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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion. ## 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. * Reduction of risk of NSAID-associated gastric ulcers in patients at risk. ## Adult Dosing * **Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. * **Maintenance of Healing:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily. * **Pathological Hypersecretory Conditions:** Starting dose is 40 mg orally or intravenously twice daily. Doses can be increased as needed. Typical doses range from 40 mg to 240 mg daily. Doses above 120 mg daily should be administered intravenously in divided doses. * **NSAID-Associated Gastric Ulcers:** 40 mg orally once daily for up to 8 weeks. ## Pediatric Dosing * **12 to 17 years:** * **Erosive Esophagitis:** 40 mg orally once daily for up to 4 weeks. * **GERD Symptoms:** 20 mg orally once daily for up to 8 weeks. * **Less than 12 years:** Dosing is not established in this age group for all indications. Consult specific pediatric guidelines. ## Dose Adjustments No dose adjustment is generally needed for renal impairment. For severe hepatic impairment, consider a dose of 20 mg orally once daily. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. * Concomitant use with rilpivirine. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence. * **Serious:** * _Clostridium difficile_-associated diarrhea. * Bone fracture (hip, wrist, spine) with prolonged use. * Hypomagnesemia with prolonged use (may be asymptomatic or manifest as tetany, arrhythmias, seizures). * Cutaneous and systemic lupus erythematosus. * Vitamin B12 deficiency. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** Antiretrovirals (e.g., rilpivirine), antifungals (e.g., ketoconazole, itraconazole), erlotinib, mycophenolate mofetil. Pantoprazole can decrease absorption. * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. ## Monitoring * Monitor for signs and symptoms of _Clostridium difficile_ infection. * Consider magnesium levels periodically in patients on long-term therapy. * Assess for bone fracture risk in patients with osteoporosis or other risk factors. * Monitor for signs of B12 deficiency with prolonged use. ## Clinical Pearls * Oral pantoprazole is generally preferred when clinically appropriate. * IV administration is indicated when oral route is not feasible. * Do not crush or chew delayed-release tablets. * Long-term use of PPIs may increase the risk of certain adverse events. Use the lowest effective dose for the shortest duration needed. *** **Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information and guidelines with the most up-to-date drug monographs and institutional protocols.