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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, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive Esophagitis (Healing):** 40 mg orally once daily for up to 8 weeks.
* **Erosive Esophagitis (Maintenance):** 40 mg orally once daily.
* **Pathological Hypersecretory Conditions:** 40 mg orally twice daily; may be increased as clinically indicated. Usual dose range is 40 mg to 240 mg daily. Doses above 160 mg should be given in divided doses. Maximum recommended daily dose is 240 mg.
## Pediatric Dosing
* **Erosive Esophagitis (GERD-associated):**
* **1 to 5 years:** 10 mg orally once daily for up to 8 weeks.
* **6 to 11 years:** 20 mg orally once daily for up to 8 weeks.
* **12 to 17 years:** 40 mg orally once daily for up to 8 weeks.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose is 20 mg orally once daily for patients with severe hepatic impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence.
* **Serious:** *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine) with long-term use, hypomagnesemia, vitamin B12 deficiency, fundic gland polyps.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Consider potential for altered absorption of drugs like ketoconazole, itraconazole, iron salts, and vitamin B12.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Coadministration with CYP2C19 substrates (e.g., clopidogrel) may increase their plasma concentrations.
## Monitoring
* Monitor for signs and symptoms of *Clostridium difficile*-associated diarrhea.
* Consider periodic monitoring of magnesium levels, especially in patients on long-term therapy or concomitant diuretic use.
* Monitor for bone fracture risk.
* Assess for signs of vitamin B12 deficiency with prolonged use.
## Clinical Pearls
* Pantoprazole is generally considered to have fewer CYP2C19-mediated drug interactions compared to some other PPIs.
* The lowest effective dose should be used for the shortest duration necessary to manage the condition.
* Long-term PPI therapy is associated with increased risks of fractures, *C. difficile* infection, hypomagnesemia, and vitamin B12 deficiency.
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**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for definitive drug information, dosing, and treatment decisions.
