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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. * Reduction of risk of NSAID-associated gastric ulcers in patients with a history of ulcers requiring continuous NSAID treatment. * 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. * **NSAID-associated gastric ulcers:** 40 mg orally once daily. * **Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome):** Start with 40 mg orally or intravenously twice daily. Doses may be increased as needed. Maximum recommended dose is 120 mg intravenously every 8 hours or 240 mg intravenously once daily. ## Pediatric Dosing Dosing for pediatric patients varies by indication and age/weight. Consult specific pediatric guidelines or product labeling. Generally: * **GERD and erosive esophagitis:** * Children 5 to 11 years: 20 mg orally once daily for up to 8 weeks. * Adolescents 12 to 17 years: 40 mg orally once daily for up to 8 weeks. ## Dose Adjustments No dose adjustment is typically needed for patients with renal impairment. For severe hepatic impairment, consider a dose of 20 mg orally once daily. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence. * **Serious:** * *Clostridioides difficile*-associated diarrhea. * Bone fracture (hip, wrist, spine) with long-term, high-dose use. * Hypomagnesemia, potentially leading to hypocalcemia, hypokalemia, and cardiac arrhythmias. * Vitamin B12 deficiency with long-term use. * Systemic lupus erythematosus (new onset or exacerbation). * Fundic gland polyps. ## Key Drug Interactions * **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, posaconazole, iron salts, mycophenolate mofetil, dasatinib. * **CYP2C19 substrates:** Increased plasma concentrations of drugs like clopidogrel. * **Methotrexate:** Increased methotrexate levels. * **Rilpivirine:** Concomitant use is contraindicated. ## Monitoring * Monitor for signs and symptoms of *C. difficile*-associated diarrhea. * Consider monitoring magnesium levels, especially with prolonged therapy or concomitant diuretic use. * Assess for signs of bone fracture. * Evaluate for symptoms of vitamin B12 deficiency. ## Clinical Pearls * PPIs are most effective when taken 30 to 60 minutes before a meal. * Long-term use (over 1 year) is associated with increased risk of fractures, *C. difficile* infection, and hypomagnesemia. Consider lowest effective dose for shortest duration necessary. * IV administration may be preferred in patients unable to take oral medications or with severe symptoms. * Pantoprazole is a substrate of CYP2C19 and CYP3A4. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and your institution's guidelines for complete details before making any treatment decisions.