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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion. ## Primary Indications * Erosive esophagitis associated with gastroesophageal reflux disease (GERD). * Maintenance of healing of erosive esophagitis. * Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome). ## Adult Dosing * **Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. * **Maintenance of Healing:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily. * **Pathological Hypersecretory Conditions:** 40 mg orally or intravenously twice daily. The dose may be increased to 80 mg intravenously or orally twice daily. Doses over 80 mg daily should be divided and administered twice daily. ## Pediatric Dosing * **Erosive Esophagitis (12 to 17 years):** 40 mg orally once daily for up to 4 weeks. * **Erosive Esophagitis (5 to 11 years):** 20 mg orally once daily for up to 4 weeks. Doses may be increased to 40 mg once daily if needed. * **Erosive Esophagitis (less than 5 years):** Dosing is not established. ## Dose Adjustments No dose adjustment is typically required for renal impairment. In severe hepatic impairment, the maximum daily dose is 20 mg orally or 40 mg intravenously. ## Contraindications * Known hypersensitivity to pantoprazole, any component of the formulation, or any other substituted benzimidazole. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use may increase the risk of *Clostridioides difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, iron salts, mycophenolate mofetil. Pantoprazole can decrease absorption. * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** Clopidogrel. Pantoprazole can inhibit CYP2C19, potentially reducing the efficacy of clopidogrel. ## Monitoring * Monitor for signs and symptoms of *C. difficile* infection. * Monitor serum magnesium levels, especially with prolonged use (typically greater than 1 year) or concomitant use of digoxin or diuretics. * Assess for signs of bone fracture (e.g., hip, wrist, spine) in patients at risk. * Assess vitamin B12 status in patients with long-term therapy. ## Clinical Pearls * Administer oral pantoprazole 30 minutes before a meal. * Pantoprazole delayed-release tablets should be swallowed whole and not chewed or crushed. * Pantoprazole for injection requires reconstitution and dilution prior to IV administration. *** *This information is for educational purposes only and does not constitute medical advice. Always consult the most current prescribing information and your healthcare provider for any health concerns or before making any decisions related to your health or treatment.*