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## Pantoprazole
### Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
### Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis
* Zollinger-Ellison syndrome
* Healing of duodenal ulcers
* Prevention of NSAID-induced gastric ulcers
### Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg once daily. May increase to 40 mg twice daily for severe erosive esophagitis. Duration typically 4-8 weeks.
* **Zollinger-Ellison Syndrome:** 40 mg twice daily. Doses up to 240 mg daily have been used, administered as 40 mg three times daily.
* **Duodenal Ulcers:** 40 mg once daily. Duration typically 4 weeks.
* **NSAID-induced Ulcers (Prevention):** 40 mg once daily.
### Pediatric Dosing
* **GERD (Age 5 to 16 years):** 20 mg to 40 mg once daily. Dosing is weight-based (1.0 mg/kg/day to 2.0 mg/kg/day). Maximum dose is 40 mg daily.
* **Erosive Esophagitis (Age 5 to 16 years):** 40 mg once daily.
### Dose Adjustments
* **Hepatic Impairment:** Maximum dose is 20 mg once daily.
* **Renal Impairment:** No dose adjustment needed.
### Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
### Adverse Effects
* **Common:** Diarrhea, headache, dizziness, nausea, abdominal pain, flatulence.
* **Serious:**
* *Clostridioides difficile*-associated diarrhea (CDAD)
* Fracture of the hip, wrist, or spine (long-term use)
* Hypomagnesemia (long-term use)
* Vitamin B12 deficiency (long-term use)
* Fundic gland polyps
### Key Drug Interactions
* **Antiretrovirals (e.g., rilpivirine, atazanavir):** Pantoprazole may decrease plasma concentrations. Avoid coadministration or monitor for therapeutic failure.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity. Consider temporarily discontinuing pantoprazole.
* **CYP2C19 substrates (e.g., clopidogrel):** Pantoprazole is a moderate inhibitor of CYP2C19 and may reduce the efficacy of clopidogrel. Monitor for effectiveness or consider alternative PPIs with less CYP2C19 interaction.
* **Iron salts, certain azoles (ketoconazole, itraconazole):** Absorption may be decreased due to decreased gastric acidity.
### Monitoring
* Electrolytes (especially magnesium) with long-term therapy.
* Bone mineral density if patient is at risk for osteoporosis.
* Signs and symptoms of *C. difficile* infection.
* B12 levels with prolonged therapy.
### Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* Enteric-coated granules for oral suspension should not be crushed or chewed.
* IV formulations are available for patients unable to take oral medications.
* Long-term use of PPIs is associated with increased risk of fractures, hypomagnesemia, and vitamin B12 deficiency.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information with the latest official drug monographs or consult with a healthcare provider.*
