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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production.
## Primary Indications
* Healing of erosive esophagitis associated with GERD
* Maintenance of healing of erosive esophagitis
* Treatment of pathological hypersecretory conditions, such as Zollinger-Ellison syndrome
## Adult Dosing
* **Healing of 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 managed on 20 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased as needed. Usual dosage range is 40 mg to 120 mg daily. Doses >80 mg should be divided and administered every 12 hours.
## Pediatric Dosing
* **Erosive esophagitis (ages 5-16 years):** 20 mg orally once daily for up to 8 weeks.
* **Erosive esophagitis (ages 16-18 years):** 40 mg orally once daily for up to 8 weeks.
* **Pathological hypersecretory conditions (ages 12-18 years):** Starting dose is typically 40 mg orally twice daily. Doses may be increased as needed.
## Dose Adjustments
No specific dose adjustment is generally recommended for hepatic or renal impairment. However, caution may be advised in severe hepatic impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common adverse effects include diarrhea, headache, dizziness, abdominal pain, nausea, and flatulence. Long-term use of PPIs has been associated with an increased risk of:
* Clostridium difficile-associated diarrhea
* Bone fractures (hip, wrist, spine)
* Vitamin B12 deficiency
* Hypomagnesemia
* Increased risk of certain infections (e.g., pneumonia)
## Key Drug Interactions
* **Clopidogrel:** Pantoprazole may decrease the efficacy of clopidogrel due to CYP2C19 inhibition. Consider alternative PPIs if coadministration is necessary.
* **Methotrexate:** PPIs can increase methotrexate levels. Consider withholding PPI if high-dose methotrexate is used.
* **Drugs dependent on gastric pH for absorption:** Antiretrovirals (e.g., atazanavir, nelfinavir), antifungals (e.g., ketoconazole, itraconazole), iron salts, and mycophenolate mofetil may have altered absorption.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremors, muscle cramps, seizures, arrhythmias).
* Consider monitoring vitamin B12 levels with prolonged therapy.
* Monitor bone mineral density with long-term use, especially in patients at risk for osteoporosis.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes to 1 hour before a meal.
* Oral delayed-release tablets should be swallowed whole and not chewed or crushed.
* Intravenous administration should be over at least 2 minutes.
* Consider the risks of long-term PPI use, especially when used for non-specific dyspepsia or GERD symptoms.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance.*
