PANOBEES-D Tablets

Pantoprazole 40 mg + Domperidone 10 mg

PANOBEES-D is a prescription gastrointestinal combination containing Pantoprazole Sodium IP equivalent to Pantoprazole 40 mg and Domperidone IP 10 mg in an enteric-coated tablet.

The formulation combines gastric acid suppression from pantoprazole with the peripheral dopamine-antagonist/prokinetic and antiemetic activity of domperidone. Because domperidone has important cardiovascular safety restrictions, the combination should be presented as a physician-directed prescription product rather than as a routine OTC acidity medicine.

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1. Product Information

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2. Composition

Each enteric-coated tablet contains:

• Pantoprazole Sodium IP
  Equivalent to Pantoprazole — 40 mg
• Domperidone IP — 10 mg
• Excipients — q.s.

The artwork specifically identifies the product as Pantoprazole and Domperidone Tablets and shows a pack of 10 × 15 tablets.

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3. What is PANOBEES-D?

PANOBEES-D combines two medicines with different mechanisms of action.

Pantoprazole 40 mg

A proton pump inhibitor (PPI) that reduces gastric acid production by inhibiting the gastric H⁺/K⁺-ATPase proton pump.

Domperidone 10 mg

A peripheral dopamine D₂-receptor antagonist with antiemetic and prokinetic effects.

Together, the ingredients provide:

Pantoprazole → Acid suppression
Domperidone → Peripheral antiemetic/prokinetic activity

The exact use of the combination should follow the current product prescribing information and the physician’s assessment.

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4. Mechanism of Action

Pantoprazole 40 mg

Pantoprazole inhibits the H⁺/K⁺-ATPase proton pump in gastric parietal cells.

This enzyme is responsible for the final step in gastric acid secretion.

Pantoprazole

H⁺/K⁺-ATPase inhibition
↓
Reduced gastric acid secretion
↓
Reduced acid exposure
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Support for healing and control of acid-related conditions

Pantoprazole is an established treatment for conditions including erosive esophagitis associated with GERD and pathological hypersecretory conditions.

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Domperidone 10 mg

Domperidone blocks peripheral dopamine D₂ receptors.

Its pharmacological effects include:

• Promotion of upper gastrointestinal motility
• Support of gastric emptying
• Peripheral antiemetic activity
• Increased lower oesophageal sphincter tone

Domperidone has limited penetration into the central nervous system compared with many centrally acting dopamine antagonists.

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5. Combined Action of PANOBEES-D

Pantoprazole 40 mg

Reduces gastric acid production.

Domperidone 10 mg

Provides peripheral dopamine-receptor blockade with prokinetic and antiemetic effects.

Combined pharmacological approach

Acid suppression + management of selected associated upper-GI symptoms

The combination should not be interpreted as meaning that every patient with reflux, acidity or bloating requires domperidone.

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6. Therapeutic Uses

Pantoprazole has established uses in physician-directed treatment of:

• Gastroesophageal reflux disease (GERD)
• Erosive esophagitis associated with GERD
• Maintenance of healing of erosive esophagitis
• Pathological hypersecretory conditions
• Zollinger-Ellison syndrome

The specific indication for PANOBEES-D as a fixed-dose combination should follow its current Indian product licence and prescribing information.

Website-safe wording:

PANOBEES-D is intended for physician-directed management of selected gastrointestinal conditions where acid suppression with pantoprazole and an appropriate role for domperidone are clinically considered.

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7. Role of Pantoprazole

Pantoprazole provides the primary acid-suppressive action.

It can help:

• Reduce gastric acid secretion
• Reduce acid exposure to the oesophagus
• Control acid-related symptoms
• Promote healing of acid-related oesophageal injury
• Maintain healing in appropriate patients

Pantoprazole 40 mg is an established adult strength for erosive esophagitis associated with GERD.

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8. Role of Domperidone

Domperidone contributes:

• Peripheral antiemetic action
• Prokinetic activity
• Support for gastric emptying
• Modulation of upper-GI motility

However, domperidone should be used at the lowest effective dose for the shortest appropriate duration because of its cardiovascular safety profile.

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9. Dosage and Administration

The artwork confirms the strengths but does not specify a dosage schedule.

Recommended website wording:

Dosage: Take PANOBEES-D exactly as prescribed by the treating physician. The dose and duration depend on the diagnosis, clinical response, other medicines being used and individual patient factors.

For pantoprazole alone, current prescribing information uses different regimens according to the indication. For example, adult erosive esophagitis associated with GERD is commonly treated with 40 mg once daily for up to 8 weeks, while pathological hypersecretory conditions may require different dosing.

Therefore, this should not be presented as a universal PANOBEES-D dose unless confirmed by the product’s approved PI.

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10. How to Take PANOBEES-D

• Take orally with water.
• Swallow the enteric-coated tablet whole.
• Do not crush or chew the tablet.
• Follow the timing specified by the physician.
• Do not increase the dose if symptoms persist.
• Do not continue treatment indefinitely without medical review.

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11. Missed Dose

If a dose is missed:

• Take it when remembered unless the next dose is near.
• If the next dose is close, skip the missed dose.
• Resume the normal schedule.
• Do not double the dose.

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12. Common Side Effects

Possible side effects may include:

Pantoprazole-related

• Headache
• Diarrhoea
• Nausea
• Abdominal discomfort
• Flatulence
• Constipation
• Dizziness

Pantoprazole clinical-trial labeling commonly reports headache, diarrhoea, nausea, abdominal pain, vomiting, flatulence and dizziness among adverse reactions.

Domperidone-related

• Dry mouth
• Abdominal cramps
• Headache
• Diarrhoea
• Increased prolactin-related effects in some patients

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13. Important Cardiac Safety Warning

Domperidone requires particular caution.

Domperidone has been associated with:

• QT interval prolongation
• Torsades de pointes
• Serious ventricular arrhythmias
• Sudden cardiac death

The risk is higher in certain patients, including those over 60 years, those receiving higher oral doses, and those taking QT-prolonging medicines or CYP3A4 inhibitors.

European safety recommendations limit oral domperidone to the lowest effective dose for the shortest possible duration, generally not exceeding one week, with a recommended adult maximum of 30 mg/day.

Seek urgent medical attention for:

• Fainting
• Severe dizziness
• Palpitations
• Rapid or irregular heartbeat
• Chest discomfort associated with an abnormal heartbeat

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14. Domperidone Contraindications / Precautions

Particular caution or avoidance is required in patients with:

• Known QT prolongation
• Significant cardiac conduction abnormalities
• Bradycardia
• Significant electrolyte disturbances
• Certain underlying cardiac diseases
• Congestive heart failure
• Moderate or severe hepatic impairment
• Concomitant use of certain QT-prolonging medicines
• Concomitant use of potent CYP3A4 inhibitors

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15. Drug Interactions

Patients should inform their doctor about all prescription, OTC and herbal medicines.

Important domperidone interactions include:

• QT-prolonging medicines
• Certain antiarrhythmic medicines
• Certain macrolide antibiotics
• Certain azole antifungals
• Potent CYP3A4 inhibitors

These combinations can increase the risk of cardiac adverse effects.

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16. Pantoprazole Drug Interactions

Pantoprazole can interact with medicines affected by gastric acidity or certain metabolic pathways.

Particular attention may be required with:

• Certain antiretroviral medicines
• Warfarin
• Methotrexate, particularly at high doses
• Digoxin
• Medicines whose absorption depends significantly on gastric acidity

A complete medication history should be reviewed before treatment.

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17. Long-Term Pantoprazole Considerations

Long-term PPI therapy should be used when clinically justified and periodically reviewed.

Potential concerns associated with prolonged PPI treatment include:

• Hypomagnesemia
• Vitamin B12 deficiency
• Certain gastrointestinal infections
• Bone-fracture risk in susceptible patients
• Acute interstitial nephritis

The duration of therapy should therefore be based on the underlying diagnosis and treatment response.

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18. Liver Precautions

Patients with liver disease should inform their physician before treatment.

Domperidone is specifically contraindicated in moderate or severe hepatic impairment under the EMA safety recommendations.

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19. Kidney Precautions

Patients with significant renal impairment should inform their doctor.

The physician may consider renal function when determining the overall treatment regimen, particularly when therapy is prolonged or multiple medicines are being used.

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20. Pregnancy

If pregnant, planning pregnancy or trying to conceive, consult a healthcare professional before taking PANOBEES-D.

The combination should not be self-medicated during pregnancy.

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21. Breastfeeding

Consult a physician before using PANOBEES-D while breastfeeding.

The healthcare professional should assess the clinical need and available alternatives.

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22. Elderly Patients

Extra caution is appropriate in older adults because the risk of serious cardiovascular adverse reactions associated with domperidone is higher in patients over 60 years.

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23. Pediatric Use

PANOBEES-D should not be routinely promoted for children unless the specific product, formulation and indication are authorized for the relevant pediatric population.

The presence of pantoprazole 40 mg does not by itself establish that the combination product is suitable for children.

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24. Driving and Operating Machinery

Some patients may experience dizziness or other symptoms that could affect alertness.

Patients should understand their individual response before driving or operating machinery.

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25. When to Seek Medical Attention

Consult a healthcare professional for:

• Persistent heartburn
• Difficulty swallowing
• Painful swallowing
• Persistent vomiting
• Unexplained weight loss
• Vomiting blood
• Black/tarry stools
• Severe abdominal pain
• Symptoms that persist despite treatment

Emergency attention

Seek urgent care for:

• Fainting
• Severe palpitations
• Rapid/irregular heartbeat
• Severe allergic reaction
• Difficulty breathing
• Facial, lip or throat swelling

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26. Storage

Store PANOBEES-D:

• In a cool, dry place.
• Protected from excessive moisture.
• Away from direct sunlight and excessive heat.
• Out of reach of children.

Keep tablets in the original packaging until use.

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27. Key Features

Pantoprazole 40 mg

Provides potent gastric acid suppression through proton pump inhibition.

Domperidone 10 mg

Provides peripheral dopamine D₂ receptor antagonism with prokinetic and antiemetic effects.

Enteric-coated formulation

Designed to protect pantoprazole from degradation in the acidic stomach environment.

Dual-action formulation

Combines acid suppression with a second pharmacological mechanism.

Prescription medicine

The artwork carries the Rx symbol.