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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 * **Healing of Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. * **Maintenance of Healing of Erosive Esophagitis:** 40 mg orally once daily. * **Pathological Hypersecretory Conditions:** Starting dose 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. Oral doses up to 240 mg once daily have been used. ## Pediatric Dosing * **GERD (age 5 to 16 years):** * Healing of Erosive Esophagitis: 20 mg or 40 mg orally once daily for up to 8 weeks. The choice between 20 mg and 40 mg depends on the severity of esophagitis. * Maintenance of Healing: 20 mg orally once daily. * Dosing for pediatric patients < 5 years is not established. ## Dose Adjustments * **Hepatic Impairment:** Maximum daily dose of 40 mg orally. IV formulations are not recommended. * **Renal Impairment:** No dose adjustment necessary. ## Contraindications * Known hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation. ## Adverse Effects Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness. Less Common: Arthralgia, myalgia. Long-term use may be associated with: increased risk of fractures (hip, wrist, spine), *Clostridium difficile*-associated diarrhea, vitamin B12 deficiency, hypomagnesemia. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption (e.g., ketoconazole, itraconazole, iron salts, mycophenolate mofetil):** Pantoprazole can decrease absorption. * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 Substrates (e.g., clopidogrel):** May have altered efficacy. * **Voriconazole:** May increase pantoprazole concentrations. ## Monitoring * Monitor for signs and symptoms of hypomagnesemia (e.g., muscle spasms, seizures, tremors, cardiac arrhythmias). * Monitor for signs and symptoms of *Clostridium difficile* infection. * Consider monitoring vitamin B12 levels with long-term therapy. ## Clinical Pearls * Administer oral pantoprazole 30 minutes to 1 hour before a meal. * Oral tablets should be swallowed whole and not chewed or crushed. * IV pantoprazole should be administered as a slow infusion over 15 minutes. * When switching from IV to oral, consider the total daily dose. *** *Disclaimer: This information is intended for clinical pharmacists and should not be a substitute for professional medical advice. Always verify current prescribing information and consult with a healthcare provider for patient-specific treatment decisions.*