Sompraz D Adult Dosage
For adults with GERD, Sompraz D (pantoprazole 40 mg + domperidone) should be taken as one tablet once daily, preferably in the morning before meals, for 4-8 weeks depending on symptom severity and presence of erosive esophagitis. 1
Standard Dosing Recommendations
Initial Treatment
- Pantoprazole 40 mg once daily is the FDA-approved dose for short-term treatment of erosive esophagitis associated with GERD, taken for up to 8 weeks 1
- The tablet should be swallowed whole with or without food, but preferably 30-60 minutes before meals for optimal efficacy 2
- Do not split, chew, or crush the delayed-release tablet 1
Treatment Duration by Indication
- For erosive esophagitis: 40 mg once daily for up to 8 weeks; if not healed after 8 weeks, an additional 8-week course may be considered 1
- For symptomatic GERD without erosive disease: 40 mg once daily for 4 weeks initially, with extension to 8 weeks if symptoms persist 3, 2
- For maintenance of healed erosive esophagitis: 40 mg once daily (controlled studies did not extend beyond 12 months) 1
Clinical Efficacy Evidence
Pantoprazole 40 mg demonstrates superior efficacy compared to H2-receptor antagonists and is equivalent to other PPIs at standard doses:
- Complete symptom relief occurs in 40% of patients after 7 days and 63% after 28 days of pantoprazole 40 mg treatment 4
- Erosive esophagitis healing rates reach 79% after 4 weeks of treatment 4
- Pantoprazole 40 mg is equivalent to esomeprazole 40 mg for healing esophageal lesions (88% overall healing rate) 5
- Symptom severity reduces by 73-80% from baseline after 4 weeks of treatment 6
Important Administration Guidelines
Timing Considerations
- Take pantoprazole in the morning, NOT at bedtime, as bedtime dosing reduces efficacy 2
- The 30-60 minute pre-meal timing ensures the drug is present when proton pumps are most active 7
- Concomitant antacid use does not affect absorption 1
For Patients Unable to Swallow 40 mg Tablets
- Two 20 mg tablets may be taken instead of one 40 mg tablet 1
When to Consider Dose Escalation
If symptoms persist after 4-8 weeks of once-daily therapy, twice-daily dosing (40 mg twice daily) may be considered, though this is not FDA-approved 2:
- Twice-daily dosing should be reserved for patients with documented treatment failure on standard dosing 2
- Most patients on twice-daily dosing should eventually be stepped down to once-daily therapy 2
- For chronic cough related to GERD, treatment may require 2-3 months before improvement is observed 2
Long-Term Management
Patients requiring maintenance therapy should be maintained on the lowest effective dose with periodic reassessment:
- Patients with severe erosive esophagitis (LA grade C/D), Barrett's esophagus, or esophageal strictures require continuous daily maintenance therapy 2
- All patients on long-term therapy should have their need for continued treatment periodically reassessed 2
- For patients without erosive disease, consider step-down to on-demand therapy after initial symptom control 2
Common Pitfalls and Caveats
- Avoid taking at bedtime: This is the most common error that reduces PPI efficacy 2
- Do not crush or split tablets: The delayed-release coating is essential for drug stability and absorption 1
- Avoid premature dose escalation: Allow 4-8 weeks at standard dosing before considering higher doses 3, 2
- Document indication clearly: Up to 15% of PPI users are on higher-than-standard doses without clear evidence of benefit 2
Safety and Tolerability
Pantoprazole 40 mg is very well tolerated, with more than 90% of patients experiencing no adverse events throughout treatment 8. The most commonly reported adverse events include headache, diarrhea, and nausea, with only 3.48% of patients experiencing any adverse events in large observational studies 6.