precautions (5.10),

Clinical Pharmacology (12.2)].

Intervention:

Temporarily stop Pantoprazole treatment at least 14 days

before assessing CgA levels and consider repeating the test if

initial CgA levels are high. If serial tests are performed (e.g.

for monitoring), the same commercial laboratory should be

used for testing, as reference ranges between tests may vary.

False Positive Urine Tests for THC

Clinical Impact:

There have been reports of false positive urine screening tests

for tetrahydrocannabinol (THC) in patients receiving PPIs [see

Warnings and Precautions (5.11)].

Intervention:

An alternative confirmatory method should be considered to

verify positive results.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Risk Summary

Available data from published observational studies did not demonstrate an association of major

malformations or other adverse pregnancy outcomes with pantoprazole.

In animal reproduction studies, no evidence of adverse development outcomes was observed with

pantoprazole. Reproduction studies have been performed in rats at oral doses up to 450 mg/kg/day

(about 88 times the recommended human dose) and rabbits at oral doses up to 40 mg/kg/day (about 16

times the recommended human dose) with administration of pantoprazole during organogenesis in

pregnant animals and have revealed no evidence of harm to the fetus due to pantoprazole in this study

(see Data).

A pre- and postnatal development toxicity study in rats with additional endpoints to evaluate the effect on

bone development was performed with pantoprazole sodium. Oral pantoprazole doses of 5, 15, and 30

mg/kg/day (approximately 1, 3, and 6 times the human dose of 40 mg/day) were administered to pregnant

females from gestation day (GD) 6 through lactation day (LD) 21. Changes in bone morphology were

observed in pups exposed to pantoprazole in utero and through milk during the period of lactation as

well as by oral dosing from postnatal day (PND) 4 through PND 21 [see Use in Specific Populations

(8.4)]. There were no drug-related findings in maternal animals. Advise pregnant women of the potential

risk of fetal harm.

The estimated background risk of major birth defects and miscarriage for the indicated population is

unknown. All pregnancies have a background risk of birth defect, loss or other adverse outcomes. In the

U.S. general population, the estimated background risk of major birth defects and miscarriage in the

clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.

Data

Human Data

Available data from published observational studies failed to demonstrate an association of adverse

pregnancy-related outcomes and pantoprazole use. Methodological limitations of these observational

studies cannot definitely establish or exclude any drug-associated risk during pregnancy. In a

prospective study by the European Network of Teratology Information Services, outcomes from a

group of 53 pregnant women administered median daily doses of 40 mg pantoprazole were compared to

a control group of 868 pregnant women who did not take any proton pump inhibitors (PPIs). There was

no difference in the rate of major malformations between women exposed to PPIs and the control group,

corresponding to a Relative Risk (RR)=0.55, [95% Confidence Interval (CI) 0.08-3.95]. In a population-

based retrospective cohort study covering all live births in Denmark from 1996 to 2008, there was no

significant increase in major birth defects during analysis of first trimester exposure to pantoprazole in

549 live births. A meta-analysis that compared 1,530 pregnant women exposed to PPIs in at least the

first trimester with 133,410 unexposed pregnant women showed no significant increases in risk for

congenital malformations or spontaneous abortion with exposure to PPIs (for major malformations

OR=1.12 ([95% CI 0.86-1.45] and for spontaneous abortions OR=1.29 [95% CI 0.84-1.97]).

Animal Data

Reproduction studies have been performed in rats at oral pantoprazole doses up to 450 mg/kg/day (about

88 times the recommended human dose based on body surface area) and in rabbits at oral doses up to 40

mg/kg/day (about 16 times the recommended human dose based on body surface area) with

administration of pantoprazole sodium during organogenesis in pregnant animals. The studies have

revealed no evidence of impaired fertility or harm to the fetus due to pantoprazole.

A pre- and postnatal development toxicity study in rats with additional endpoints to evaluate the effect on

bone development was performed with pantoprazole sodium. Oral pantoprazole doses of 5, 15, and 30

mg/kg/day (approximately 1, 3, and 6 times the human dose of 40 mg/day on a body surface area basis)

were administered to pregnant females from gestation day (GD) 6 through lactation day (LD) 21. On

postnatal day (PND 4) through PND 21, the pups were administered oral doses at 5, 15, and 30

mg/kg/day (approximately 1, 2.3, and 3.2 times the exposure (AUC) in humans at a dose of 40 mg). There

were no drug-related findings in maternal animals. During the preweaning dosing phase (PND 4 to 21)

of the pups, there were increased mortality and/or moribundity and decreased body weight and body

weight gain at 5 mg/kg/day (approximately equal exposures (AUC) in humans receiving the 40 mg dose)

and higher doses. On PND 21, decreased mean femur length and weight and changes in femur bone mass

and geometry were observed in the offspring at 5 mg/kg/day (approximately equal exposures (AUC) in

humans at the 40 mg dose) and higher doses. The femur findings included lower total area, bone mineral

content and density, periosteal and endosteal circumference, and cross-sectional moment of inertia.

There were no microscopic changes in the distal femur, proximal tibia, or stifle joints. Changes in bone

parameters were partially reversible following a recovery period, with findings on PND 70 limited to

lower femur metaphysis cortical/subcortical bone mineral density in female pups at 5 mg/kg/day

(approximately equal exposures (AUC) in humans at the 40 mg dose) and higher doses.

8.2 Lactation

Risk Summary

Pantoprazole has been detected in breast milk of a nursing mother after a single 40 mg oral dose of

pantoprazole. There were no effects on the breastfed infant (see Data). There are no data on

pantoprazole effects on milk production.

The developmental and health benefits of breastfeeding should be considered along with the mother’s

clinical need for Pantoprazole and any potential adverse effects on the breastfed child from

pantoprazole or from the underlying maternal condition.

Data

The breast milk of a 42-year-old woman receiving 40 mg of oral pantoprazole, at 10 months postpartum,

was studied for 24 hours, to demonstrate low levels of pantoprazole present in the breast milk.

Pantoprazole was detectable in milk only 2 and 4 hours after the dose with milk levels of approximately

36 mcg/L and 24 mcg/L, respectively. A milk-to-plasma ratio of 0.022 was observed at 2 hours after

drug administration. Pantoprazole was not detectable (<10 mcg/L) in milk at 6, 8 and 24 hours after the

dose. The relative dose to the infant was estimated to be 7.3 mcg of pantoprazole, which is equivalent to

0.14% of the weight-adjusted maternal dose. No adverse events in the infant were reported by the

mother.

8.4 Pediatric Use

The safety and effectiveness of Pantoprazole for short-term treatment (up to eight weeks) of EE

associated with GERD have been established in pediatric patients 1 year through 16 years of age.

Effectiveness for EE has not been demonstrated in patients less than 1 year of age. In addition, for

patients less than 5 years of age, there is no appropriate dosage strength in an age-appropriate

formulation available. Therefore, Pantoprazole is indicated for the short-term treatment of EE

associated with GERD for patients 5 years and older. The safety and effectiveness of Pantoprazole for

pediatric uses other than EE have not been established.

1 year through 16 years of age

Use of Pantoprazole in pediatric patients 1 year through 16 years of age for short-term treatment (up to

eight weeks) of EE associated with GERD is supported by: a) extrapolation of results from adequate

and well-controlled studies that supported the approval of Pantoprazole for treatment of EE associated

with GERD in adults, and b) safety, effectiveness, and pharmacokinetic studies performed in pediatric

patients [see Clinical Studies (14.1), Clinical Pharmacology (12.3)].

Safety of Pantoprazole in the treatment of EE associated with GERD in pediatric patients 1 through 16

years of age was evaluated in three multicenter, randomized, double-blind, parallel-treatment studies,

involving 249 pediatric patients, including 8 with EE (4 patients ages 1 year to 5 years and 4 patients 5

years to 11 years). The children ages 1 year to 5 years with endoscopically diagnosed EE (defined as an

endoscopic Hetzel-Dent score ≥ 2) were treated once daily for 8 weeks with one of two dose levels of

Pantoprazole (approximating 0.6 mg/kg or 1.2 mg/kg). All 4 of these patients with EE were healed

(Hetzel-Dent score of 0 or 1) at 8 weeks. Because EE is uncommon in the pediatric population,

predominantly pediatric patients with endoscopically-proven or symptomatic GERD were also included

in these studies. Patients were treated with a range of doses of Pantoprazole once daily for 8 weeks.

For safety findings see Adverse Reactions (6.1). Because these pediatric trials had no placebo, active

comparator, or evidence of a dose response, the trials were inconclusive regarding the clinical benefit

of Pantoprazole for symptomatic GERD in the pediatric population. The effectiveness of Pantoprazole

for treating symptomatic GERD in pediatric patients has not been established.

Although the data from the clinical trials support use of Pantoprazole for the short-term treatment of EE

associated with GERD in pediatric patients 1 year through 5 years, there is no commercially available

dosage formulation appropriate for patients less than 5 years of age [see Dosage and Administration (2)].

In a population pharmacokinetic analysis, clearance values in the children 1 to 5 years old with

endoscopically proven GERD had a median value of 2.4 L/h. Following a 1.2 mg/kg equivalent dose (15

mg for ≤ 12.5 kg and 20 mg for > 12.5 to < 25 kg), the plasma concentrations of pantoprazole were

highly variable and the median time to peak plasma concentration was 3 to 6 hours. The estimated AUC

for patients 1 to 5 years old was 37% higher than for adults receiving a single 40 mg tablet, with a

geometric mean AUC value of 6.8 mcghr/mL.

Neonates to less than one year of age

Pantoprazole was not found to be effective in a multicenter, randomized, double-blind, placebo-

controlled, treatment-withdrawal study of 129 pediatric patients 1 through 11 months of age. Patients

were enrolled if they had symptomatic GERD based on medical history and had not responded to non-

pharmacologic interventions for GERD for two weeks. Patients received Pantoprazole daily for four

weeks in an open-label phase, then patients were randomized in equal proportion to receive

Pantoprazole treatment or placebo for the subsequent four weeks in a double-blind manner. Efficacy

was assessed by observing the time from randomization to study discontinuation due to symptom

worsening during the four-week treatment-withdrawal phase. There was no statistically significant

difference between Pantoprazole and placebo in the rate of discontinuation.

In this trial, the adverse reactions that were reported more commonly (difference of ≥ 4%) in the treated

population compared to the placebo population were elevated CK, otitis media, rhinitis, and laryngitis.

In a population pharmacokinetic analysis, the systemic exposure was higher in patients less than 1 year

of age with GERD compared to adults who received a single 40 mg dose (geometric mean AUC was

103% higher in preterm infants and neonates receiving single dose of 2.5 mg of Pantoprazole, and 23%

higher in infants 1 through 11 months of age receiving a single dose of approximately 1.2 mg/kg). In

these patients, the apparent clearance (CL/F) increased with age (median clearance: 0.6 L/hr, range: 0.03

to 3.2 L/hr).

These doses resulted in pharmacodynamic effects on gastric but not esophageal pH. Following once

daily dosing of 2.5 mg of Pantoprazole in preterm infants and neonates, there was an increase in the mean

gastric pH (from 4.3 at baseline to 5.2 at steady-state) and in the mean % time that gastric pH was > 4

(from 60% at baseline to 80% at steady-state). Following once daily dosing of approximately 1.2 mg/kg

of Pantoprazole in infants 1 through 11 months of age, there was an increase in the mean gastric pH

(from 3.1 at baseline to 4.2 at steady-state) and in the mean % time that gastric pH was > 4 (from 32% at

baseline to 60% at steady-state). However, no significant changes were observed in mean

intraesophageal pH or % time that esophageal pH was < 4 in either age group.

Because Pantoprazole was not shown to be effective in the randomized, placebo-controlled study in this

age group, the use of Pantoprazole for treatment of symptomatic GERD in infants less than 1 year of age

is not indicated.

Animal Toxicity Data

In a pre- and post-natal development study in rats, the pups were administered oral doses of pantoprazole

at 5, 15, and 30 mg/kg/day (approximately 1, 2.3, and 3.2 times the exposure (AUC) in children aged 6 to

11 years at a dose of 40 mg) on postnatal day (PND 4) through PND 21, in addition to lactational

exposure through milk. On PND 21, decreased mean femur length and weight and changes in femur bone

mass and geometry were observed in the offspring at 5 mg/kg/day (approximately equal exposures

(AUC) in children aged 6 to 11 years at the 40 mg dose) and higher doses. Changes in bone parameters

were partially reversible following a recovery period.

In neonatal/juvenile animals (rats and dogs) toxicities were similar to those observed in adult animals,

including gastric alterations, decreases in red cell mass, increases in lipids, enzyme induction and

hepatocellular hypertrophy. An increased incidence of eosinophilic chief cells in adult and

neonatal/juvenile rats, and atrophy of chief cells in adult rats and in neonatal/juvenile dogs, was

observed in the fundic mucosa of stomachs in repeated-dose studies. Full to partial recovery of these

effects were noted in animals of both age groups following a recovery period.

8.5 Geriatric Use

In short-term US clinical trials, EE healing rates in the 107 elderly patients (≥ 65 years old) treated with

Pantoprazole were similar to those found in patients under the age of 65. The incidence rates of adverse

reactions and laboratory abnormalities in patients aged 65 years and older were similar to those

associated with patients younger than 65 years of age.

10 OVERDOSAGE

Experience in patients taking very high doses of Pantoprazole (greater than 240 mg) is limited.

Spontaneous post-marketing reports of overdose are generally within the known safety profile of

Pantoprazole.

Pantoprazole is not removed by hemodialysis. In case of overdosage, treatment should be symptomatic

and supportive.

Single oral doses of pantoprazole at 709 mg/kg, 798 mg/kg, and 887 mg/kg were lethal to mice, rats, and

dogs, respectively. The symptoms of acute toxicity were hypoactivity, ataxia, hunched sitting, limb-

splay, lateral position, segregation, absence of ear reflex, and tremor.

If overexposure to Pantoprazole occurs, call your Poison Control Center at 1-800-222-1222 for current

information on the management of poisoning or overdosage.

11 DESCRIPTION

The active ingredient in Pantoprazole Sodium Delayed-Release Tablets, USP is a substituted

benzimidazole, sodium 5-(difluoromethoxy)-2-[[(3,4-dimethoxy-2-pyridinyl)methyl] sulfinyl]-1H-

benzimidazole sesquihydrate, a compound that inhibits gastric acid secretion. Its empirical formula is

H F N NaO S x 1.5 H O, with a molecular weight of 432.4. The structural formula is:

Pantoprazole sodium sesquihydrate is a white to off-white crystalline powder and is racemic.

Pantoprazole has weakly basic and acidic properties. Pantoprazole sodium sesquihydrate is freely

soluble in water, very slightly soluble in phosphate buffer at pH 7.4, and practically insoluble in n-

hexane.

The stability of the compound in aqueous solution is pH-dependent. The rate of degradation increases

with decreasing pH. At ambient temperature, the degradation half-life is approximately 2.8 hours at pH

5 and approximately 220 hours at pH 7.8.

Pantoprazole is supplied as a delayed-release tablet, available in two strengths (20 mg and 40 mg).

Each Pantoprazole Sodium Delayed-Release Tablet contains 45.1 mg or 22.55 mg of pantoprazole

sodium sesquihydrate (equivalent to 40 mg or 20 mg pantoprazole, respectively) with the following

inactive ingredients: crospovidone, glyceryl dibehenate, hypromellose, lactose monohydrate,

methacrylic acid copolymer dispersion, talc, titanium dioxide, and triethyl citrate. The 20 mg tablet also

contains black iron oxide, isopropyl alcohol, and propylene glycol. Pantoprazole Sodium Delayed-

Release Tablets (40 mg and 20 mg) complies with USP dissolution test 4.

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Pantoprazole is a PPI that suppresses the final step in gastric acid production by covalently binding to

the (H , K )-ATPase enzyme system at the secretory surface of the gastric parietal cell. This effect

leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. The

binding to the (H , K )-ATPase results in a duration of antisecretory effect that persists longer than 24

hours for all doses tested (20 mg to 120 mg).

12.2 Pharmacodynamics

Antisecretory Activity

Under maximal acid stimulatory conditions using pentagastrin, a dose-dependent decrease in gastric acid

output occurs after a single dose of oral (20-80 mg) pantoprazole in healthy subjects. Pantoprazole

given once daily results in increasing inhibition of gastric acid secretion. Following the initial oral

dose of 40 mg pantoprazole, a 51% mean inhibition was achieved by 2.5 hours. With once-a-day dosing

for 7 days, the mean inhibition was increased to 85%. Pantoprazole suppressed acid secretion in excess

of 95% in half of the subjects. Acid secretion had returned to normal within a week after the last dose

of pantoprazole; there was no evidence of rebound hypersecretion.

In a series of dose-response studies, pantoprazole, at oral doses ranging from 20 to 120 mg, caused

dose-related increases in median basal gastric pH and in the percent of time gastric pH was > 3 and > 4.

Treatment with 40 mg of pantoprazole produced significantly greater increases in gastric pH than the 20

mg dose. Doses higher than 40 mg (60, 80, 120 mg) did not result in further significant increases in

median gastric pH. The effects of pantoprazole on median pH from one double-blind crossover study

are shown in Table 5.

Table 5: Effect of Single Daily Doses of Oral

Pantoprazole on Intragastric pH

Median pH on day 7

Time

Placebo

20 mg 40 mg 80 mg

8 a.m. - 8 a.m.

(24 hours)

8 a.m. - 10 p.m.

(Daytime)

10 p.m. - 8 a.m.

(Nighttime)

Serum Gastrin Effects

Fasting serum gastrin levels were assessed in two double-blind studies of the acute healing of EE in

which 682 patients with gastroesophageal reflux disease (GERD) received 10, 20, or 40 mg of

Pantoprazole for up to 8 weeks. At 4 weeks of treatment there was an increase in mean gastrin levels of

7%, 35%, and 72% over pretreatment values in the 10, 20, and 40 mg treatment groups, respectively. A

Significantly different from placebo

Significantly different from 20 mg

*†

*†

*†

*†

similar increase in serum gastrin levels was noted at the 8-week visit with mean increases of 3%, 26%,

and 84% for the three pantoprazole dose groups. Median serum gastrin levels remained within normal

limits during maintenance therapy with Pantoprazole Sodium Delayed-Release Tablets.

In long-term international studies involving over 800 patients, a 2- to 3-fold mean increase from the

pretreatment fasting serum gastrin level was observed in the initial months of treatment with

pantoprazole at doses of 40 mg per day during GERD maintenance studies and 40 mg or higher per day

in patients with refractory GERD. Fasting serum gastrin levels generally remained at approximately 2 to

3 times baseline for up to 4 years of periodic follow-up in clinical trials.

Following short-term treatment with Pantoprazole, elevated gastrin levels return to normal by at least 3

months.

Enterochromaffin-Like (ECL) Cell Effects

In 39 patients treated with oral pantoprazole 40 mg to 240 mg daily (majority receiving 40 mg to 80 mg)

for up to 5 years, there was a moderate increase in ECL-cell density, starting after the first year of use,

which appeared to plateau after 4 years.

In a nonclinical study in Sprague-Dawley rats, lifetime exposure (24 months) to pantoprazole at doses of

0.5 to 200 mg/kg/day resulted in dose-related increases in gastric ECL-cell proliferation and gastric

neuroendocrine (NE)-cell tumors. Gastric NE-cell tumors in rats may result from chronic elevation of

serum gastrin concentrations. The high density of ECL cells in the rat stomach makes this species

highly susceptible to the proliferative effects of elevated gastrin concentrations produced by PPIs.

However, there were no observed elevations in serum gastrin following the administration of

pantoprazole at a dose of 0.5 mg/kg/day. In a separate study, a gastric NE-cell tumor without

concomitant ECL-cell proliferative changes was observed in 1 female rat following 12 months of

dosing with pantoprazole at 5 mg/kg/day and a 9 month off-dose recovery [see Nonclinical Toxicology

(13.1)].

Endocrine Effects

In a clinical pharmacology study, Pantoprazole 40 mg given once daily for 2 weeks had no effect on the

levels of the following hormones: cortisol, testosterone, triiodothyronine (T ), thyroxine (T ), thyroid-

stimulating hormone (TSH), thyronine-binding protein, parathyroid hormone, insulin, glucagon, renin,

aldosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, and growth hormone.

In a 1-year study of GERD patients treated with Pantoprazole 40 mg or 20 mg, there were no changes

from baseline in overall levels of T , T , and TSH.

12.3 Pharmacokinetics

Pantoprazole Sodium Delayed-Release Tablets are prepared as enteric-coated tablets so that absorption

of pantoprazole begins only after the tablet leaves the stomach. Peak serum concentration (C

) and

area under the serum concentration time curve (AUC) increase in a manner proportional to oral doses

from 10 mg to 80 mg. Pantoprazole does not accumulate, and its pharmacokinetics are unaltered with

multiple daily dosing. Following oral administration, the serum concentration of pantoprazole declines

biexponentially, with a terminal elimination half-life of approximately one hour.

In extensive metabolizers with normal liver function receiving an oral dose of the enteric-coated 40 mg

pantoprazole tablet, the peak concentration (C

) is 2.5 mcg/mL; the time to reach the peak

concentration (t

) is 2.5 h, and the mean total area under the plasma concentration versus time curve

(AUC) is 4.8 mcg·h/mL (range 1.4 to 13.3 mcg·h/mL).

Absorption

After administration of a single or multiple oral 40 mg doses of Pantoprazole Sodium Delayed-Release

Tablets, the peak plasma concentration of pantoprazole was achieved in approximately 2.5 hours, and

was 2.5 mcg/mL. Pantoprazole undergoes little first-pass metabolism, resulting in an absolute

bioavailability of approximately 77%. Pantoprazole absorption is not affected by concomitant

administration of antacids.

Administration of Pantoprazole Sodium Delayed-Release Tablets with food may delay its absorption up

to 2 hours or longer; however, the C

and the extent of pantoprazole absorption (AUC) are not

altered. Thus, Pantoprazole Sodium Delayed-Release Tablets may be taken without regard to timing of

meals.

Distribution

The apparent volume of distribution of pantoprazole is approximately 11 to 23.6 L, distributing mainly in

extracellular fluid. The serum protein binding of pantoprazole is about 98%, primarily to albumin.

Elimination

Metabolism

Pantoprazole is extensively metabolized in the liver through the cytochrome P450 (CYP) system.

Pantoprazole metabolism is independent of the route of administration (oral). The main metabolic

pathway is demethylation, by CYP2C19, with subsequent sulfation; other metabolic pathways include

oxidation by CYP3A4. There is no evidence that any of the pantoprazole metabolites have significant

pharmacologic activity.

Excretion

After a single oral dose of

C-labeled pantoprazole to healthy, normal metabolizer subjects,

approximately 71% of the dose was excreted in the urine, with 18% excreted in the feces through

biliary excretion. There was no renal excretion of unchanged pantoprazole.

Specific Populations

Geriatric Patients

Only slight to moderate increases in the AUC (43%) and C

(26%) of pantoprazole were found in

elderly subjects (64 to 76 years of age) after repeated oral administration, compared with younger

subjects [see Use in Specific Populations (8.5)].

Pediatric Patients

The pharmacokinetics of pantoprazole were studied in children less than 16 years of age in four

randomized, open-label clinical trials in pediatric patients with presumed/proven GERD. A pediatric

granule formulation was studied in children through 5 years of age, and Pantoprazole Delayed-Release

Tablets were studied in children older than 5 years.

In a population PK analysis, total clearance increased with increasing bodyweight in a non-linear

fashion. The total clearance also increased with increasing age only in children under 3 years of age.

Neonate through 5 Years of Age [see Use in Specific Populations (8.4)]

Children and Adolescents 6 through 16 Years of Age

The pharmacokinetics of Pantoprazole Sodium Delayed-Release Tablets were evaluated in children

ages 6 through 16 years with a clinical diagnosis of GERD. The PK parameters following a single oral

dose of 20 mg or 40 mg of Pantoprazole tablets in children ages 6 through 16 years were highly

variable (%CV ranges 40 to 80%). The geometric mean AUC estimated from population PK analysis

after a 40 mg Pantoprazole tablet in pediatric patients was about 39% and 10% higher respectively in 6

to 11 and 12 to 16 year-old children, compared to that of adults (Table 7).

Table 7: PK Parameters in Children and Adolescents

6 through 16 years with GERD receiving 40 mg

Pantoprazole Sodium Delayed-Release Tablets

6-11 years (n=12) 12-16 years (n=11)

(mcg/mL)

AUC (mcg·h/mL)

CL/F (L/h)

Male and Female Patients

There is a modest increase in pantoprazole AUC and C

in women compared to men. However,

weight-normalized clearance values are similar in women and men. In pediatric patients ages 1 through

16 years there were no clinically relevant effects of gender on clearance of pantoprazole, as shown by

population pharmacokinetic analysis.

Patients with Renal Impairment

In patients with severe renal impairment, pharmacokinetic parameters for pantoprazole were similar to

those of healthy subjects.

Patients with Hepatic Impairment

In patients with mild to severe hepatic impairment (Child-Pugh A to C cirrhosis), maximum pantoprazole

concentrations increased only slightly (1.5-fold) relative to healthy subjects. Although serum half-life

values increased to 7-9 hours and AUC values increased by 5- to 7 fold in hepatic-impaired patients,

these increases were no greater than those observed in CYP2C19 poor metabolizers, where no dosage

adjustment is warranted. These pharmacokinetic changes in hepatic-impaired patients result in minimal

drug accumulation following once-daily, multiple-dose administration. Doses higher than 40 mg/day

have not been studied in hepatically impaired patients.

Drug Interaction Studies

Effect of Other Drugs on Pantoprazole

Pantoprazole is metabolized mainly by CYP2C19 and to minor extents by CYPs 3A4, 2D6, and 2C9. In in

vivo drug-drug interaction studies with CYP2C19 substrates (diazepam [also a CYP3A4 substrate] and

phenytoin [also a CYP3A4 inducer] and clopidogrel), nifedipine, midazolam, and clarithromycin

(CYP3A4 substrates), metoprolol (a CYP2D6 substrate), diclofenac, naproxen and piroxicam (CYP2C9

substrates), and theophylline (a CYP1A2 substrate) in healthy subjects, the pharmacokinetics of

pantoprazole were not significantly altered.

Effect of Pantoprazole on Other Drugs

Clopidogrel

Clopidogrel is metabolized to its active metabolite in part by CYP2C19. In a crossover clinical study,

66 healthy subjects were administered clopidogrel (300 mg loading dose followed by 75 mg per day)

alone and with pantoprazole (80 mg at the same time as clopidogrel) for 5 days. On Day 5, the mean

AUC of the active metabolite of clopidogrel was reduced by approximately 14% (geometric mean ratio

was 86%, with 90% CI of 79 to 93%) when pantoprazole was co-administered with clopidogrel as

compared to clopidogrel administered alone. Pharmacodynamic parameters were also measured and

demonstrated that the change in inhibition of platelet aggregation (induced by 5 μM ADP) was

correlated with the change in the exposure to clopidogrel active metabolite. The clinical significance

Geometric mean values

Median values

of this finding is not clear.

Mycophenolate Mofetil (MMF)

Administration of pantoprazole 40 mg twice daily for 4 days and a single 1000 mg dose of MMF

approximately one hour after the last dose of pantoprazole to 12 healthy subjects in a cross-over study

resulted in a 57% reduction in the C

and 27% reduction in the AUC of MPA. Transplant patients

receiving approximately 2000 mg per day of MMF (n=12) were compared to transplant patients

receiving approximately the same dose of MMF and pantoprazole 40 mg per day (n=21). There was a

78% reduction in the C

and a 45% reduction in the AUC of MPA in patients receiving both

pantoprazole and MMF [see Drug Interactions (7)].

Other Drugs

In vivo studies also suggest that pantoprazole does not significantly affect the kinetics of the following

drugs (cisapride, theophylline, diazepam [and its active metabolite, desmethyldiazepam], phenytoin,

metoprolol, nifedipine, carbamazepine, midazolam, clarithromycin, diclofenac, naproxen, piroxicam, and

oral contraceptives [levonorgestrel/ethinyl estradiol]). In other in vivo studies, digoxin, ethanol,

glyburide, antipyrine, caffeine, metronidazole, and amoxicillin had no clinically relevant interactions

with pantoprazole.

Although no significant drug-drug interactions have been observed in clinical studies, the potential for

significant drug-drug interactions with more than once-daily dosing with high doses of pantoprazole

has not been studied in poor metabolizers or individuals who are hepatically impaired.

Antacids

There was also no interaction with concomitantly administered antacids.

12.5 Pharmacogenomics

CYP2C19 displays a known genetic polymorphism due to its deficiency in some subpopulations (e.g.,

approximately 3% of Caucasians and African-Americans and 17% to 23% of Asians are poor

metabolizers). Although these subpopulations of pantoprazole poor metabolizers have elimination half-

life values of 3.5 to 10 hours in adults, they still have minimal accumulation (23% or less) with once-

daily dosing. For adult patients who are CYP2C19 poor metabolizers, no dosage adjustment is needed.

Similar to adults, pediatric patients who have the poor metabolizer genotype of CYP2C19 (CYP2C19

*2/*2) exhibited greater than a 6-fold increase in AUC compared to pediatric extensive (CYP2C19

*1/*1) and intermediate (CYP2C19 *1/*x) metabolizers. Poor metabolizers exhibited approximately

10 fold lower apparent oral clearance compared to extensive metabolizers.

For known pediatric poor metabolizers, a dose reduction should be considered.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

In a 24-month carcinogenicity study, Sprague-Dawley rats were treated orally with pantoprazole doses

of 0.5 to 200 mg/kg/day, about 0.1 to 40 times the exposure on a body surface area basis of a 50 kg

person dosed with 40 mg/day. In the gastric fundus, treatment with 0.5 to 200 mg/kg/day produced

enterochromaffin-like (ECL) cell hyperplasia and benign and malignant neuroendocrine cell tumors in a

dose-related manner. In the forestomach, treatment with 50 and 200 mg/kg/day (about 10 and 40 times the

recommended human dose on a body surface area basis) produced benign squamous cell papillomas and

malignant squamous cell carcinomas. Rare gastrointestinal tumors associated with pantoprazole

treatment included an adenocarcinoma of the duodenum with 50 mg/kg/day and benign polyps and

adenocarcinomas of the gastric fundus with 200 mg/kg/day. In the liver, treatment with 0.5 to 200

mg/kg/day produced dose-related increases in the incidences of hepatocellular adenomas and

carcinomas. In the thyroid gland, treatment with 200 mg/kg/day produced increased incidences of

follicular cell adenomas and carcinomas for both male and female rats.

In a 24-month carcinogenicity study, Fischer 344 rats were treated orally with doses of 5 to

50 mg/kg/day of pantoprazole, approximately 1 to 10 times the recommended human dose based on body

surface area. In the gastric fundus, treatment with 5 to 50 mg/kg/day produced enterochromaffin-like

(ECL) cell hyperplasia and benign and malignant neuroendocrine cell tumors. Dose selection for this

study may not have been adequate to comprehensively evaluate the carcinogenic potential of

pantoprazole.

In a 24-month carcinogenicity study, B6C3F1 mice were treated orally with doses of 5 to 150 mg/kg/day

of pantoprazole, 0.5 to 15 times the recommended human dose based on body surface area. In the liver,

treatment with 150 mg/kg/day produced increased incidences of hepatocellular adenomas and

carcinomas in female mice. Treatment with 5 to 150 mg/kg/day also produced gastric-fundic ECL cell

hyperplasia.

A 26-week p53 +/- transgenic mouse carcinogenicity study was not positive.

Pantoprazole was positive in the in vitro human lymphocyte chromosomal aberration assays, in one of

two mouse micronucleus tests for clastogenic effects, and in the in vitro Chinese hamster ovarian

cell/HGPRT forward mutation assay for mutagenic effects. Equivocal results were observed in the in

vivo rat liver DNA covalent binding assay. Pantoprazole was negative in the in vitro Ames mutation

assay, the in vitro unscheduled DNA synthesis (UDS) assay with rat hepatocytes, the in vitro AS52/GPT

mammalian cell-forward gene mutation assay, the in vitro thymidine kinase mutation test with mouse

lymphoma L5178Y cells, and the in vivo rat bone marrow cell chromosomal aberration assay.

There were no effects on fertility or reproductive performance when pantoprazole was given at oral

doses up to 500 mg/kg/day in male rats (98 times the recommended human dose based on body surface

area) and 450 mg/kg/day in female rats (88 times the recommended human dose based on body surface

area).

14 CLINICAL STUDIES

Pantoprazole Sodium Delayed-Release Tablets were used in the following clinical trials.

14.1 Erosive Esophagitis (EE) Associated with Gastroesophageal Reflux Disease (GERD)

Adult Patients

A US multicenter, double-blind, placebo-controlled study of Pantoprazole 10 mg, 20 mg, or 40 mg once

daily was conducted in 603 patients with reflux symptoms and endoscopically diagnosed EE of grade 2

or above (Hetzel-Dent scale). In this study, approximately 25% of enrolled patients had severe EE of

grade 3, and 10% had grade 4. The percentages of patients healed (per protocol, n = 541) in this study

are shown in Table 8.

Table 8: Erosive Esophagitis Healing Rates

(Per Protocol)

Pantoprazole

Placebo

Week

10 mg daily

(n = 153)

20 mg daily

(n = 158)

40 mg daily

(n = 162)

(n = 68)

45.6%

58.4%

75.0%

14.3%

66.0%

83.5%

92.6%

39.7%

(p < 0.001) Pantoprazole versus placebo

(p < 0.05) versus 10 mg Pantoprazole

(p < 0.05) versus 10 mg or 20 mg Pantoprazole

*†

*‡

*†

*‡

In this study, all Pantoprazole treatment groups had significantly greater healing rates than the placebo

group. This was true regardless of H. pylori status for the 40 mg and 20 mg Pantoprazole treatment

groups. The 40 mg dose of Pantoprazole resulted in healing rates significantly greater than those found

with either the 20 mg or 10 mg dose.

A significantly greater proportion of patients taking Pantoprazole 40 mg experienced complete relief of

daytime and nighttime heartburn and the absence of regurgitation, starting from the first day of treatment,

compared with placebo. Patients taking Pantoprazole consumed significantly fewer antacid tablets per

day than those taking placebo.

Pantoprazole 40 mg and 20 mg once daily were also compared with nizatidine 150 mg twice daily in a

US multicenter, double-blind study of 243 patients with reflux symptoms and endoscopically diagnosed

EE of grade 2 or above. The percentages of patients healed (per protocol, n = 212) are shown in Table

Table 9: Erosive Esophagitis Healing Rates

(Per Protocol)

Pantoprazole Nizatidine

Week

20 mg daily

(n = 72)

40 mg daily

(n = 70)

150 mg twice daily

(n = 70)

61.4%

64.0%

22.2%

79.2%

82.9%

41.4%

Once-daily treatment with Pantoprazole 40 mg or 20 mg resulted in significantly superior rates of

healing at both 4 and 8 weeks compared with twice-daily treatment with 150 mg of nizatidine. For the 40

mg treatment group, significantly greater healing rates compared to nizatidine were achieved regardless

of the H. pylori status.

A significantly greater proportion of the patients in the Pantoprazole treatment groups experienced

complete relief of nighttime heartburn and regurgitation, starting on the first day and of daytime

heartburn on the second day, compared with those taking nizatidine 150 mg twice daily. Patients taking

Pantoprazole consumed significantly fewer antacid tablets per day than those taking nizatidine.

Pediatric Patients Ages 5 Years through 16 Years

The efficacy of Pantoprazole in the treatment of EE associated with GERD in pediatric patients ages 5

years through 16 years is extrapolated from adequate and well-conducted trials in adults, as the

pathophysiology is thought to be the same. Four pediatric patients with endoscopically diagnosed EE

were studied in multicenter, randomized, double-blind, parallel-treatment trials. Children with

endoscopically diagnosed EE (defined as an endoscopic Hetzel-Dent score ≥ 2) were treated once daily

for 8 weeks with one of two dose levels of Pantoprazole (20 mg or 40 mg). All 4 patients with EE were

healed (Hetzel-Dent score of 0 or 1) at 8 weeks.

14.2 Long-Term Maintenance of Healing of Erosive Esophagitis

Two independent, multicenter, randomized, double-blind, comparator-controlled trials of identical

design were conducted in adult GERD patients with endoscopically confirmed healed EE to

demonstrate efficacy of Pantoprazole in long-term maintenance of healing. The two US studies enrolled

386 and 404 patients, respectively, to receive either 10 mg, 20 mg, or 40 mg of Pantoprazole Sodium

Delayed-Release Tablets once daily or 150 mg of ranitidine twice daily. As demonstrated in Table 10,

Pantoprazole 40 mg and 20 mg were significantly superior to ranitidine at every timepoint with respect

to the maintenance of healing. In addition, Pantoprazole 40 mg was superior to all other treatments

studied.

(p < 0.001) Pantoprazole versus nizatidine

Table 10: Long-Term Maintenance of Healing of Erosive Gastroesophageal Reflux

Disease (GERD Maintenance): Percentage of Patients Who Remained Healed

Note: Pantoprazole 10 mg was superior (p < 0.05) to ranitidine in Study 2, but not Study 1.

Pantoprazole

20 mg daily

Pantoprazole

40 mg daily

Ranitidine

150 mg twice daily

Study 1

n = 75

n = 74

n = 75

Month 1

Month 3

Month 6

Month 12

Study 2

n = 74

n = 88

n = 84

Month 1

Month 3

Month 6

Month 12

Pantoprazole 40 mg was superior to ranitidine in reducing the number of daytime and nighttime

heartburn episodes from the first through the twelfth month of treatment. Pantoprazole 20 mg,

administered once daily, was also effective in reducing episodes of daytime and nighttime heartburn in

one trial, as presented in Table 11.

Table 11: Number of Episodes of Heartburn (mean ±

SD)

Pantoprazole

40 mg daily

Ranitidine

150 mg twice daily

Month 1

Daytime

5.1 ± 1.6

18.3 ± 1.6

Nighttime

3.9 ± 1.1

11.9 ± 1.1

Month 12 Daytime

2.9 ± 1.5

17.5 ± 1.5

Nighttime

2.5 ± 1.2

13.8 ± 1.3

14.3 Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome

In a multicenter, open-label trial of 35 patients with pathological hypersecretory conditions, such as

Zollinger-Ellison Syndrome, with or without multiple endocrine neoplasia-type I, Pantoprazole

successfully controlled gastric acid secretion. Doses ranging from 80 mg daily to 240 mg daily

maintained gastric acid output below 10 mEq/h in patients without prior acid-reducing surgery and

below 5 mEq/h in patients with prior acid-reducing surgery.

Doses were initially titrated to the individual patient needs, and adjusted in some patients based on the

clinical response with time [see Dosage and Administration (2)]. Pantoprazole was well tolerated at these

dose levels for prolonged periods (greater than 2 years in some patients).

16 HOW SUPPLIED/STORAGE AND HANDLING

Product: 63739-564

(p < 0.05 vs. ranitidine)

(p < 0.05 vs. Pantoprazole 20 mg)

*†

*†

*†

*†

*†

*†

(p < 0.001 vs. ranitidine, combined data from the two US studies)

NDC: 63739-564-10 10 TABLET, DELAYED RELEASE in a BLISTER PACK / 10 in a BOX, UNIT-

DOSE

17 PATIENT COUNSELING INFORMATION

Advise the patient to read the FDA-approved patient labeling (Medication Guide).

Gastric Malignancy

Advise patients to return to their healthcare provider if they have a suboptimal response or an early

symptomatic relapse [see Warnings and Precautions (5.1)].

Acute Interstitial Nephritis

Advise patients to call their healthcare provider immediately if they experience signs and/or symptoms

associated with acute interstitial nephritis [see Warnings and Precautions (5.2)].

Clostridium difficile-Associated Diarrhea

Advise patients to immediately call their healthcare provider if they experience diarrhea that does not

improve [see Warnings and Precautions (5.3)].

Bone Fracture

Advise patients to report any fractures, especially of the hip, wrist or spine, to their healthcare provider

[see Warnings and Precautions (5.4)].

Cutaneous and Systemic Lupus Erythematosus

Advise patients to immediately call their healthcare provider for any new or worsening of symptoms

associated with cutaneous or systemic lupus erythematosus [see Warnings and Precautions (5.5)].

Cyanocobalamin (Vitamin B-12) Deficiency

Advise patients to report any clinical symptoms that may be associated with cyancobalamin deficiency to

their healthcare provider if they have been receiving Pantoprazole for longer than 3 years [see Warnings

and Precautions (5.6)].

Hypomagnesemia

Advise patients to report any clinical symptoms that may be associated with hypomagnesemia to their

healthcare provider, if they have been receiving Pantoprazole for at least 3 months [see Warnings and

Precautions (5.7)].

Drug Interactions

Instruct patients to inform their healthcare provider of any other medications they are currently taking,

including rilpivirine-containing products [see Contraindications (4)] digoxin [see Warnings and

Precautions (5.7)] and high dose methotrexate [see Warnings and Precautions (5.12)].

Pregnancy

Advise a pregnant woman of the potential risk to a fetus. Advise females of reproductive potential to

inform their healthcare provider of a known or suspected pregnancy [see Use in Specific Populations

(8.1)].

Administration

Do not split, crush, or chew Pantoprazole Sodium Delayed-Release Tablets.

Swallow Pantoprazole Sodium Delayed-Release Tablets whole, with or without food in the

stomach.

Concomitant administration of antacids does not affect the absorption of Pantoprazole Sodium

Delayed-Release Tablets.

Take a missed dose as soon as possible. If it is almost time for the next dose, skip the missed dose

and take the next dose at the regular scheduled time. Do not take 2 doses at the same time.

This product’s label may have been updated. For current full prescribing information, call 1-844-834-

0530.

Distributed by:

Lannett Company, Inc.

Philadelphia, PA 19136

CIA72949S

Rev. 05/2019

MEDICATION GUIDE

Pantoprazole (pan-TOE-pruh-zole) Sodium Delayed-Release Tablets,

USP

CIA77568N Rev. 05/2019

What is the most important information I should know about Pantoprazole?

You should take Pantoprazole exactly as prescribed, at the lowest dose possible and for the

shortest time needed.

Pantoprazole may help your acid-related symptoms, but you could still have serious stomach

problems. Talk with your doctor.

Pantoprazole can cause serious side effects, including:

A type of kidney problem (acute interstitial nephritis). Some people who take proton pump

inhibitor (PPI) medicines, including Pantoprazole, may develop a kidney problem called acute

interstitial nephritis that can happen at any time during treatment with Pantoprazole. Call your doctor

right away if you have a decrease in the amount that you urinate or if you have blood in your urine.

Diarrhea caused by an infection (Clostridium difficile) in your intestines. Call your doctor right

away if you have watery stools or stomach pain that does not go away. You may or may not have a

fever.

Bone fractures (hip, wrist, or spine). Bone fractures in the hip, wrist, or spine may happen in

people who take multiple daily doses of PPI medicines for a long period of time (a year or longer).

Tell your doctor if you have a bone fracture, especially in the hip, wrist, or spine.

Certain types of lupus erythematosus. Lupus erythematosus is an autoimmune disorder (the

body’s immune cells attack other cells or organs in the body). Some people who take PPI medicines,

including Pantoprazole, may develop certain types of lupus erythematosus or have worsening of the

lupus they already have. Call your doctor right away if you have new or worsening joint pain or a

rash on your cheeks or arms that gets worse in the sun.

Talk to your doctor about your risk of these serious side effects.

Pantoprazole can have other serious side effects. See “What are the possible side effects of

Pantoprazole?”

What is Pantoprazole?

A prescription medicine called a proton pump inhibitor (PPI) used to reduce the amount of acid in your

stomach.

In adults, Pantoprazole is used for:

up to 8 weeks for the healing and symptom relief of acid-related damage to the lining of the

esophagus (called erosive esophagitis or EE). Your doctor may prescribe another 8 weeks of

Pantoprazole in patients whose EE does not heal.

maintaining healing of EE and to help prevent the return of heartburn symptoms caused by GERD. It

is not known if Pantoprazole is safe and effective when used longer than 12 months for this purpose.

the long-term treatment of conditions where your stomach makes too much acid. This includes a

rare condition called Zollinger-Ellison Syndrome.

In children 5 years of age and older, Pantoprazole is used for:

up to 8 weeks for the healing and symptom relief of EE.

It is not known if Pantoprazole is safe if used longer than 8 weeks in children.

Pantoprazole is not for use in children under 5 years of age.

It is not known if Pantoprazole is safe and effective in children for treatement other than EE.

Do not take Pantoprazole if you are:

allergic to pantoprazole sodium, any other PPI medicine, or any of the ingredients in Pantoprazole.

See the end of this Medication Guide for a complete list of ingredients.

taking a medicine that contains rilpivirine (EDURANT, COMPLERA, ODEFSEY, JULUCA) used

to treat HIV-1 (Human Immunodeficiency Virus).

Before taking Pantoprazole, tell your doctor about all of your medical conditions, including if you:

have low magnesium levels in your blood.

are pregnant or plan to become pregnant. Pantoprazole may harm your unborn baby. Tell your doctor

if you become pregnant or think you may be pregnant during treatment with Pantoprazole.

are breastfeeding or plan to breastfeed. Pantoprazole can pass into your breast milk. Talk with your

doctor about the best way to feed your baby if you take Pantoprazole.

Tell your doctor about all of the medicines you take, including prescription and over-the-counter

medicines, vitamins and herbal supplements. Especially tell your doctor if you take methotrexate

(Otrexup, Rasuvo, Trexall, XATMEP), digoxin (LANOXIN), or a water pill (diuretic).

How should I take Pantoprazole?

Take Pantoprazole exactly as prescribed by your doctor.

Pantoprazole delayed-release tablets (Pantoprazole tablets):

Do not split, chew, or crush Pantoprazole tablets.

Swallow Pantoprazole tablets whole, with or without food.

Tell your doctor if you are not able to swallow your Pantoprazole tablet.

You may use antacids while taking Pantoprazole tablets.

If you miss a dose of Pantoprazole, take it as soon as possible. If it is almost time for your next

dose, do not take the missed dose. Take the next dose at your regular time. Do not take 2 doses at the

same time.

If you take too much Pantoprazole, call your doctor or your poison control center at 1-800-222-

1222 right away or go to the nearest emergency room.

What are the possible side effects of Pantoprazole?

Pantoprazole can cause serious side effects, including:

See “What is the most important information I should know about Pantoprazole?”

Low vitamin B-12 levels in your body can happen in people who have taken Pantoprazole for a long

time (more than 3 years). Tell your doctor if you have symptoms of low vitamin B-12 levels,

including shortness of breath, lightheadedness, irregular heartbeat, muscle weakness, pale skin,

feeling tired, mood changes, and tingling or numbness in the arms and legs.

Low magnesium levels in your body can happen in people who have taken Pantoprazole for at

least 3 months. Tell your doctor if you have symptoms of low magnesium levels, including

seizures, dizziness, irregular heartbeat, jitteriness, muscle aches or weakness, and spasms of hands,

feet or voice.

Stomach growths (fundic gland polyps). People who take PPI medicines for a long time have an

increased risk of developing a certain type of stomach growths called fundic gland polyps,

especially after taking PPI medicines for more than 1 year.

The most common side effects of Pantoprazole in adults include: headache, diarrhea, nausea,

stomach-area (abdominal) pain, vomiting, gas, dizziness, and joint pain.

The most common side effects of Pantoprazole in children include: upper respiratory infection,

headache, fever, diarrhea, vomiting, rash, and stomach-area (abdominal) pain.

These are not all the possible side effects of Pantoprazole. Call your doctor for medical advice about

side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store Pantoprazole?

Store Pantoprazole at room temperature between 59° to 86°F (15° to 30°C).

Keep Pantoprazole and all medicines out of the reach of children.

General information about the safe and effective use of Pantoprazole.

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not

use Pantoprazole for a condition for which it was not prescribed. Do not give Pantoprazole to other

people, even if they have the same symptoms that you have. It may harm them. You can ask your doctor

or pharmacist for information about Pantoprazole that is written for health professionals.

What are the ingredients in Pantoprazole?

Active ingredient: pantoprazole sodium sesquihydrate

Inactive ingredients in Pantoprazole Sodium Delayed-Release Tablets: crospovidone, glyceryl

dibehenate, hypromellose, lactose monohydrate, methacrylic acid copolymer dispersion, talc, titanium

dioxide, and triethyl citrate. The 20 mg tablets also contains black iron oxide, isopropyl alcohol, and

propylene glycol.

For more information, call 1-844-834-0530.

This Medication Guide has been approved by the U.S. Food and Drug Administration.

This product's label may have been updated. For more information, call 1-844-834-0530.

Distributed by:

Lannett Company, Inc.

Philadelphia, PA 19136

CIA77568N

Rev. 05/2019

All brand names are the trademarks of their respective owners.

Pantoprazole Sodium

PANTOPRAZOLE SODIUM

pantoprazole sodium tablet, delayed release

Product Information

Product T ype

HUMAN PRESCRIPTION DRUG

Ite m Code (Source )

NDC:6 3739 -56 4(NDC:6 2175-6 17)

Route of Administration

ORAL

Active Ingredient/Active Moiety

Ingredient Name

Basis of Strength

Stre ng th

PANTO PRAZO LE SO DIUM (UNII: 6 8 716 19 Q5X) (PANTOPRAZOLE - UNII:D8 TST4O56 2)

PANTOPRAZOLE

40 mg

Inactive Ingredients

Ingredient Name

Stre ng th

FERRO SO FERRIC O XIDE (UNII: XM0 M8 7F357)

CRO SPO VIDO NE, UNSPECIFIED (UNII: 2S78 30 E56 1)

GLYCERYL DIBEHENATE (UNII: R8 WTH25YS2)

HYPRO MELLO SE, UNSPECIFIED (UNII: 3NXW29 V3WO)

LACTO SE MO NO HYDRATE (UNII: EWQ57Q8 I5X)

TALC (UNII: 7SEV7J4R1U)

TITANIUM DIO XIDE (UNII: 15FIX9 V2JP)

TRIETHYL CITRATE (UNII: 8 Z9 6 QXD6 UM)

METHACRYLIC ACID - METHYL METHACRYLATE CO PO LYMER ( 1:1) (UNII: 74G4R6 TH13)

McKesson Corporation dba SKY Packaging

Product Characteristics

Color

WHITE

S core

no sco re

S hap e

OVAL

S iz e

12mm

Flavor

Imprint Code

Contains

Packag ing

#

Item Code

Package Description

Marketing Start Date Marketing End Date

1

NDC:6 3739 -56 4-10

10 in 1 BOX, UNIT-DOSE

0 1/20 /20 11

1

10 in 1 BLISTER PACK; Type 0 : No t a Co mbinatio n Pro duct

Marketing Information

Marke ting Cate gory

Application Numbe r or Monograph Citation

Marke ting Start Date

Marke ting End Date

ANDA

ANDA0 78 28 1

0 1/20 /20 11

Labeler -

McKesson Corporation dba SKY Packaging (140529962)

Establishment

Name

Ad d re s s

ID/FEI

Busine ss Ope rations

McKesso n Co rpo ratio n dba RX Pak

0 2518 328 1

REPACK(6 3739 -56 4)

Revised: 9/2019

Panašūs produktai

Ieškokite perspėjimų, susijusių su šiuo produktu

Peržiūrėti dokumentų istoriją

Pasidalykite šia informacija