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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces 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 or intravenously once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily. (Lower doses may be adequate for some patients).
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased as needed. Maximum recommended oral dose is 240 mg per day given as 40 mg three times a day. Maximum recommended intravenous dose is 240 mg per day given as 80 mg every 8 hours.
## Pediatric Dosing
Dosing is based on weight and indication. Specific recommendations vary by age group and may require local protocol guidance. For example:
* **12 to 17 years:** Erosive esophagitis: 40 mg orally once daily for up to 8 weeks.
* **5 to 11 years:** Erosive esophagitis: 20 mg orally once daily for up to 8 weeks. For patients weighing > 40 kg, 40 mg orally once daily for up to 8 weeks.
## Dose Adjustments
No dose adjustment is generally required for hepatic or renal impairment.
## Contraindications
Known hypersensitivity to pantoprazole, any component of the formulation, or other benzimidazoles.
## Adverse Effects
Common side effects include headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, and rash. Long-term use may be associated with increased risk of *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Pantoprazole can decrease absorption of drugs like ketoconazole, itraconazole, posaconazole, and certain HIV protease inhibitors.
* **Methotrexate:** PPIs may
