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## Pantoprazole
### Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces the amount of acid produced in the stomach.
### Primary Indications
* Gastroesophageal reflux disease (GERD)
* Healing of erosive esophagitis
* Reduction of risk of NSAID-induced gastric ulcers
* Zollinger-Ellison syndrome
### Adult Dosing
* **GERD/Erosive Esophagitis:** 20 mg to 40 mg once daily. For severe erosive esophagitis, 40 mg once daily may be used.
* **NSAID-induced Ulcer Prophylaxis:** 20 mg once daily.
* **Zollinger-Ellison Syndrome:** 40 mg twice daily, may be increased to 80 mg twice daily.
### Pediatric Dosing
* **GERD/Erosive Esophagitis:**
* 1-5 years: 10 mg once daily.
* 5-16 years: 20 mg once daily.
* Dosing above 40 mg daily in children has not been established.
### Dose Adjustments
No dose adjustment is generally required for hepatic or renal impairment, although caution may be advised in severe hepatic impairment.
### Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
### Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
### Key Drug Interactions
* **Antiretrovirals (e.g., rilpivirine, nelfinavir):** Pantoprazole can decrease the absorption of these drugs, leading to reduced efficacy. Avoid concurrent use.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity. Consider dose interruption or reduction of methotrexate.
* **CYP2C19 Substrates (e.g., clopidogrel):** Pantoprazole can reduce the antiplatelet effect of clopidogrel. Monitor for reduced effectiveness.
### Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, arrhythmias).
* Monitor for signs of *Clostridium difficile*-associated diarrhea.
* Consider monitoring vitamin B12 levels with long-term therapy.
### Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* Do not crush or chew delayed-release tablets.
* Effectiveness may be reduced with concurrent use of antacids.
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*Disclaimer: This information is intended for clinical professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
