Pan-D dosage: how to take it

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.

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

Common questions