Anaphylactic reactions due to pantoprazole: case report of two cases

Gupta, P. P.; Mishra, Deebya Raj; Agrawal, Kopila; Bhandari, Rabin; Jirel, S; Malla, Gyanendra

doi:10.2147/imcrj.s153099

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…Although some cases of post pantoprazole administration anaphylaxis (22,23) and edema (24,25) have been reported in humans, these clinical signs were not observed in our population. While the aim of this study was not to evaluate the clinical safety of pantoprazole in calves, the lack of observed adverse effects correlate with previously reported pantoprazole use in ruminants for case management of cattle (4,26), camels (27), sheep (15,28), yaks (29), and goats (30,31).…”

Section: Discussioncontrasting

confidence: 71%

Pharmacokinetics and Tissue Levels of Pantoprazole in Neonatal Calves After Intravenous Administration

et al. 2020

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Background: Neonatal calves are at risk of developing abomasal ulceration, but there is a lack of pharmacokinetic data for potential anti-ulcerative therapies, such as pantoprazole, in ruminant species.Objective: The study objectives were to estimate plasma pharmacokinetic parameters for pantoprazole in neonatal dairy calves after intravenous (IV) administration. A secondary objective was to quantify the concentrations of pantoprazole in edible tissues after IV dosing.Methods: Pantoprazole was administered to 9 neonatal Holstein calves at a dose of 1 mg/kg IV. Plasma samples were collected over 24 h and analyzed via HPLC-MS for determining pantoprazole concentrations. Pharmacokinetic parameters were derived via non-compartmental analysis. Tissue samples were collected at 1, 3, and 5 days after administration and analyzed via HPLC-MS.Results: Following IV administration, plasma clearance, elimination half-life, and volume of distribution of pantoprazole were estimated at 4.46 mL/kg/min, 2.81 h, and 0.301 L/kg, respectively. The global extraction ratio was estimated at 0.053 ± 0.015. No pantoprazole was detected in the edible tissues 1, 3, or 5 days after administration. A metabolite, pantoprazole sulfone was detected in all the edible tissues 1 and 3 days after administration.Conclusion: The reported plasma clearance for pantoprazole is less than that reported for alpacas but higher than reported in foals. The elimination half-life in calves appears to be longer than observed in foals and alpacas. While pantoprazole sulfone was detected in the tissues after IV administration, further research is needed as to the metabolism and potential tissue accumulation of other pantoprazole metabolites in calves. Future pharmacodynamic studies are necessary to determine the efficacy of pantoprazole on abomasal acid suppression in calves.

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Section: Discussioncontrasting

confidence: 71%

Pharmacokinetics and Tissue Levels of Pantoprazole in Neonatal Calves After Intravenous Administration

et al. 2020

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“…Anaphylaxis has been reported in people after administration of pantoprazole tablets, manifesting as edema, pruritus, nausea, vomiting, respiratory distress, and rashes (13). In people, anaphylactic reactions have been observed with omeprazole, pantoprazole, and lansoprazole skin prick tests by one study, and the same study suggests that cross-reactivity may exist in people to proton pump inhibitors (14).…”

Section: Discussionmentioning

confidence: 97%

“…When used in humans for therapy, multiple adverse events have been reported from patients administered PPIs, mainly skin reactions, nephritis, pancytopenia, anaphylaxis, edema, hepatotoxicity, as well as biochemical changes such as hyponatremia and hypomagnesemia (8)(9)(10)(11)(12)(13)(14). Pantoprazole specifically has been associated with thrombocytopenia, hepatotoxicity, and pancreatitis (9,11,(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Clinical Investigation of the Safety and Adverse Effects of Pantoprazole in Hospitalized Ruminants

2020

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Clinical safety data for the use of gastroprotectants in hospitalized ruminants is lacking. In human patients, multiple adverse effects are possible from the use of pantoprazole including hematologic and electrolyte abnormalities as well as anaphylaxis and edema. The medical records of all hospitalized cattle, goats, and sheep administered pantoprazole over an ∼5-year period were retrospectively analyzed for adverse effects. Seventy-nine eligible patients were observed. Hypomagnesemia was observed after pantoprazole administration in 10 cattle; however, no significant changes were noted when compared to baseline before pantoprazole administration. Significant changes were noted in serum indicators of hepatic and renal function; however, these represented downward trends that were most likely clinically insignificant. Anaphylaxis after pantoprazole administration was not observed; however, seven cattle displayed edema after pantoprazole administration. Veterinary clinicians should be aware of the potential for hypomagnesemia in hospitalized ruminants being administered pantoprazole and monitor patients accordingly. While these preliminary retrospective results indicate that pantoprazole may be a safe adjunctive therapy in hospitalized ruminants, additional studies are necessary to further determine the safety and toxicity of pantoprazole in ruminants.

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“…In human patients, several adverse effects have been attributable to pantoprazole including anaphylaxis, thrombocytopenia and electrolyte disorders (27)(28)(29)(30)(31). While uncommon, these adverse effects also appear to be limited to geriatric human patients that undergo long-term therapy with pantoprazole (31).…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Pantoprazole and Pantoprazole Sulfone in Goats After Intravenous Administration: A Preliminary Report

et al. 2021

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Background: Ruminant species are at risk of developing abomasal ulceration, but there is a lack of pharmacokinetic data for anti-ulcer therapies, such as the proton pump inhibitor pantoprazole, in goats.Objective: The primary study objective was to estimate the plasma pharmacokinetic parameters for pantoprazole in adult goats after intravenous administration. A secondary objective was to describe the pharmacokinetic parameters for the metabolite, pantoprazole sulfone, in goats.Methods: Pantoprazole was administered intravenously to six adult goats at a dose of 1 mg/kg. Plasma samples were collected over 36h and analyzed via reverse phase high performance liquid chromatography for determination of pantoprazole and pantoprazole sulfone concentrations. Pharmacokinetic parameters were determined by non-compartmental analysis.Results: Plasma clearance, elimination half-life, and volume of distribution of pantoprazole were estimated at 0.345 mL/kg/min, 0.7 h, and 0.9 L/kg, respectively following IV administration. The maximum concentration, elimination half-life and area under the curve of pantoprazole sulfone were estimated at 0.1 μg/mL, 0.8 h, and 0.2 hr*μg/mL, respectively. The global extraction ratio was estimated 0.00795 ± 0.00138. All animals had normal physical examinations after conclusion of the study.Conclusion: The reported plasma clearance for pantoprazole is lower than reported for foals, calves, and alpacas. The elimination half-life appears to be < that reported for foals and calves. Future pharmacodynamic studies are necessary for determination of the efficacy of pantoprazole on acid suppression in goats.

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Anaphylactic reactions due to pantoprazole: case report of two cases

Cited by 7 publications

References 11 publications

Pharmacokinetics and Tissue Levels of Pantoprazole in Neonatal Calves After Intravenous Administration

Pharmacokinetics and Tissue Levels of Pantoprazole in Neonatal Calves After Intravenous Administration

A Retrospective Clinical Investigation of the Safety and Adverse Effects of Pantoprazole in Hospitalized Ruminants

Pharmacokinetics of Pantoprazole and Pantoprazole Sulfone in Goats After Intravenous Administration: A Preliminary Report

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