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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, such as Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily. Doses may be titrated up to 240 mg daily in divided doses.
## Pediatric Dosing
* **Erosive esophagitis (5 to 16 years):** 20 mg orally once daily for up to 4 weeks.
* **Erosive esophagitis (16 to 18 years):** 40 mg orally once daily for up to 8 weeks.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment. However, caution may be warranted 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, and dizziness. Long-term use of PPIs has been associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** PPIs can decrease the absorption of drugs like ketoconazole, itraconazole, and certain antiretrovirals (e.g., rilpivirine).
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Use caution with substrates like clopidogrel, though clinical significance is debated.
## Monitoring
* Monitor for signs and symptoms of *Clostridium difficile* infection.
* Monitor serum magnesium levels periodically, especially with prolonged use.
* Monitor for signs of bone fracture.
* Consider monitoring vitamin B12 levels with long-term therapy.
## Clinical Pearls
* Administer pantoprazole 30 minutes before a meal for optimal efficacy.
* Pantoprazole delayed-release tablets should be swallowed whole and not crushed or chewed.
* Long-term use of PPIs should be reserved for patients with specific indications and periodically reassessed.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical advice. Always refer to the most current prescribing information and consult with a healthcare provider before making any treatment decisions.*
