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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. * Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome. ## Adult Dosing * **Healing of 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 orally once daily. * **Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome):** Start with 40 mg orally or intravenously twice daily. Doses can be increased as needed. Doses up to 240 mg intravenously daily have been administered. ## Pediatric Dosing Dosing varies significantly by age and indication. Consult specific pediatric guidelines. For example: * **GERD (1 month to 5 years):** 1 mg/kg/day orally once daily, not to exceed 20 mg/day. * **GERD (5 years to 11 years):** 20 mg orally once daily for up to 4 weeks. * **Healing of erosive esophagitis (5 years to 11 years):** 40 mg orally once daily for up to 8 weeks. ## Dose Adjustments No dose adjustment is generally required for hepatic impairment, although caution may be advised with severe impairment. No dose adjustment is needed for renal impairment. ## Contraindications * Known hypersensitivity to pantoprazole, any component of the formulation, or other substituted benzimidazoles. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, flatulence, and dizziness. Long-term use may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, and vitamin B12 deficiency. ## Key Drug Interactions * **Certain Antiretrovirals:** Pantoprazole can decrease the absorption of antiretrovirals (e.g., rilpivirine, atazanavir). Avoid coadministration. * **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity. Consider a temporary interruption of pantoprazole. * **CYP2C19 Substrates:** Pantoprazole can affect the metabolism of drugs primarily metabolized by CYP2C19. ## Monitoring * Monitor for signs and symptoms of *Clostridium difficile* infection. * Consider monitoring vitamin B12 levels with prolonged therapy. * Monitor bone mineral density in patients at risk for osteoporosis. ## Clinical Pearls * Administer oral pantoprazole 30 minutes before a meal. * Intravenous administration should be over 15 minutes or longer. * The 20 mg dose is available for patients requiring lower acid suppression. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance.*