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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, such as Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks. For maintenance of healing, 40 mg orally once daily.
* **Pathological hypersecretory conditions:** 40 mg orally twice daily initially. Doses may be adjusted based on gastric acid output. Doses up to 240 mg daily have been administered.
## Pediatric Dosing
* **GERD and erosive esophagitis (age 5 to 11 years):** 20 mg orally once daily for up to 4 weeks.
* **GERD and erosive esophagitis (age 12 to 17 years):** 40 mg orally once daily for up to 8 weeks.
## Dose Adjustments
No dose adjustment is typically necessary for patients with hepatic impairment. Use with caution in severe hepatic impairment. No dose adjustment is needed for renal impairment.
## Contraindications
Hypersensitivity to pantoprazole or any component of its formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness.
Long-term use of PPIs may be associated with an increased risk of:
* Fractures (hip, wrist, spine)
* Clostridium difficile infection
* Vitamin B12 deficiency
* Hypomagnesemia
## Key Drug Interactions
* **Clopidogrel:** Pantoprazole may decrease the efficacy of clopidogrel due to CYP2C19 inhibition. Consider alternative PPIs if concomitant use is necessary.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **Drugs requiring gastric acid for absorption (e.g., ketoconazole, itraconazole, iron salts):** Pantoprazole may decrease absorption.
## Monitoring
* Monitor for signs and symptoms of Clostridium difficile-associated diarrhea.
* Monitor serum magnesium levels, especially with prolonged use or concomitant use of other medications that may lower magnesium.
* Monitor for signs of bone fracture.
* Monitor for signs and symptoms of vitamin B12 deficiency.
## Clinical Pearls
* Administer pantoprazole 30 minutes before a meal.
* Do not crush or chew delayed-release tablets; swallow whole.
* For patients unable to swallow whole, the delayed-release tablet can be dispersed in 100 mL of non-acidic liquid (e.g., apple juice) or mixed with applesauce.
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*Please consult the most current prescribing information for definitive guidance. This information is intended for healthcare professionals and does not substitute professional medical judgment.*
