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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion. ## Primary Indications * Gastroesophageal reflux disease (GERD) - healing of erosive esophagitis * Maintenance of healing of erosive esophagitis * Pathological hypersecretory conditions, including 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:** Starting dose 40 mg orally or intravenously twice daily. Doses may be increased to 240 mg daily. * Maximum oral dose: 240 mg daily, given as 60 mg every 6 to 12 hours. * Maximum IV dose: 720 mg daily, given as 90 mg infused over 30 minutes or longer every 8 hours. ## Pediatric Dosing * **Healing of Erosive Esophagitis (ages 5 to 16 years):** * 20 mg orally once daily for up to 8 weeks. * **GERD (ages 5 to 16 years):** * 20 mg orally once daily for up to 8 weeks. * Dosing for children under 5 years of age is not established. ## Dose Adjustments No dose adjustment is generally required for hepatic or renal impairment. However, caution may be warranted in severe hepatic impairment. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness. Less Common: Arthralgia, myalgia, fatigue. Rare: Serious skin reactions (e.g., Stevens-Johnson syndrome), acute interstitial nephritis, Clostridium difficile-associated diarrhea. Long-term use may be associated with an increased risk of fractures (hip, wrist, spine), hypomagnesemia, and vitamin B12 deficiency. ## Key Drug Interactions * **Clopidogrel:** Pantoprazole may decrease the antiplatelet effect of clopidogrel. Consider alternative PPIs or monitor closely. * **Methotrexate:** PPIs may increase methotrexate levels. Consider temporarily discontinuing PPIs during high-dose methotrexate therapy. * **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, iron salts, digoxin, mycophenolate mofetil. Reduced absorption may occur. * **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Monitor for potential toxicity of coadministered drugs. ## Monitoring * Symptom relief for GERD. * For long-term use, monitor for signs and symptoms of hypomagnesemia and vitamin B12 deficiency. * Bone mineral density screening may be considered for patients at risk of osteoporosis. ## Clinical Pearls * Administer 30 minutes before a meal. * For oral suspension, reconstitute with 10 mL of water and swirl gently. Do not chew or crush the granules. * IV formulation should be administered as an infusion over 15 minutes or longer. *** **Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for definitive treatment decisions. This summary does not replace comprehensive drug literature or clinical judgment.