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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive Esophagitis (Healing):** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Erosive Esophagitis (Maintenance):** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased to 240 mg daily, given as 40 mg to 80 mg every 8 hours.
## Pediatric Dosing
* **GERD (Erosive Esophagitis):**
* **1 to 5 years:** 10 mg orally once daily for up to 8 weeks.
* **5 to 12 years:** 20 mg orally once daily for up to 8 weeks.
* **12 to 17 years:** 40 mg orally once daily for up to 8 weeks.
* *Note: Intravenous dosing in pediatric patients is less well-established and typically guided by specialist consultation or local protocols.*
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 40 mg orally once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any of its components.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness.
Serious: Bone fracture (hip, wrist, spine), *Clostridioides difficile*-associated diarrhea, hypomagnesemia, vitamin B12 deficiency, systemic lupus erythematosus.
## Key Drug Interactions
* **Drugs Dependent on Gastric pH:** PPIs can alter gastric pH, affecting the absorption of drugs like ketoconazole, itraconazole, and certain antiretrovirals.
* **Methotrexate:** Pantoprazole may increase methotrexate levels; consider dose reduction or temporary discontinuation if coadministered.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19 and may increase concentrations of drugs metabolized by this enzyme (e.g., clopidogrel).
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremor, tetany, seizures).
* Monitor for signs of *C. difficile*-associated diarrhea.
* Consider vitamin B12 levels with long-term therapy.
## Clinical Pearls
* Pantoprazole is available in delayed-release oral formulations and as a powder for injection.
* Oral pantoprazole should be taken at least 1 hour before a meal.
* Long-term use of PPIs is associated with an increased risk of fractures, *C. difficile* infection, and vitamin B12 deficiency. Consider the lowest effective dose for the shortest duration necessary.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.*
