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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis
* Healing of duodenal ulcers
* Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or IV once daily for up to 8 weeks. For maintenance: 20-40 mg once daily.
* **Duodenal Ulcer Healing:** 40 mg orally or IV once daily for up to 4 weeks.
* **Hypersecretory Conditions:** 40 mg orally or IV twice daily. Doses may be increased as clinically needed. Maximum daily dose is 120 mg, typically divided into two doses.
## Pediatric Dosing
* **12 years and older:**
* GERD/Erosive Esophagitis: 40 mg orally once daily for up to 8 weeks.
* **Less than 12 years:** Dosing is variable and depends on indication and weight. Consult specific pediatric guidelines or local protocols.
## Dose Adjustments
No dose adjustment is generally needed for hepatic or renal impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea, headache, nausea, abdominal pain, dizziness.
* **Serious:**
* Long-term use: Increased risk of *Clostridioides difficile*-associated diarrhea, bone fractures (hip, wrist, spine), vitamin B12 deficiency, and hypomagnesemia.
* Acute interstitial nephritis.
* Fundic gland polyps.
## Key Drug Interactions
* **Drugs affected by gastric pH:** Absorption of drugs requiring acidic gastric pH (e.g., ketoconazole, itraconazole, atazanavir, nelfinavir) may be decreased.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. May increase concentrations of drugs metabolized by this enzyme (e.g., clopidogrel, warfarin, phenytoin, diazepam).
## Monitoring
* Monitor for signs and symptoms of *C. difficile* infection.
* Consider monitoring magnesium levels in patients on long-term therapy, especially those taking concomitant diuretics or digoxin.
* Assess for bone fracture risk in patients on long-term therapy.
* Monitor for signs of vitamin B12 deficiency with prolonged use.
## Clinical Pearls
* Administer oral pantoprazole 30-60 minutes before a meal.
* IV administration: Reconstitute vial with 5 mL sterile water for injection, then further dilute in 50 mL or 100 mL of 0.9% Sodium Chloride or 5% Dextrose injection. Administer as a slow IV infusion over 15 minutes.
* Parenteral administration is generally reserved for patients unable to take oral medication.
* The risk of adverse effects increases with duration of use. Re-evaluate the need for continued therapy periodically.
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*Disclaimer: This information is intended for clinical decision-making support and does not replace professional judgment. Always consult the most current prescribing information and relevant clinical guidelines before initiating or modifying therapy.*
