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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. Some patients may be treated with 20 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily, but may be increased to 80 mg orally twice daily. Doses are adjusted based on clinical response. Maximum dose is typically 160 mg daily.
## Pediatric Dosing
* **Erosive esophagitis (1-5 years):** 10 mg orally once daily for up to 8 weeks.
* **Erosive esophagitis (5-11 years):** 20 mg orally once daily for up to 8 weeks.
* **Erosive esophagitis (12-16 years):** 40 mg orally once daily for up to 8 weeks.
* *Note: Dosing for pediatric patients can vary based on indication and specific clinical guidelines. Consult current pediatric-specific literature.*
## Dose Adjustments
No dose adjustment is necessary for patients with hepatic impairment. No dose adjustment is necessary for patients with renal impairment.
## Contraindications
Known hypersensitivity to pantoprazole or any component of its formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence.
Serious:
* Clostridioides difficile-associated diarrhea (CDAD).
* Fracture (hip, wrist, spine) with prolonged use.
* Hypomagnesemia with prolonged use.
* Vitamin B12 deficiency with prolonged use.
* Fundic gland polyps.
* Potential increased risk of certain infections (e.g., Salmonella, Campylobacter).
* Cutaneous and systemic lupus erythematosus.
## Key Drug Interactions
* **Drugs requiring gastric pH for absorption:** Ketoconazole, itraconazole, iron salts, mycophenolate mofetil. PPIs can decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. May affect metabolism of drugs like clopidogrel (though clinical significance is debated).
* **Voriconazole:** May increase voriconazole levels.
## Monitoring
* Monitor for signs and symptoms of C. difficile infection.
* Consider magnesium monitoring with prolonged therapy (typically > 3 months), especially with concurrent diuretic use.
* Monitor for signs of vitamin B12 deficiency with prolonged therapy.
* Assess bone mineral density in patients at risk for osteoporosis.
## Clinical Pearls
* Administer pantoprazole oral suspension 30 minutes before a meal.
* Do not crush or chew pantoprazole delayed-release tablets or capsules.
* Long-term use of PPIs is associated with increased risks of fracture, hypomagnesemia, and vitamin B12 deficiency. Use the lowest effective dose for the shortest duration necessary.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance. Local protocols may dictate specific dosing strategies.*
