Please check your internet connection and try again.
## Pantoprazole
### Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion.
### Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis
* Healing of duodenal ulcers
* Reduction of risk of NSAID-associated gastric ulcers
* Zollinger-Ellison syndrome
### Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or IV once daily for 4-8 weeks.
* **Healing of Duodenal Ulcers:** 40 mg orally once daily for 4 weeks.
* **Reduction of NSAID-associated Gastric Ulcers:** 20 mg orally once daily.
* **Zollinger-Ellison Syndrome:** Start at 40 mg orally or IV once daily, titrate as needed. Usual maintenance dose 40 mg twice daily. Doses up to 240 mg daily have been administered.
### Pediatric Dosing
* **GERD/Erosive Esophagitis:**
* **1 to <5 years:** 10 mg orally once daily for up to 8 weeks.
* **5 to <12 years:** 20 mg orally once daily for up to 8 weeks.
* **≥12 years:** 40 mg orally once daily for up to 8 weeks.
* **Note:** IV formulations are not generally recommended for pediatric patients due to limited data.
### Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 20 mg orally once daily.
### Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
### Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, flatulence.
* **Serious:** *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), vitamin B12 deficiency, hypomagnesemia, fundic gland polyps.
### Key Drug Interactions
* **Drugs Dependent on Gastric pH:** May decrease absorption of drugs like ketoconazole, itraconazole, posaconazole, iron salts, and vitamin B12.
* **Methotrexate:** May increase levels of methotrexate.
* **CYP2C19 Substrates:** Potential for interactions with drugs like clopidogrel (though clinical significance is debated).
### Monitoring
* Monitor for signs and symptoms of *Clostridium difficile* infection.
* Monitor electrolytes (magnesium, sodium, potassium) especially with prolonged use.
* Consider monitoring vitamin B12 levels with long-term therapy.
* Monitor bone mineral density in patients at risk for osteoporosis.
### Clinical Pearls
* Pantoprazole can be taken with or without food.
* For patients unable to swallow intact tablets, pantoprazole delayed-release tablets can be mixed with applesauce. Do not crush or chew.
* Long-term use of PPIs is associated with increased risk of certain adverse events. Use the lowest effective dose for the shortest duration necessary.
***
**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always consult the most current prescribing information and your healthcare provider for any medical decisions.
