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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Healing of erosive esophagitis
* Reduction of risk of NSAID-associated gastric ulcers
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of Healing Erosive Esophagitis:** 40 mg orally once daily; some patients may be treated with 20 mg orally once daily.
* **NSAID-Associated Gastric Ulcers:** 40 mg orally once daily for up to 8 weeks.
* **Pathological Hypersecretory Conditions:** Initiate with 40 mg orally or intravenously twice daily. Doses may be increased as needed. Usual doses range from 40 mg to 120 mg daily. Doses >80 mg daily should be divided and administered every 12 hours. Maximum daily dose: 120 mg intravenously or 240 mg orally.
## Pediatric Dosing
* **GERD (1 month to 5 years):** 1.1 to 1.5 mg/kg/day orally once daily, not to exceed 40 mg/day.
* **GERD (5 to 12 years):** 20 mg orally once daily for up to 8 weeks.
* **Erosive Esophagitis (5 to 12 years):** 40 mg orally once daily for up to 8 weeks.
* **GERD (12 years and older):** 40 mg orally once daily for up to 8 weeks.
Dosing for children may vary based on specific indication and local protocols.
## Dose Adjustments
No dose adjustment is typically required for renal impairment. Use with caution in hepatic impairment; consider reducing dose by half.
## Contraindications
* Known hypersensitivity to pantoprazole or other PPIs.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness.
* **Serious:** *Clostridioides difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, lupus erythematosus.
## Key Drug Interactions
* **Antiretrovirals:** Reduced absorption of certain antiretroviral drugs (e.g., nelfinavir, atazanavir).
* **Methotrexate:** May increase levels of methotrexate.
* **CYP2C19 Substrates:** Potential for altered levels of drugs metabolized by CYP2C19 (e.g., clopidogrel, warfarin, phenytoin).
## Monitoring
* Monitor for signs and symptoms of *C. difficile*-associated diarrhea.
* Consider serum magnesium levels, especially with prolonged use (>3 months) or concurrent use of diuretics or digoxin.
* Monitor for signs of bone fracture.
* Assess for vitamin B12 deficiency with long-term therapy.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* Pantoprazole delayed-release capsules can be opened, and beads sprinkled on applesauce or mashed potatoes for patients unable to swallow capsules whole. Do not chew beads.
* Intravenous pantoprazole is typically administered over 2 minutes or infused over 15 minutes.
* Consider the risks associated with long-term PPI use (e.g., bone fractures, *C. difficile* infection, hypomagnesemia).
* For patients with Zollinger-Ellison syndrome, duration of treatment should be based on clinical need.
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*This information is intended for healthcare professionals and does not replace the need to consult the most current prescribing information and institutional protocols.*
