PULSER

Description

About PULSER Tablet

PULSER Tablet, manufactured by Kasturi Pharmaceuticals and available in Nepal, contains the active ingredient Pantoprazole Sodium Sesquihydrate. It is a proton pump inhibitor (PPI) that works by blocking the final step of acid secretion in your stomach, reducing both basal and stimulated acid production.

What is PULSER Tablet Used For?

PULSER Tablet is prescribed for a variety of conditions related to excess stomach acid, including:

• Peptic ulcer disease
• H. pylori infection
• Gastro-oesophageal reflux disease (GERD)
• Zollinger-Ellison syndrome
• Oesophagitis (inflammation of the esophagus)
• Acid-related dyspepsia (indigestion)
• NSAID-associated ulceration (ulcers caused by pain relievers)
• Ulcers that don’t respond to H2 receptor antagonists
• Gastrointestinal (GI) bleeding from stress
• Preventing acid aspiration syndrome during anesthesia induction

Dosage Information

The dosage of PULSER Tablet varies depending on the condition being treated and the patient’s age and health.

Adult Dosing

• Erosive Esophagitis Associated with GERD:
  • Treatment: 40 mg orally once daily for 8-16 weeks.
  • Maintenance: 40 mg orally once daily.
  • Alternative: 40 mg intravenously (IV) once daily for 7-10 days.
• Short-term GERD Treatment (when oral therapy isn’t possible): 40 mg IV infusion over 15 minutes once daily for 7-10 days, then switch to oral therapy when able.
• Zollinger-Ellison Syndrome:
  • Oral: 40 mg once daily; doses up to 240 mg/day may be used in some cases.
  • IV: 80 mg infusion every 8-12 hours for up to 7 days, then switch to oral therapy when able.
• Peptic Ulcer Disease:
  • Duodenal ulcer: 40 mg orally once daily for 2-4 weeks.
  • Gastric ulcer: 40 mg orally once daily for 4-8 weeks.
• Elderly Patients: No dosage adjustment is typically needed.
• Hepatic Impairment: Maximum dose is 20 mg/day or 40 mg on alternate days.

Child Dosing (for Erosive Esophagitis Associated with GERD)

• Under 5 years: Safety and effectiveness have not been established.
• 5 years and older:
  • 15 kg to less than 40 kg: 20 mg orally once daily for up to 8 weeks.
  • 40 kg or greater: 40 mg orally once daily for up to 8 weeks.

Renal Impairment

• No dosage adjustment is needed.

How to Administer PULSER Tablet

• Controlled-release tablets: Take on an empty stomach, ideally 1 hour before meals. Swallow the tablet whole; do not chew or crush it.
• Normal release tablets: Can be taken with or without food.

IV Preparation

• GERD with erosive esophagitis (15-minute infusion): Reconstitute with 10 mL of normal saline (NS), then dilute further with 100 mL of D5W, NS, or Lactated Ringer’s (LR) solution to a final concentration of 0.4 mg/mL.
• Zollinger-Ellison syndrome:
  • 15-minute infusion: Reconstitute each vial with 10 mL of NS. Combine two vials and dilute with 80 mL of D5W, NS, or LR to a total volume of 100 mL (concentration 0.8 mg/mL).
  • 2-minute injection: Reconstitute with 10 mL of NS to a final concentration of 4 mg/mL.

IV Administration

• Infuse over 15 minutes.
• The maximum infusion rate is 3 mg/minute (7 mL/minute) for GERD and 6 mg/minute (7 mL/minute) for conditions causing excessive acid secretion.

Important Considerations

Contraindications

Do not use PULSER Tablet if you are taking rilpivirine, atazanavir, or nelfinavir, or if you are lactating.

Precautions

• Your doctor should rule out gastric malignancy before starting treatment.
• Consider zinc supplementation if you’re receiving IV therapy and are prone to zinc deficiency.
• Use with caution during pregnancy.
• Monitoring: Your doctor will likely monitor your magnesium levels before starting and periodically during prolonged use.

Interactions with Other Medications

PULSER Tablet can interact with other medications, including:

• Increased risk: Digoxin-induced heart problems, low magnesium levels with diuretics, increased INR and prothrombin time with warfarin, and increased levels of methotrexate and saquinavir.
• Decreased absorption/effectiveness: Sucralfate (delayed absorption), ketoconazole, and itraconazole.
• Potentially Fatal: May significantly reduce the effectiveness of rilpivirine, atazanavir, and nelfinavir.

Possible Side Effects

Common side effects (1-10%) include:

• Headache (>4%)
• Abdominal pain (4%)
• Diarrhea (4%)
• Constipation (<4%)
• Itching (4%)
• Rash (4%)
• Flatulence (<4%)
• Hyperglycemia (1%)
• Nausea (1%)
• Vomiting (>4%)
• Facial swelling (<4%)
• Generalized swelling (<2%)
• Chest pain (4%)
• Photosensitivity (<2%)

Serious but less common side effects (frequency not defined) include:

• Angioedema
• Atrophic gastritis
• Anterior ischemic optic neuropathy
• Hepatocellular damage leading to liver failure
• Interstitial nephritis
• Pancreatitis
• Pancytopenia
• Rhabdomyolysis
• Risk of anaphylaxis
• Stevens-Johnson syndrome
• Fatal toxic epidermal necrolysis
• Erythema multiforme

Important Note

This information about PULSER Tablet is for general knowledge and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a healthcare professional for any health concerns or before making any decisions related to your health or treatment.