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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Erosive esophagitis associated with gastroesophageal reflux disease (GERD)
* Maintenance of healing of erosive esophagitis
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* Peptic ulcer disease (gastric and duodenal)
* *Helicobacter pylori* eradication (in combination with antibiotics)
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for 4 to 8 weeks. For maintenance of healing, 20 mg orally once daily may be used. For severe cases, 40 mg orally once daily may be needed.
* **Pathological hypersecretory conditions:** Starting dose typically 40 mg orally twice daily. Doses may be increased as needed. Doses up to 240 mg daily have been administered intravenously.
* **Peptic ulcer disease:** 40 mg orally once daily for up to 4 weeks.
* ***H. pylori* eradication:** 40 mg orally twice daily in combination with specific antibiotic regimens (e.g., amoxicillin and clarithromycin or clarithromycin and metronidazole).
## Pediatric Dosing
Dosing varies by indication and age. Consult specific pediatric guidelines or product labeling.
* **GERD and erosive esophagitis (1 month to 16 years):** Typically 0.7 to 1.3 mg/kg/day orally, divided into one or two doses, up to a maximum of 40 mg/day.
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 20 mg orally once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of its formulation.
## Adverse Effects
Common: Diarrhea, headache, nausea, abdominal pain, flatulence, dizziness.
Long-term use: Increased risk of *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, and potentially kidney disease.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, iron salts, mycophenolate mofetil. Concomitant use may decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. May affect metabolism of drugs like clopidogrel, although clinical significance is debated.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremor, tetany, seizures).
* Monitor for bone fracture risk with long-term use.
* Monitor for signs of vitamin B12 deficiency with long-term use.
* Consider magnesium levels periodically in patients on long-term therapy or those taking concomitant medications known to lower magnesium levels.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* Delayed-release formulations should be swallowed whole and not crushed or chewed.
* Intravenous formulations are available and may be used when oral administration is not feasible.
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*This information is intended for healthcare professionals and does not substitute for complete prescribing information. Always verify current drug information with the official product labeling or a reliable drug information resource.*
