Pantoprazole 40 Mg Powder For Solution For Injection
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Package leaflet: Information for the user
Pantoprazole 40 mg Powder for Solution for Injection
Pantoprazole
Read all of this leaflet carefully before you
start using this medicine because it contains
important information for you.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, or pharmacist or nurse.
• If you get side effects, talk to your doctor, or pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section4.
What is in this leaflet
1. What Pantoprazole 40 mg Powder for Solution for Injection is and what it is used for
2. What you need to know before you use Pantoprazole 40 mg Powder for Solution for Injection
3. How to use Pantoprazole 40 mg Powder for Solution for Injection
4. Possible side effects
5. How to store Pantoprazole 40 mg Powder for Solution for Injection
6. Content of the pack and other information
1. What Pantoprazole 40 mg Powder for Solution for Injection is and what it is used for
Pantoprazole is a selective “proton pump inhibitor”, a medicine which reduces the amount of acid produced in your stomach. It is used for treating acid-related diseases of the stomach and intestine.
• chest pain
• stomach pain
• severe and/or persistent diarrhoea, as Pantoprazole 40 mg Powder for Solution for Injection has been associated with a small increase in infectious diarrhoea.
Your doctor may decide that you need some tests to rule out malignant disease because pantoprazole also alleviates the symptoms of cancer and could cause delay in diagnosing it. If your symptoms continue in spite of your treatment, further investigations will be considered.
Children and adolescents
Pantoprazole is not recommended for use in children as it has not been proven to work in children below 18 years of age.
Other medicines and Pantoprazole 40 mg Powder for Solution for Injection
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines that you buy without a prescription. This is because pantoprazole can affect the way some medicines work and some medicines can have an effect on pantoprazole.
Tell your doctor if you are taking any of the following medicines:
• Medicines such as ketoconazole, itraconazole and posaconazole (used to treat fungal infections) or erlotinib (used for certain types of cancer) because Pantoprazole may stop these and other medicines from working properly.
• Warfarin and phenprocoumon, which affect the thickening, or thinning of the blood. You may need further checks.
• Atazanavir (used to treat HIV-infection).
Methotrexate (used to treat rheumatoid arthritis, psoriasis, and cancer) - if you are taking methotrexate your doctor may temporarily stop your Pantoprazole 40 mg Powder for Solution for Injection treatment because pantoprazole can increase levels of methotrexate in the blood.
This preparation is injected into a vein and will only be given to you if your doctor thinks pantoprazole injections are more suitable for you at the moment than pantoprazole tablets. Tablets will replace your injections as soon as your doctor sees fit.
Pantoprazole 40 mg Powder for Solution for Injection is used for treating:
• Reflux oesophagitis. An inflammation of your oesophagus (the tube which connects your throat to your stomach) accompanied by the regurgitation of stomach acid.
• Stomach and duodenal ulcers.
• Zollinger-Ellison-Syndrome and other conditions producing too much acid in the stomach.
2. What you need to know before you use Pantoprazole 40 mg Powder for Solution for Injection
Do not use Pantoprazole 40 mg Powder for Solution for Injection
• If you are allergic to pantoprazole or any of the other ingredients of this medicine (listed in section 6).
• If you are allergic to medicines containing other proton pump inhibitors.
Warnings and precautions
Talk to your doctor or pharmacist or nurse before using Pantoprazole 40 mg Powder for Solution for Injection :
• if you have severe liver problems. Please tell your doctor if you ever had problems with your liver in the past. He will check your liver enzymes more frequently. In the case of a rise of liver enzymes the treatment should be stopped.
• if you are taking a medicine containing atazanavir (for the treatment of HIV-infection) at the same time as pantoprazole, ask your doctor for specific advice.
• People who take multiple daily doses of proton pump inhibitor medicines for a long period of time (a year or longer) may have an increased risk of fractures of the hip, wrist or spine. Talk to your doctor about your risk of bone fracture if you take Pantoprazole.
• if you have low magnesium levels in your body. This problem can be serious. Low magnesium can happen in some people who take proton pump inhibitor medicine for at least 3 months. If low magnesium levels happen, it is usually after a year of treatment. You may or may not have symptoms of low magnesium.
• if you have ever had a skin reaction after treatment with a medicine similar to Pantoprazole that reduces stomach acid.
• if you are due to have a specific blood test (Chromogranin A)
If you get a rash on you skin, especially in areas exposed to the sun tell your doctor as soon as you can, as you may need to stop your treatment with Pantoprazole. Remember to also mention any other ill-effects like pain in your joints.
Tell your doctor immediately before or after taking this medicine, if you notice any of the following symptoms: an unintentional loss of weight
• repeated vomiting
• difficulty in swallowing or pain when swallowing
• vomiting blood; this may appear as dark coffee grounds in your vomit
• you look pale and feel weak (anaemia)
• you notice blood in your stools; Which may be black or tarry in appearance
Pregnancy, breast-feeding and fertility
There are no adequate data from the use of pantoprazole in pregnant women. Excretion into human milk has been reported. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Driving and using machines
If you experience side effects like dizziness or disturbed vision, you should not drive or operate machines.
Pantoprazole 40 mg Powder for Solution for Injection contains sodium
This medicine contains less than 1 mmol sodium (23 mg) per vial, i.e. is essentially 'sodium- free'.
3. How to use Pantoprazole 40 mg Powder for Solution for Injection
Your nurse or your doctor will administer the daily dose to you as an injection into a vein over a period of 2 - 15 minutes.
The recommended dose is:
Adults
For gastric ulcers, duodenal ulcers and reflux oesophagitis.
One vial (40 mg pantoprazole) a day.
For the long-term treatment of Zollinger-Ellison syndrome and other conditions in which too much stomach acid is produced.
Two vials (80 mg pantoprazole) a day.
Your doctor may later adjust the dose, depending on the amount of stomach acid you produce. If you are prescribed more than two vials (80 mg) a day, the injections will be given in two equal doses. Your doctor may prescribe a temporary dose of more than four vials (160 mg) a day. If your stomach acid level needs to be controlled rapidly, a starting dose of 160 mg (four vials) should be enough to lower the amount of stomach acid sufficiently.
• Hepatic Impairment: If you suffer from severe liver problems, the daily injection should be only 20 mg (half a vial).
• Use in children and adolescents: Children (under 18 years). These injections are not recommended for use in children.
If you use more Pantoprazole 40 mg Powder for Solution for Injection than you should
These doses are carefully checked by your nurse or your doctor so an overdose is extremely unlikely. There are no known symptoms of overdose.
If you have any further questions about the use of this medicine, ask your doctor or pharmacist or nurse.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
If you get any of the following side effects, tell your doctor immediately, or contact the casualty department at your nearest hospital:
• Serious allergic reactions (frequency rare, may affect up to 1 in 1,000 people): swelling
The following information is intended for healthcare professionals only
A ready-to-use solution is prepared by injecting 10 ml of sodium chloride 9 mg/ml (0.9 %) solution for injection into the vial containing the dry powder. This solution may either be administered directly or after mixing it with 100 ml sodium chloride 9 mg/ml (0.9 %) solution for injection or glucose 55 mg/ml (5 %) solution for injection. Glass or plastic containers should be used for dilution.
Pantoprazole 40 mg Powder for Solution for Injection should not be prepared or mixed with solvents other than those stated.
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of the tongue and/or throat, difficulty in swallowing, hives (nettle rash), difficulties in breathing, allergic facial swelling (Quincke's oedema / angioedema), severe dizziness with very fast heartbeat and heavy sweating.
• Serious skin conditions (frequency not known, frequency cannot be estimated from the available data): blistering of the skin and rapid deterioration of your general condition, erosion (including slight bleeding) of eyes, nose, mouth/lips or genitals (Stevens-Johnson-Syndrome, Lyell-Syndrome, Erythema multiforme), and sensitivity to light.
• Other serious conditions (frequency not known, frequency cannot be estimated from the available data): yellowing of the skin or whites of the eyes (severe damage to liver cells, jaundice) or fever, rash, and enlarged kidneys sometimes with painful urination, and lower back pain (serious inflammation of the kidneys).
Other side effects are:
• Common (may affect up to 1 in 10 people) inflammation of the wall of the vein and blood clotting (thrombophlebitis) where the medicine is injected.
• Uncommon (may affect up to 1 in 100 people) headache; dizziness; diarrhoea; feeling sick, vomiting; bloating and flatulence (wind); constipation; dry mouth; abdominal pain and discomfort; skin rash, exanthema, eruption; itching; feeling weak, exhausted or generally unwell; sleep disorders.
Taking a proton pump inhibitor like pantoprazole, especially over a period of more than one year, may slightly increase your risk of fracture in the hip, wrist or spine. Tell your doctor if you have osteoporosis or if you are taking corticosteroids (which can increase the risk of osteoporosis).
• Rare (may affect up to 1 in 1,000 people) distortion or complete lack of the sense of taste; disturbances in vision such as blurred vision; hives; pain in the joints; muscle pains; weight changes; raised body temperature; high fever; swelling of the extremities (peripheral oedema); allergic reactions; depression; breast enlargement in males.
• Very Rare (may affect up to 1 in 10,000 people) disorientation.
• Not known (frequency cannot be estimated from the available data)
Hallucination, confusion (especially in patients with a history of these symptoms); decreased sodium level in blood, feeling of tingling, prickling, pins and needles, burning sensation or numbness; low levels of potassium which can cause muscle weakness, twitching or abnormal heart rhythm; muscle spasm or cramps; low levels of calcium.
If you are on Pantoprazole for more than three months it is possible that the levels of magnesium in your blood may fall. Low levels of magnesium can be seen as fatigue, involuntary muscle contractions, disorientation, convulsions, dizziness, increased heart rate. If you get any of these symptoms, please tell your doctor promptly. Low levels of magnesium can also lead to a reduction in potassium or calcium levels in the blood. Your doctor may decide to perform regular blood tests to monitor your levels of magnesium (see section 2).
Rash, possibly with pain in the joints
Side effects identified through blood tests:
• Uncommon (may affect up to 1 in 100 people) an increase in liver enzymes.
• Rare (may affect up to 1 in 1,000 people)
an increase in bilirubin; increased fat levels in blood; sharp drop in circulating granular white blood cells, associated with high fever.
• Very Rare (may affect up to 1 in 10,000 people) a reduction in the number of blood platelets, which may cause you to bleed or bruise more than normal; a reduction in the number of white blood cells, which may lead to more frequent infections; coexisting abnormal reduction in the number of red and white blood cells, as well as platelets.
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at:www.mhra.gov.uk/yellowcard.. By reporting side effects you can help provide more information on the safety of this medicine.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Contents of the pack and other information
What Pantoprazole 40 mg Powder for Solution for Injection contains:
Pantoprazole 40 mg Powder for Solution for Injection contains the active substance Pantoprazole (as sodium sesquihydrate).
Each vial of powder for solution for injection contains 42.29 mg of pantoprazole sodium equivalent to 40 mg of pantoprazole.
The other ingredient is sodium hydroxide. (See section 2 for sodium content).
What Pantoprazole 40 mg Powder for Solution for Injection looks like and contents of the pack:
Pantoprazole 40 mg Powder for Solution for Injection is white to off white, lyophilized powder. This is made into solution before it is given to you.
Pack sizes:
1 vial 10 vials 20 vials 50 vials
Not all pack sizes may be marketed.
Marketing Authorisation Holder and manufacturer
Marketing Authorisation Holder
Accord Healthcare Limited,
Sage House,
319 Pinner Road,
North Harrow,
Middlesex, HA1 4HF,
United Kingdom
Manufacturer
Accord Healthcare Limited,
Sage House,
319 Pinner Road,
North Harrow,
Middlesex, HA1 4HF,
United Kingdom
Wessling Hungary Kft Foti ut 56 , Budapest 1047 Hungary
The leaflet was last revised in 09/2016.
5. How to store Pantoprazole 40 mg Powder for Solution for Injection
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton or vial after EXP. The expiry date refers to the last day of that month.
Do not store above 25 °C. Keep the vial in the outer container in order to protect from light.
After reconstitution, or reconstitution and dilution, chemical and physical in use stability has been demonstrated for 12 hours at 25 °C. From a microbiological point of view, unless the method of opening and dilution precludes the risk of microbial contamination, the product should be used immediately.
Do not use this medicine if you notice that the visual appearance has changed (e.g. if cloudiness or precipitation is observed).
After preparation, the solution must be used within 12 hours. From a microbiological point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 12 hours, at no more than 25 °C.
The medicine should be administered intravenously over 2 - 15 minutes.
The content of the vial is for single intravenous use only. Any product that has remained in the container or whose visual appearance has changed (e.g. if cloudiness or precipitation is observed) must be discarded.