PANTOPRAZOLE SODIUM - pantoprazole sodium tablet, delayed release
Unit Dose Services
HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use pantoprazole sodium delayed-release tablets, USP safely and effectively. See full prescribing information for pantoprazole sodium delayed-release tablets, USP. Pantoprazole Sodium Delayed-Release Tablets, USP Initial U.S. approval: 2000
RECENT MAJOR CHANGES
Indications and Usage, Pediatric (1) 11/2009 Dosage and Administration, Pediatric (2) 11/2009 Contraindications (4) 11/2009 Warnings and Precautions, Bone Fracture (5.4) 09/2010
INDICATIONS AND USAGE
Pantoprazole sodium delayed-release tablet is a proton pump inhibitor indicated for the following:
DOSAGE AND ADMINISTRATION
DOSAGE FORMS AND STRENGTHS
Known hypersensitivity to any component of the formulation or to substituted benzimidazoles (4)
WARNINGS AND PRECAUTIONS
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)
The most frequently occurring adverse reactions are as follows:
To report SUSPECTED ADVERSE REACTIONS, contact Wockhardt USA LLC. at 1-800-346-6854 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch
Information describing use in pediatric patients with erosive esophagitis associated with GERD is approved for Wyeth Pharmaceuticals Inc.'s pantoprazole sodium delayed-release tablets. However, due to Wyeth Pharmaceuticals Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information.
See 17 for PATIENT COUNSELING INFORMATION.
FULL PRESCRIBING INFORMATION: CONTENTS*
1.1 Short-Term Treatment of Erosive Esophagitis Associated With Gastroesophageal Reflux Disease (GERD)
|* For adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of pantoprazole sodium delayed-release tablets may be considered.
** Dosage regimens should be adjusted to individual patient needs and should continue for as long as clinically indicated. Doses up to 240 mg daily have been administered.
|Short-Term Treatment of Erosive Esophagitis Associated With GERD
|Adults||40 mg||Once daily for up to 8 weeks*|
|Maintenance of Healing of Erosive Esophagitis
|Adults||40 mg||Once daily|
|Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome
|Adults||40 mg||Twice daily**|
|* Patients should be cautioned that pantoprazole sodium delayed-release tablets should not be split, chewed, or crushed|
||Oral||Swallowed whole, with or without food|
|Pantoprazole sodium delayed-release tablets (n=1473) %
||Comparators (n=345) %
||Placebo (n=82) %
|Headache Diarrhea Nausea Abdominal pain Vomiting Flatulence Dizziness Arthralgia
||12.2 8.8 7 6.2 4.3 3.9 3 2.8
||12.8 9.6 5.2 4.1 3.5 2.9 2.9 1.4
||8.5 4.9 9.8 6.1 2.4 3.7 1.2 1.2
Concomitant use of atazanavir or nelfinavir with proton pump inhibitors is not recommended. Coadministration of atazanavir or nelfinavir with proton pump inhibitors is expected to substantially decrease atazanavir or nelfinavir plasma concentrations and may result in a loss of therapeutic effect and development of drug resistance.
There have been postmarketing reports of increased INR and prothrombin time in patients receiving proton pump inhibitors, including pantoprazole sodium delayed-release tablets, and warfarin concomitantly. Increases in INR and prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly should be monitored for increases in INR and prothrombin time.
Pantoprazole causes long-lasting inhibition of gastric acid secretion. Therefore, pantoprazole may interfere with absorption of drugs where gastric pH is an important determinant of their bioavailability (e.g., ketoconazole, ampicillin esters, and iron salts).
Pantoprazole and its metabolites are excreted in the milk of rats. Pantoprazole excretion in human milk has been detected in a study of a single nursing mother after a single 40 mg oral dose. The clinical relevance of this finding is not known. Many drugs which are excreted in human milk have a potential for serious adverse reactions in nursing infants. Based on the potential for tumorigenicity shown for pantoprazole in rodent carcinogenicity studies, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the benefit of the drug to the mother.
The effectiveness of pantoprazole sodium delayed-release tablets for treating symptomatic GERD in pediatric patients has not been established. Information describing use in pediatric patients with erosive esophagitis associated with GERD is approved for Wyeth Pharmaceuticals Inc.'s pantoprazole sodium delayed-release tablets. However, due to Wyeth Pharmaceuticals Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information.
In short-term U.S. clinical trials, erosive esophagitis healing rates in the 107 elderly patients (≥ 65 years old) treated with pantoprazole sodium delayed-release tablets 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.
Erosive esophagitis healing rates in the 221 women treated with pantoprazole sodium delayed-release tablets in U.S. clinical trials were similar to those found in men. In the 122 women treated long-term with pantoprazole sodium delayed-release tablets 40 mg or 20 mg, healing was maintained at a rate similar to that in men. The incidence rates of adverse reactions were also similar for men and women.
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]1 -benzimidazole sesquihydrate, a compound that inhibits gastric acid secretion. Its empirical formula is C H F N NaO S x 1.5 H O, with a molecular weight of 432.4. The structural formula is: Pantoprazole sodium sesquihydrate, USP is a white to off-white powder and is racemic. Pantoprazole has weakly basic and acidic properties. Pantoprazole sodium sesquihydrate, USP is freely soluble in water and practically insoluble in 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 sodium is supplied as a delayed-release tablet for oral administration, available in 2 strengths (40 mg and 20 mg). Each delayed-release tablet contains 45.1 mg or 22.56 mg of pantoprazole sodium sesquihydrate USP (equivalent to 40 mg or 20 mg pantoprazole, respectively) with the following inactive ingredients: aerosil 200, calcium stearate, colloidal silicon dioxide, mannitol, pregelatinized starch, shellac glaze, sodium carbonate anhydrous, sodium starch glycolate and talc. Each delayed-release tablet contains ammonium hydroxide, eudragit L 100-55, FD and C Blue #2, hypromellose, iron oxide black, iron oxide red, iron oxide yellow, polyethylene glycol 400, polyethylene glycol 4000, polyethylene glycol 6000, propylene glycol, sodium hydroxide, titanium dioxide and triethyl citrate as the coating ingredients. Pantoprazole sodium delayed-release tablets USP, 20 mg and 40 mg, meet USP Dissolution Test 3. H16142342
|–––––––—––––––––Median pH on day 7—–––––––––––––
|Time||Placebo||20 mg||40 mg||80 mg|
|* Significantly different from placebo
# Significantly different from 20 mg
|8 a.m. - 8 a.m. (24 hours)
|8 a.m. - 10 p.m. (Daytime)
|10 p.m. - 8 a.m. (Nighttime)
|–––––––––––Pantoprazole Sodium Delayed-Release Tablets–––––––––––||Placebo|
|Week||10 mg daily (n = 153)
||20 mg daily (n = 158)
||40 mg daily (n = 162)
||(n = 68)|
|(p < 0.001) pantoprazole sodium delayed-release tablets versus placebo +
* (p < 0.05) versus 10 mg or 20 mg pantoprazole sodium delayed-release tablets
# (p < 0.05) versus 10 mg pantoprazole sodium delayed-release tablets
|4||45.6% +||58.4% # +||75% * +||14.3%|
|8||66% +||83.5 % # +||92.6% * +||39.7%|
––––Pantoprazole Sodium Delayed-Release Tablets–––––
|Week||20 mg daily (n = 72)
||40 mg daily (n = 70)
||150 mg twice daily (n = 70)
|(p < 0.001) pantoprazole sodium delayed-release tablets versus nizatidine +|
|4||61.4% +||64% +||22.2%|
|8||79.2% +||82.9% +||41.4%|
|Pantoprazole Sodium Delayed-Release Tablets 20 mg daily
||Pantoprazole Sodium Delayed-Release Tablets 40 mg daily
||Ranitidine 150 mg twice daily
|* (p < 0.05 vs. ranitidine)
# (p < 0.05 vs. pantoprazole sodium delayed-release tablets 20 mg)
Note: Pantoprazole sodium delayed-release tablet 10 mg was superior (p < 0.05) to ranitidine in Study 2, but not Study 1.
||n = 75||n = 74||n = 75|
|Month 1 Month 3 Month 6 Month 12
||91* 82* 76* 70*
||99* 93*# 90*# 86*#
||68 54 44 35
||n = 74||n = 88||n = 84|
|Month 1 Month 3 Month 6 Month 12
||89* 78* 72* 72*
||92*# 91*# 88*# 83*
||62 47 39 37
|Pantoprazole Sodium Delayed-Release Tablet 40 mg daily
||Ranitidine 150 mg twice daily
|* (p < 0.001 vs. ranitidine, combined data from the two US studies)|
|Month 1||Daytime Nighttime
||5.1 ± 1.6* 3.9 ± 1.1*
||18.3 ± 1.6 11.9 ± 1.1
|Month 12||Daytime Nighttime
||2.9 ± 1.5* 2.5 ± 1.2*
||17.5 ± 1.5 13.8 ± 1.3
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 sodium delayed-release tablets 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 [ ]. Pantoprazole sodium delayed-release tablet was well tolerated at these dose levels for prolonged periods (greater than 2 years in some patients).
see Dosage and Administration (2)
pantoprazole sodium tablet, delayed release
|Labeler - Unit Dose Services (831995316)|
|Registrant - Unit Dose Services (831995316)|
|Unit Dose Services||831995316||REPACK(50436-8102)|