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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
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **Erosive Esophagitis:** 40 mg orally or IV once daily for up to 8 weeks.
* **Maintenance of Healing:** 40 mg orally once daily. Some patients may be treated with 20 mg once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is 40 mg orally or IV twice daily. Doses may be increased to 80 mg IV or orally every 8 hours. Maximum dose is 240 mg daily.
## Pediatric Dosing
* **Erosive Esophagitis (5 to 16 years):** 20 mg orally once daily for up to 8 weeks.
* **Erosive Esophagitis (1 month to <5 years):** 1.1 to 1.5 mg/kg/day orally or IV once daily, not to exceed 40 mg/day. Duration of treatment should be individualized.
## Dose Adjustments
No dose adjustment is typically necessary for renal impairment. Consider dose reduction in severe hepatic impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, dizziness, and flatulence. Long-term PPI use may be associated with an increased risk of fractures (hip, wrist, spine), Clostridium difficile infection, vitamin B12 deficiency, and hypomagnesemia.
## Key Drug Interactions
* **Warfarin:** Increased INR and bleeding risk. Monitor INR closely.
* **Methotrexate:** May increase methotrexate levels.
* **Drugs dependent on gastric pH for absorption (e.g., ketoconazole, itraconazole, iron salts, digoxin):** Decreased absorption due to reduced gastric acidity.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremors, seizures, muscle cramps, arrhythmias).
* Monitor for signs and symptoms of C. difficile infection.
* Monitor bone mineral density with prolonged use.
## Clinical Pearls
* Administer pantoprazole oral suspension 30 minutes prior to a meal.
* Pantoprazole for injection should be reconstituted and diluted before IV administration.
* For maintenance of healing, the lowest effective dose should be used.
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**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always refer to the most current prescribing information and consult with a healthcare professional for any specific medical questions or treatment decisions.
