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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. * Treatment of pathological hypersecretory conditions, including 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. * **Pathological Hypersecretory Conditions:** 40 mg orally or intravenously twice daily initially, may be increased as needed. Usual dose range: 40 mg to 240 mg daily. Doses above 120 mg daily should be administered intravenously in divided doses. ## Pediatric Dosing * **Erosive Esophagitis (GERD-associated):** * **1 to 5 years:** 10 mg orally once daily for up to 8 weeks. * **5 to 12 years:** 20 mg orally once daily for up to 8 weeks. * **12 years and older:** 40 mg orally once daily for up to 8 weeks. * **Intravenous Dosing (12 years and older):** 1.6 mg/kg once daily (maximum 40 mg/day) for up to 7 days. ## Dose Adjustments No dose adjustment is generally required for renal impairment. Caution is advised in severe hepatic impairment; a daily dose of 20 mg orally is recommended. ## Contraindications * Known hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, dizziness, and flatulence. ## Key Drug Interactions * **Drugs dependent on gastric pH for absorption:** PPIs can decrease the absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors (e.g., atazanavir). * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** Pantoprazole can inhibit CYP2C19, potentially increasing levels of drugs metabolized by this enzyme (e.g., clopidogrel). ## Monitoring * Monitor for signs and symptoms of *Clostridioides difficile*-associated diarrhea. * Long-term PPI use may be associated with an increased risk of osteoporosis-related fractures, *Clostridium difficile* infection, and vitamin B12 deficiency. Consider monitoring bone mineral density and vitamin B12 levels with prolonged therapy. ## Clinical Pearls * Administer pantoprazole orally 30 minutes to 1 hour before a meal. * For intravenous administration, reconstitute and dilute as per manufacturer instructions. Infuse over 15 minutes. * IV formulation is typically used when oral route is not feasible. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before initiating therapy.*