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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that inhibits the H+/K+-ATPase enzyme system in the gastric parietal cell, suppressing both basal and stimulated gastric acid secretion. ## Primary Indications * Short-term treatment of erosive esophagitis associated with GERD. * Maintenance of healing of erosive esophagitis. * Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome). * Prophylaxis of stress-induced upper GI bleeding (ICU/critically ill). ## Adult Dosing * **GERD/Erosive Esophagitis:** 40 mg PO or IV once daily for up to 8 weeks. * **Maintenance of Healing:** 40 mg PO daily. * **Hypersecretory Conditions:** Starting dose 40 mg PO twice daily; titrate up to 240 mg/day if clinically indicated. * **Stress Ulcer Prophylaxis:** 40 mg IV daily. ## Pediatric Dosing * **GERD (5 years or older):** * 15 kg to < 40 kg: 20 mg PO once daily. * ≥ 40 kg: 40 mg PO once daily. * **Note:** IV dosing in pediatrics is not standard/labeled; utilize unit-specific protocols if required. ## Dose Adjustments * **Hepatic Impairment:** Severe impairment may require dose reduction or increased monitoring; maximum dose often recommended at 20 mg daily. * **Renal Impairment:** No dosage adjustment necessary. * **Elderly:** No dosage adjustment necessary, but use lowest effective dose. ## Contraindications * Hypersensitivity to pantoprazole or any component of the formulation. * Concurrent therapy with rilpivirine-containing products. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain. * **Serious:** *Clostridioides difficile*-associated diarrhea, hypomagnesemia, vitamin B12 deficiency (long-term use), acute interstitial nephritis, bone fractures, and cutaneous/systemic lupus erythematosus. ## Key Drug Interactions * **pH-Dependent Drugs:** May decrease absorption of drugs requiring acidic environments (e.g., atazanavir, ketoconazole, iron salts, mycophenolate mofetil). * **CYP2C19 Inhibitors/Inducers:** Pantoprazole is primarily metabolized by CYP2C19. * **Methotrexate:** High-dose methotrexate serum levels may be increased. * **Warfarin:** Monitor INR frequently; potential for increased risk of bleeding. ## Monitoring * Monitor for symptom relief and resolution of erosive esophagitis. * With long-term use: Monitor magnesium levels and clinical signs of B12 deficiency. * Monitor for signs of *C. difficile* infection (unremitting watery diarrhea). ## Clinical Pearls * **Administration:** Tablets should be swallowed whole; do not crush or chew. IV administration should be a 15-minute infusion or 2-minute bolus depending on hospital protocols. * **Duration:** PPIs should be used for the shortest duration necessary; consider de-prescribing or stepping down to H2 blockers if long-term therapy is not indicated. * **Availability:** Bioavailability is high (approx. 77%). IV to PO conversion is typically 1:1. *** **Educational Disclaimer:** This information is for educational purposes only. Drug dosing, indications, and local protocols may vary significantly by institution and patient status. Always verify current prescribing information in a trusted clinical resource (e.g., Lexicomp, Micromedex, or the package insert) before prescribing or administering medication.