Antaxid Drug Interactions

Pantoprazole is metabolized through the cytochrome P450 system, primarily the CYP2C19 and CYP3A4 isozymes, and subsequently undergoes Phase II conjugation (see Pharmacology: Drug-Drug Interactions under Actions).
Based on studies evaluating possible interactions of pantoprazole with other drugs, no dosage adjustments is needed with concomitant use of the following: theophylline, cisapride, antipyrine, caffeine, carbamazepine, diazepam (and its active metabolite, desmethyldiazepam), diclofenac, naproxen, piroxicam, digoxin, ethanol, glyburide, an oral contraceptive (levonorgestrel, ethinyl estradiol), metoprolol, nifedipine, phenytoin, warfarin (see text that follows), midazolam, clarithromycin, metronidazole, or amoxicillin. Clinically relevant interactions of pantoprazole with other drugs with the same metabolic pathways are not expected. Therefore, when coadministered with pantoprazole, adjustment of the dosage of pantoprazole of such drugs may not be necessary. There was also no interaction with concomitantly administered antacids. There have been postmarketing reports of increased INR and prothrombin time in patients receiving proton pump inhibitors, including pantoprazole, and warfarin concomitantly. Increase 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.
Severe generalised myalgia and bone pain were reported in a patient who received methotrexate and pantoprazole. The same reaction occurred on rechallenge with the combination, but not with methotrexate alone. Although methotrexate concentrations were unchanged, concentrations of the metabolite 7-hydroxymethotrexate were raised suggesting an interaction with its renal elimination.
Because of profound and long lasting inhibition of gastric acid secretion, pantoprazole may interfere with absorption of drugs where gastric pH is an important determinant of their bioavailability (eg. Ketoconazole, ampicillin esters, and iron salts).