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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Reduction of risk of NSAID-associated gastric ulcers in patients at risk.
* Pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. For maintenance of healing, 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **NSAID-Associated Ulcer Prophylaxis:** 20 mg orally once daily.
* **Zollinger-Ellison Syndrome:** 40 mg orally or intravenously once daily. Doses may be increased up to 240 mg intravenously or 40 mg orally twice daily. Daily doses greater than 80 mg should be administered by continuous IV infusion.
## Pediatric Dosing
* **Erosive Esophagitis (12 years and older):** 40 mg orally once daily for up to 8 weeks.
* **GERD (5 years and older):** 20 mg to 40 mg orally once daily for up to 8 weeks.
* **Note:** Dosing for younger children is not well-established and may depend on local protocol.
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 40 mg orally or 20 mg intravenously.
## Contraindications
* Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness, fatigue.
* **Serious:** *Clostridioides difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, fundic gland polyps, lupus erythematosus (cutaneously and systemically).
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Drugs like ketoconazole, itraconazole, iron salts, and cyanocobalamin may have decreased absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. It may increase levels of drugs like clopidogrel, citalopram, and diazepam.
## Monitoring
* Magnesium levels, especially with prolonged use (>3 months) or concomitant use of diuretics or digoxin.
* Bone mineral density in patients at risk for osteoporosis.
* Kidney function if *C. difficile* infection is suspected.
## Clinical Pearls
* Administer pantoprazole orally 30 minutes before a meal.
* IV administration is an option when oral intake is not feasible.
* Long-term use of PPIs is associated with potential risks and should be periodically re-evaluated.
* Pantoprazole does not neutralize existing stomach acid but prevents future acid production.
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**Disclaimer:** This information is intended for healthcare professionals. Please refer to the most current prescribing information and consult with appropriate resources for patient-specific management.
