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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases stomach acid production.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis
* Zollinger-Ellison syndrome
* Healing of duodenal ulcers
* H. pylori eradication (in combination regimens)
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or intravenously once daily. Duration of therapy varies by indication.
* **Healing of Duodenal Ulcers:** 40 mg orally once daily for 4 weeks.
* **Zollinger-Ellison Syndrome:** Initiate at 40 mg orally or intravenously twice daily. Doses may be increased as needed. Maximum recommended dose is 120 mg twice daily.
## Pediatric Dosing
* **GERD (age 5 to 16 years):** 20 mg to 40 mg orally once daily.
* **Erosive Esophagitis (age 5 to 16 years):** 40 mg orally once daily.
* **H. pylori eradication (age 12 to 16 years):** Specific regimens vary; consult guidelines.
## Dose Adjustments
No dose adjustment is typically needed for hepatic or renal impairment, but caution may be advised in severe hepatic disease.
## Contraindications
* Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common adverse effects include diarrhea, headache, nausea, dizziness, and abdominal pain. Long-term use of PPIs has been associated with an increased risk of C. difficile infection, bone fractures, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, iron salts, and certain antiretrovirals may have decreased absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole can potentially affect the metabolism of drugs metabolized by CYP2C19.
## Monitoring
* Monitor for improvement in GERD symptoms.
* Assess for adverse effects, particularly with long-term use.
* Consider vitamin B12 levels and bone density screening in patients on long-term therapy.
## Clinical Pearls
* Administer pantoprazole oral suspension 30 minutes before a meal.
* Pantoprazole delayed-release tablets should be swallowed whole and not chewed or crushed.
* IV administration requires reconstitution and further dilution.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.
