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Pantoprazole is a proton pump inhibitor (PPI) used to decrease stomach acid production.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis
* Zollinger-Ellison syndrome
* Part of *Helicobacter pylori* eradication regimens
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or intravenously once daily.
* **Zollinger-Ellison Syndrome:** Starting dose of 40 mg orally or intravenously twice daily, titrate as needed. Maximum dose: 240 mg daily.
* ***H. pylori* Eradication:** 40 mg orally twice daily, given with amoxicillin and clarithromycin for 7-14 days.
## Pediatric Dosing
* **GERD/Erosive Esophagitis:**
* **1 to 5 years:** 10 mg orally once daily.
* **5 to 16 years:** 20 mg orally once daily.
* **Note:** Dosing for children < 1 year is not established. Dosing for IV administration in pediatrics may vary; consult local protocols.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 20 mg orally or 40 mg intravenously once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or other PPIs.
## Adverse Effects
* Common: Diarrhea, headache, nausea, abdominal pain, flatulence.
* Serious: *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency. Long-term use may be associated with increased risk of certain infections.
## Key Drug Interactions
* **Clopidogrel:** Pantoprazole may decrease the antiplatelet effect of clopidogrel. Consider alternatives if concurrent use is necessary.
* **Drugs Dependent on Gastric pH:** Absorption may be affected (e.g., ketoconazole, itraconazole, iron salts, vitamin B12).
* **Methotrexate:** PPIs may increase methotrexate levels.
## Monitoring
* Electrolytes (especially magnesium) with prolonged therapy.
* Renal function if significant hepatic impairment exists.
## Clinical Pearls
* Administer orally before a meal.
* IV administration is a suitable alternative for patients unable to take oral medications.
* Long-term use should be periodically reassessed for continued need.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and institutional protocols before making clinical decisions.
