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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases stomach acid production.
## Primary Indications
* Healing of erosive esophagitis
* Maintenance of healing of erosive esophagitis
* Symptomatic gastroesophageal reflux disease (GERD)
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **Erosive Esophagitis:** 40 mg once daily. Duration of treatment varies (up to 8 weeks for initial healing, up to 8 weeks for maintenance).
* **Symptomatic GERD:** 20 mg once daily. May increase to 40 mg once daily if not adequately controlled after 4 weeks.
* **Pathological Hypersecretory Conditions:** Starting dose typically 40 mg twice daily. Doses may be increased as needed. Usual maintenance dose range: 40 mg to 80 mg daily. Maximum dose: 80 mg every 12 hours.
## Pediatric Dosing
* **Age 5 to 11 years:**
* **Erosive Esophagitis:** 20 mg once daily for up to 8 weeks.
* **Symptomatic GERD:** 10 mg once daily for up to 8 weeks. May increase to 20 mg once daily if not adequately controlled.
* **Age 12 to 17 years:**
* **Erosive Esophagitis:** 40 mg once daily for up to 8 weeks.
* **Symptomatic GERD:** 20 mg once daily for up to 8 weeks. May increase to 40 mg once daily if not adequately controlled.
## Dose Adjustments
No dose adjustment necessary for hepatic impairment when used for GERD. For erosive esophagitis in patients with moderate to severe hepatic impairment, the recommended dose is 20 mg once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, flatulence, vomiting, dizziness.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Antiretrovirals (e.g., atazanavir, nelfinavir), antifungals (e.g., ketoconazole, itraconazole), certain tyrosine kinase inhibitors. May decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels. Consider withholding pantoprazole during methotrexate treatment.
* **CYP2C19 substrates:** Pantoprazole may inhibit CYP2C19, potentially affecting the metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of fracture (especially with long-term use).
* Monitor for signs and symptoms of C. difficile-associated diarrhea.
* Monitor magnesium levels, especially with concomitant use of other drugs that can cause hypomagnesemia (e.g., diuretics).
* For pathological hypersecretory conditions, monitor gastric acid output.
## Clinical Pearls
* Administer orally 30 minutes before a meal.
* Do not crush or chew delayed-release tablets.
* Long-term use of PPIs is associated with an increased risk of bone fractures, Clostridium difficile infection, and vitamin B12 deficiency.
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**Disclaimer:** This information is intended for healthcare professionals and should not be used as a substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for definitive guidance.
