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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Healing of erosive esophagitis
* Maintenance of healing of erosive esophagitis
* Symptomatic gastroesophageal reflux disease (GERD)
* Reduction of risk of NSAID-associated gastric ulcers in patients taking NSAIDs long-term
* Pathological hypersecretory conditions, including Zollinger-Ellison syndrome
## Adult Dosing
* **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 once daily.
* **Symptomatic GERD:** 40 mg orally once daily for up to 4 weeks.
* **NSAID-associated gastric ulcers:** 40 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose 40 mg orally or intravenously twice daily. Doses may be increased to 240 mg daily.
## Pediatric Dosing
* **Age 5 to 11 years:**
* **Erosive esophagitis:** 20 mg orally once daily for 4 to 8 weeks.
* **Age 12 to 17 years:**
* **Erosive esophagitis:** 40 mg orally once daily for 4 to 8 weeks.
* **Symptomatic GERD:** 40 mg orally once daily for 4 weeks.
* Dosing for children younger than 5 years is not established.
## Dose Adjustments
No dose adjustment is generally required for hepatic impairment. Use with caution in severe hepatic impairment; a maximum daily dose of 20 mg may be appropriate. No dose adjustment is required for renal impairment.
## Contraindications
* Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness.
* **Serious:** *Clostridium difficile*-associated diarrhea, bone fracture (hip, wrist, spine), hypomagnesemia (can be severe and prolonged), vitamin B12 deficiency, systemic lupus erythematosus (cutaneous and systemic), fundic gland polyps.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** PPIs can decrease the absorption of drugs such as certain antifungals (ketoconazole, itraconazole), antiretrovirals (atazanavir, ritonavir), and others.
* **Methotrexate:** Concomitant use with PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19.
## Monitoring
* Electrolytes (magnesium, sodium, potassium) especially with prolonged use or concomitant diuretic use.
* Bone mineral density in patients at risk for osteoporosis.
* Signs and symptoms of *Clostridium difficile*-associated diarrhea.
* Vitamin B12 levels with prolonged therapy.
## Clinical Pearls
* Administer pantoprazole oral suspension at least 30 minutes before a meal.
* Pantoprazole delayed-release tablets should be swallowed whole and not chewed or crushed.
* Long-term PPI use can be associated with increased risk of fractures, *C. difficile* infection, and hypomagnesemia. Consider the lowest effective dose and shortest duration of therapy.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant literature before making any clinical decisions.
