Pan-D: Uses, How It Works, Side Effects

What is Pan-D used for?

Pan-D is used to treat acid reflux, combining a medicine that lowers stomach acid with one that helps the stomach empty.

• Acid reflux, heartburn and acidity (gastro-oesophageal reflux disease, GERD)
• Reflux that has not settled enough with pantoprazole alone, as decided by a doctor

How does Pan-D work?

Pan-D works in two ways. Pantoprazole binds to the proton pumps (an enzyme called H+/K+ ATPase) in the stomach lining and switches them off, so the stomach makes much less acid for about a day. Domperidone blocks dopamine, a chemical messenger that slows the stomach; this helps the stomach empty faster and tightens the valve at the top of the stomach, so less acid flows back up.

What happens in your body after you take it

1. You swallow the capsule

   The capsule opens in the stomach and releases tiny pellets of two kinds. The pantoprazole pellets have a coating that does not dissolve in stomach acid, which would otherwise destroy the medicine. The domperidone pellets are made to release the medicine slowly over many hours.

2. Pantoprazole is absorbed in the small intestine

   In the less acidic small intestine, the coating dissolves and pantoprazole passes into the blood. Its level peaks about 2 to 3 hours after the dose.

3. Domperidone is released slowly

   Domperidone seeps out of its pellets gradually and is absorbed from the gut. Much of each dose is broken down by the gut wall and liver before it reaches the blood, and the slow release spreads the rest over the day.

4. Acid pumps are switched off

   Pantoprazole collects in the acid-making cells of the stomach lining. There, acid turns it into its active form, which locks onto the proton pumps and stops them pushing acid into the stomach. This is why the capsule is usually taken before breakfast, when the pumps switch on.

5. The stomach empties faster

   Domperidone blocks dopamine receptors in the gut. The stomach muscles push food on more quickly, and the ring of muscle at the bottom of the food pipe tightens, so less stomach content flows back up. It also acts on the vomiting centre near the brain, which can ease nausea.

6. It mostly stays out of the brain

   Very little domperidone crosses the protective barrier around the brain. This is why it rarely causes the shaking and stiffness that some similar medicines can. It does reach the pituitary gland, which sits outside this barrier, and can raise a hormone called prolactin.

7. The liver clears both medicines

   The liver breaks down pantoprazole, mainly with an enzyme called CYP2C19, and domperidone, mainly with CYP3A4. Medicines that block CYP3A4 can make domperidone build up, which raises the risk to the heart. The broken-down medicines leave the body in urine and stool, while the blocked acid pumps stay off until new ones are made.

How to take Pan-D

Take Pan-D exactly as your doctor advises or as printed on the pack. The doctor decides how long you take it and should review it.

• It is usually taken once a day, before a meal, commonly before breakfast. Follow your prescription.
• Swallow the capsule whole with water. Do not open, crush or chew it, because the pellets inside are made to protect pantoprazole from stomach acid and to release domperidone slowly.
• Do not take extra capsules, and do not take other medicines that contain domperidone at the same time. More than 30 mg of domperidone a day raises the risk of heart rhythm problems.
• If you miss a dose, take it when you remember. If it is almost time for the next dose, skip the missed one. Do not take two doses together.
• Acid symptoms often ease within 2 to 3 days, but full benefit can take longer. Do not keep taking it for weeks or months without your doctor reviewing it.
• People with liver disease or serious kidney disease may not be able to take it or may need a different medicine. Tell your doctor about these conditions.
• Pan-D is not meant for children. Any use in children is decided by a doctor.

Pan-D dosage: how to take it

Side effects of Pan-D

Most people take Pan-D without problems, and side effects are usually mild. The rare but serious risk is a heart rhythm problem caused by domperidone.

Uncommon or mild

• Headache
• Diarrhoea
• Feeling sick (nausea) or stomach pain
• Wind (gas)
• Dizziness
• Dry mouth

Pan-D side effects: common and serious

Who should be careful

Some people should not take Pan-D or need to check with a doctor first, mainly because of domperidone's effect on the heart and pantoprazole's long-term effects.

• Heart disease, heart failure, an irregular heartbeat, or a known long QT interval on an ECG (heart tracing): European regulators say domperidone should not be used
• Age over 60: the risk of heart rhythm problems with domperidone is higher
• Low potassium or magnesium in the blood, for example from vomiting, diarrhoea or water tablets (diuretics)
• Liver disease: domperidone is broken down by the liver and should not be used in moderate or severe liver disease
• Serious kidney disease: domperidone may need to be taken less often, so the doctor may choose another medicine
• Bleeding from the stomach or gut, or a blockage or tear in the gut
• A pituitary tumour that releases prolactin (prolactinoma)
• Warning signs that need a doctor's check first: unexplained weight loss, difficulty or pain when swallowing, repeated vomiting, vomiting blood, or black stools. Pantoprazole can ease symptoms and hide a more serious problem
• Long-term use: pantoprazole can lower vitamin B12 and magnesium and slightly raise the risk of bone fractures and gut infections
• Pregnancy: information is limited, so ask your doctor
• Breastfeeding: Indian product information says breastfeeding is not recommended while taking domperidone
• Past allergic reaction to pantoprazole, similar medicines such as omeprazole, or domperidone

Medicines and things that interact with Pan-D

Pan-D interacts with a number of medicines, and some combinations can be dangerous for the heart. Tell your doctor or pharmacist about everything you take.

• Medicines that can affect heart rhythm (prolong the QT interval), such as amiodarone and sotalol, some medicines for mental health such as haloperidol, citalopram and escitalopram, the antibiotics erythromycin, levofloxacin and moxifloxacin, and methadone: European regulators say they should not be taken with domperidone
• Medicines that strongly block the liver enzyme CYP3A4, such as ketoconazole and itraconazole (antifungals), clarithromycin (an antibiotic) and ritonavir (an HIV medicine): they raise domperidone levels and the risk to the heart
• Diltiazem and verapamil (for blood pressure and heart rhythm): can raise domperidone levels
• Other medicines containing domperidone, including some combination products: risk of too high a dose
• HIV medicines atazanavir, nelfinavir and rilpivirine: pantoprazole can make them less effective. Rilpivirine must not be taken with it
• Methotrexate, especially at high doses: levels may rise and stay high for longer
• Warfarin and similar blood thinners: your doctor may check your INR more often
• Medicines that need stomach acid to be absorbed, such as iron tablets, some antifungals and some cancer medicines such as erlotinib, and mycophenolate (after a transplant): may work less well
• Levodopa (for Parkinson's disease): domperidone can raise its levels
• Some laboratory tests: pantoprazole can rarely cause a false positive urine drug test for cannabis (THC)

If someone takes too much

Storage

Store in a cool, dry place, protected from light, in the original strip, and out of the reach of children. Do not use after the expiry date.

Regulatory status in India

Prescription medicine sold in India. The two-ingredient combination of pantoprazole 40 mg and domperidone 30 mg sustained-release appears on the CDSCO list of fixed-dose combinations approved by the Drugs Controller General (India), and it is not on the CDSCO list of prohibited medicines. Some other combinations containing domperidone are prohibited, for example tramadol with dicyclomine and domperidone (August 2024). In April 2025 CDSCO also ordered a halt to several unapproved three- and four-ingredient combinations of pantoprazole and domperidone with levosulpiride or simethicone. Pan-D contains only pantoprazole and domperidone.

Other brands with the same medicine

Other brands with the same two ingredients include Pantocid DSR and Pantop-D. Generic pantoprazole and domperidone prolonged-release capsules are also available. They all contain pantoprazole 40 mg and domperidone 30 mg and work the same way. Check the label for the strength. Pan 40 is different: it contains pantoprazole only.

Other strengths and forms

Pan-D is sold by Alkem as a capsule that combines pantoprazole with domperidone. It is a different product from Pan tablets, which contain pantoprazole alone. Check the label of the one you have.

Common questions