Role of pantaprazole and Domperidone in the treatment of Gastroesophageal reflux disease treatment pharmacology, indication, adverse effects, contradiction

1. Gastroesophageal reflux disease (GERD) is one of the commonest
problems faced by clinicians in their day to day practice. Besides life
style modifications and general measures, inhibition of gastric acid
secretion and prokinetic gastro intestinal agents to prevent reflux have
an important role to play in the management of GERD.
Proton pump inhibitors are commonly used in the treatment of patients
with GERD as they provide the most rapid symptomatic control and
best healing rates among the available agents is a combination of
Pantoprazole, a potent inhibitor of gastric acid secretion and
Domperidone, a prokinetic agent which has the property of
strengthening the tone and contractions of the gut wall in particular the
tone of the lower esophageal sphincter. Together they relieve belching,
bloating, nausea, heartburn and acid regurgitation.

3. Pantoprazole is a proton pump inhibitor which blocks the final and
common step in gastric acid secretion. It has the advantage of being a
very potent inhibitor of gastric acid output. It exerts its action by
specific inhibition of the H+/K+ATPase enzyme system (proton pump) at
the secretory surface of the apical membrane of the gastric parietal cell.
Pantoprazole is appreciably more effective than H2 antagonist in the
treatment of reflux esophagitis.
Domperidone is a synthetic agent having potent dopamine receptor
antagonist properties. It is postulated that Domperidone causes an
antiemetic action by blocking dopamine receptors. It incre motility.
Nausea and vomiting frequently occur in reflux esophagitis which is
relieved by Domperidone Furthermore, Domperidone causes relaxation
of the pylorus and duodenum while the tone of the lower esophageal
sphincter is enhanced. These effects combine to accelerate the

4. emptying of the gastric contents and to reduce reflux from the
duodenum and stomach into the esophagus.
Domperidone is usually administered as 10-20 mg. 2-3 times daily
before meals. Administration of Domperidone (30 mg.) as sustained
release pellets enables once daily administration of the medication.
Incorporation of Domperidone in sustained release form allows once a
day administration of the combination. This improves the patient
compliance without compromising on the efficacy.
Indications:
Reflux or ulcerative esophagitis.
Dosage and Administration :
Gastro esophageal reflux disease (GERD) : Healing of erosive
esophagitis. One capsule a day for 4-8 weeks.
Maintenance of healing of erosive esophagitis : One combination
capsule a day for upto 6 months,
Adverse Reactions and Interactions :
Usually Well tolerated.
G. I. disturbances and drowsiness may occur.
Hypergastrinemia may occur due to prolonged achlorhydria.

5. Prolong the half life of diazepam, phenytoin.
Contraindications :
Known hypersensitivity to any component of the formulation.