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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 * Zollinger-Ellison syndrome * Healing of duodenal ulcers * H. pylori eradication (in combination regimens) ## Adult Dosing * **GERD/Erosive Esophagitis:** 40 mg orally once daily. Some patients may require 40 mg twice daily. * **Healing of Duodenal Ulcers:** 40 mg orally once daily. * **Zollinger-Ellison Syndrome:** Starting dose typically 40 mg orally twice daily, may be increased up to 240 mg per day divided into doses. * **H. pylori Eradication:** 40 mg orally twice daily for 7-14 days in combination with antibiotics. ## Pediatric Dosing * **GERD/Erosive Esophagitis:** * **1 month to < 5 years:** 10 mg to 20 mg orally once daily, depending on weight. * **5 years to < 12 years:** 20 mg orally once daily. * **≥ 12 years:** 40 mg orally once daily. * *Note: Dosing for pediatric patients may vary based on local protocol and clinical judgment.* ## Dose Adjustments * **Hepatic Impairment:** Maximum daily dose of 20 mg orally. ## Contraindications * Known hypersensitivity to pantoprazole or any component of its formulation. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence. * **Serious:** Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia (potentially severe), vitamin B12 deficiency, lupus erythematosus (cutaneou s and systemic). ## Key Drug Interactions * **Drugs dependent on gastric pH for absorption:** Antiretrovirals (e.g., atazanavir, nelfinavir), antifungals (e.g., ketoconazole, itraconazole), certain tyrosine kinase inhibitors. * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** May affect metabolism of drugs like clopidogrel (though clinical significance is debated). ## Monitoring * Electrolytes (magnesium, sodium, potassium) with prolonged therapy. * Bone mineral density with long-term use. * Signs and symptoms of C. difficile infection. * Vitamin B12 levels with prolonged therapy. ## Clinical Pearls * Administer 30 minutes before a meal. * Tablets should be swallowed whole and not chewed, crushed, or split. * If administering via NG tube, do not crush tablets; the intact tablet can be dispersed in 10 mL of water and then administered through the NG tube. * Long-term use of PPIs can lead to adverse events; consider the lowest effective dose for the shortest duration necessary. *** **Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always consult current prescribing information and your healthcare provider for the most accurate and up-to-date drug information.