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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
* **Healing of 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 of 40 mg orally or intravenously twice daily. Doses may be increased to 240 mg orally or intravenously daily. Doses greater than 80 mg daily should be administered intravenously in divided doses.
## Pediatric Dosing
* **GERD:**
* 1 year and older: 15 to 40 kg: 20 mg orally once daily. Greater than 40 kg: 40 mg orally once daily. Duration of treatment generally 8 weeks.
* Erosive esophagitis: 5 years and older: 15 to 40 kg: 20 mg orally once daily. Greater than 40 kg: 40 mg orally once daily. Duration of treatment generally 8 weeks.
* **Note:** Limited data in pediatric patients for doses higher than 40 mg daily or IV administration.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 40 mg orally once daily.
* **Renal Impairment:** No dose adjustment necessary.
## 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), hypomagnesemia, vitamin B12 deficiency, lupus erythematosus.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, iron salts, mycophenolate mofetil.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates/inhibitors:** Potent inhibitors of CYP2C19 (e.g., fluvoxamine) may increase pantoprazole exposure.
## Monitoring
* Magnesium levels (especially with prolonged use, >1 year).
* Bone mineral density in patients at risk for osteoporosis.
* Consider monitoring vitamin B12 levels with long-term therapy.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* IV administration: Infuse over at least 15 minutes or 2 minutes if reconstituted as 5 mg/mL.
* Long-term use of PPIs is associated with an increased risk of fractures, *C. difficile* infection, and hypomagnesemia.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the appropriateness of any medication for your specific condition. Please verify current prescribing information for the most up-to-date details.*
