説明
Like all PPIs, pantoprazole reduces gastric acid and impairs levothyroxine tablet dissolution, leading to decreased T4 absorption and potentially under-treated hypothyroidism.
機序
Pantoprazole irreversibly inhibits H⁺/K⁺-ATPase, producing prolonged achlorhydria that reduces the solubility of levothyroxine tablets; this mechanism is common to all PPIs, though strength of inhibition varies.
臨床的意義
Studies confirm elevated TSH in levothyroxine-treated patients on PPIs; the effect may be more pronounced with pantoprazole than lower-potency PPIs at equivalent doses in some patient populations.
対処法
Separate levothyroxine and pantoprazole administration by at least 30–60 minutes; monitor TSH 6–8 weeks after adding or changing PPI; use liquid levothyroxine if absorption remains problematic.