Please check your internet connection and try again.
## Pantoprazole
### Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion.
### Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
### Adult Dosing
* **Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of Healing:** 40 mg orally once daily. Some patients may be treated with 20 mg once daily.
* **Pathological Hypersecretory Conditions:** Start with 40 mg orally or intravenously twice daily. Doses may be increased as needed. Doses greater than 240 mg daily must be administered intravenously and divided into two doses. Maximum IV dose is 720 mg per day.
### Pediatric Dosing
* **Erosive Esophagitis (GERD-associated):**
* 1 to less than 5 years: 10 mg orally once daily for up to 8 weeks.
* 5 to less than 12 years: 20 mg orally once daily for up to 8 weeks.
* 12 to 16 years: 40 mg orally once daily for up to 8 weeks.
* **Note:** Efficacy and safety for longer than 8 weeks have not been established. Intravenous formulations are not approved for pediatric use.
### Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 40 mg orally.
* **Renal Impairment:** No dose adjustment necessary.
### Contraindications
* Known hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation.
### Adverse Effects
* Common: Diarrhea, headache, dizziness, abdominal pain, nausea, flatulence.
* Long-term use of PPIs may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
### Key Drug Interactions
* Drugs requiring gastric acid for absorption (e.g., certain antifungals like ketoconazole, itraconazole; certain HIV protease inhibitors like atazanavir, nelfinavir): Pantoprazole may decrease absorption.
* Methotrexate: PPIs may increase methotrexate levels.
* CYP2C19 substrates: Pantoprazole may inhibit CYP2C19, potentially affecting metabolism of drugs like clopidogrel (though clinical significance is debated).
### Monitoring
* Monitor for signs and symptoms of *Clostridium difficile* infection.
* Consider periodic monitoring of serum magnesium levels, especially in patients on long-term therapy or concomitant diuretic use.
* Assess for fracture risk in patients with risk factors.
* Monitor for signs of vitamin B12 deficiency.
### Clinical Pearls
* Pantoprazole can be taken with or without food.
* For patients with difficulty swallowing, the 40 mg delayed-release orally disintegrating tablet formulation may be an option. The tablet should not be chewed or crushed.
* Long-term PPI use should be periodically re-evaluated for the need for continued therapy.
**Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the current prescribing information and your healthcare provider for definitive guidance on drug use.
