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Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses 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, such as Zollinger-Ellison syndrome.
## Adult Dosing
* **Healing of Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of Healing of Erosive Esophagitis:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Start with 40 mg orally or intravenously twice daily. Doses may be increased as needed. Typical doses range from 40 mg to 240 mg per day. Doses greater than 240 mg should be administered intravenously every 8 hours.
* **Intravenous Administration:** 40 mg IV once daily.
## Pediatric Dosing
* **1 month to <5 years:** 20-40 mg orally once daily. Dose selection is based on weight.
* **5 years to <12 years:** 20 mg orally once daily.
* **12 years to <18 years:** 40 mg orally once daily for erosive esophagitis.
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment.
## Contraindications
* Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence.
Serious: *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, systemic lupus erythematosus (new onset or exacerbation).
## Key Drug Interactions
* **Drugs requiring gastric pH for absorption:** Absorption may be decreased (e.g., ketoconazole, itraconazole, posaconazole, erlotinib, nelfinavir, rilpivirine).
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** May affect metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of *Clostridium difficile*-associated diarrhea.
* Consider monitoring serum magnesium levels, especially with prolonged use or in patients taking concomitant medications like diuretics or digoxin.
* Consider monitoring vitamin B12 levels with long-term therapy.
## Clinical Pearls
* Pantoprazole is generally considered to have fewer CYP2C19 interactions compared to other PPIs.
* Administer oral formulations on an empty stomach for optimal absorption.
* IV formulation should be administered as an infusion over 15 minutes.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before making any treatment decisions.*
