Please check your internet connection and try again.
# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Healing of erosive esophagitis
* Dose reduction of certain H2 blockers
* Dujian-YI syndrome
* Peptic ulcer disease (in combination with antibiotics for *H. pylori* eradication)
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or intravenously once daily. Duration varies based on indication (up to 8 weeks for erosive esophagitis).
* ***H. pylori* Eradication:** 40 mg orally twice daily for 7-14 days in combination with antibiotics (e.g., amoxicillin and clarithromycin).
* **Zollinger-Ellison Syndrome:** Starting dose typically 40 mg orally or intravenously once daily, titrate as needed. Doses up to 240 mg daily have been administered intravenously, divided into 3 doses.
## Pediatric Dosing
* **GERD/Erosive Esophagitis (≥ 5 years):**
* Weight < 40 kg: 20 mg orally once daily.
* Weight ≥ 40 kg: 40 mg orally once daily.
* **Intravenous Dosing (≥ 5 years):** Dosing may vary. Consult specific institutional guidelines or product information.
## Dose Adjustments
No dose adjustment is typically needed for hepatic impairment, but caution is advised. No dose adjustment is needed for renal impairment.
## Contraindications
* Hypersensitivity to pantoprazole or any component of the formulation.
* Concomitant use with rilpivirine.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term PPI use may be associated with an increased risk of C. difficile infection, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, iron salts, digoxin, mycophenolate mofetil.
* **CYP2C19 pathway:** May affect metabolism of drugs like clopidogrel (though clinical significance is debated), warfarin, and methotrexate.
* **Rilpivirine:** Contraindicated due to increased risk of virologic failure.
## Monitoring
* Monitor for signs and symptoms of *C. difficile* infection.
* Consider monitoring magnesium levels, especially with prolonged use or concomitant diuretic use.
* Assess for signs of bone fracture.
* Monitor for B12 deficiency symptoms.
## Clinical Pearls
* Administer oral pantoprazole 30-60 minutes before a meal.
* IV formulation can be administered as a continuous infusion or bolus.
* Consider the potential for drug interactions, especially with drugs whose absorption is pH-dependent or those metabolized via CYP2C19.
* Long-term use should be re-evaluated regularly to determine if continued therapy is warranted.
***
**Disclaimer:** This information is intended for clinical pharmacy professionals and does not substitute for a thorough review of the current prescribing information and patient-specific factors. Always verify current dosing, indications, and safety information with official drug compendia or product labeling.
