Critically-ill Patients

Also known as: Critically Ill / Critically-ill / Critical-Illness

DrugDrug NameDrug Description
DB00213PantoprazolePantoprazole is a first-generation proton pump inhibitor (PPI) used for the management of gastroesophageal reflux disease (GERD), for gastric protection to prevent recurrence of stomach ulcers or gastric damage from chronic use of NSAIDs, and for the treatment of pathological hypersecretory conditions including Zollinger-Ellison (ZE) Syndrome. It can also be found in quadruple regimens for the treatment of _H. pylori_ infections along with other antibiotics including [DB01060], [DB01211], and [DB00916], for example [A177271][F4498]. Its efficacy is considered similar to other medications within the PPI class including [DB00338], [DB00736], [DB00448], [DB05351], and [DB01129]. Pantoprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cell. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. As the binding of pantoprazole to the (H+, K+)-ATPase enzyme is irreversible and new enzyme needs to be expressed in order to resume acid secretion, pantoprazole's duration of antisecretory effect persists longer than 24 hours [FDA Label]. PPIs such as pantoprazole have also been shown to inhibit the activity of dimethylarginine dimethylaminohydrolase (DDAH), an enzyme necessary for cardiovascular health. DDAH inhibition causes a consequent accumulation of the nitric oxide synthase inhibitor asymmetric dimethylarginie (ADMA), which is thought to cause the association of PPIs with increased risk of cardiovascular events in patients with unstable coronary syndromes [A177577, A177580]. Due to their good safety profile and as several PPIs are available over the counter without a prescription, their current use in North America is widespread. Long term use of PPIs such as pantoprazole have been associated with possible adverse effects, however, including increased susceptibility to bacterial infections (including gastrointestinal _C. difficile_), reduced absorption of micronutrients including iron and B12, and an increased risk of developing hypomagnesemia and hypocalcemia which may contribute to osteoporosis and bone fractures later in life [A177571]. Rapid discontinuation of PPIs such as pantoprazole may cause a rebound effect and a short term increase in hypersecretion [A177574]. Pantoprazole doses should be slowly lowered, or tapered, before discontinuing to prevent this rebound effect.
DrugDrug NamePhaseStatusCount
DB00638Inulin1 / 2Completed1
DB00333Methadone1 / 2Completed1
DB00126Ascorbic acid2Recruiting1
DB09153Sodium chloride2Unknown Status1
DB06151Acetylcysteine2 / 3Completed1
DB00099Filgrastim2 / 3Completed1
DB00421Spironolactone2 / 3Recruiting1
DB11121Chloroxylenol4Not Yet Recruiting1
DB01221Ketamine4Not Yet Recruiting1
DB00761Potassium chloride4Completed1
DB04924ItoprideNot AvailableRecruiting1
DB01233MetoclopramideNot AvailableRecruiting1
DB00560TigecyclineNot AvailableRecruiting1