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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 gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome).
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing erosive esophagitis:** 40 mg orally once daily.
* **Pathological hypersecretory conditions:** 40 mg orally or intravenously twice daily, may be increased to a maximum of 240 mg daily in divided doses.
## Pediatric Dosing
* **Erosive esophagitis (ages 5 to 16 years):** 40 mg orally once daily for up to 4 weeks. For longer treatment, consider up to 8 weeks.
* **GERD symptoms (ages 5 to 16 years):** 20 mg orally once daily for up to 8 weeks.
* **Note:** Dosing for younger children or other indications in pediatrics may vary and often relies on physician discretion or local protocols.
## Dose Adjustments
* **Hepatic impairment:** Maximum dose of 20 mg orally once daily.
* **Renal impairment:** No dose adjustment necessary.
## Contraindications
* Known hypersensitivity to pantoprazole or any of its components.
* Use with rilpivirine-containing products.
## Adverse Effects
* Common: Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence.
* Long-term use associated with increased risk of: bone fractures (hip, wrist, spine), Clostridium difficile infection, vitamin B12 deficiency, hypomagnesemia.
## Key Drug Interactions
* **Rilpivirine:** Contraindicated due to potential for decreased rilpivirine plasma concentrations.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **Drugs Dependent on Gastric pH:** May affect absorption of drugs like ketoconazole, itraconazole, posaconazole, iron salts, and vitamin B12.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19; monitor for potential increases in levels of drugs like clopidogrel (though clinical significance debated), voriconazole.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., muscle spasms, dizziness, seizures).
* Monitor for signs of Clostridium difficile-associated diarrhea.
* Consider vitamin B12 levels with prolonged therapy.
* Bone mineral density assessment may be considered in patients at risk for osteoporosis.
## Clinical Pearls
* Administer 30-60 minutes before a meal.
* For oral suspension, reconstitute with 10 mL of water and shake well.
* Intravenous administration requires reconstitution and further dilution.
* PPIs are generally recommended for the shortest duration necessary to treat the condition.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance.
