Please check your internet connection and try again.
# 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)
* Duo/gastric ulcer healing
* H. pylori eradication (in combination with antibiotics)
## Adult Dosing
* **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. Some patients may be treated with 20 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose 40 mg orally or intravenously twice daily. Doses can be adjusted based on clinical need. Maximum dose: 120 mg twice daily intravenously, 240 mg twice daily orally.
* **Duo/gastric ulcer healing:** 40 mg orally once daily for up to 4 weeks.
* **H. pylori eradication:** 40 mg orally twice daily for 7-14 days in combination with clarithromycin and amoxicillin, or clarithromycin and metronidazole.
## Pediatric Dosing
* **Erosive esophagitis (5 to 16 years):** 20 mg or 40 mg orally once daily for up to 8 weeks. Dose selection depends on weight (20 mg for <40 kg, 40 mg for ≥40 kg).
* **GERD (1 month to <5 years):** Dosing is variable and often requires specific institutional protocols or specialist consultation. Common starting doses are 1 mg/kg/day orally divided once or twice daily, with a maximum of 20 mg/day. There is significant uncertainty in pediatric dosing for this age group.
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment. However, caution is advised 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, dizziness, and flatulence. Long-term use may be associated with increased risk of C. difficile infection, bone fractures (hip, wrist, spine), hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** PPIs can decrease absorption of drugs requiring acidic environments (e.g., ketoconazole, itraconazole, iron salts, vitamin B12, certain HIV protease inhibitors like atazanavir).
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Coadministration with substrates like clopidogrel may reduce efficacy, though clinical significance is debated.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., muscle spasms, seizures, arrhythmias).
* Monitor for signs and symptoms of C. difficile infection.
* Monitor bone mineral density with long-term therapy, especially in patients with risk factors for osteoporosis.
* Monitor for vitamin B12 deficiency with long-term therapy.
## Clinical Pearls
* Administer 30-60 minutes before a meal for optimal efficacy.
* Oral formulations (tablets and delayed-release granules) should not be crushed or chewed; they can be administered with applesauce or pudding, or via nasogastric tube for granules.
* Intravenous pantoprazole is a potential substitute for oral administration when oral intake is not feasible.
* Duration of therapy should be the shortest clinically indicated.
***
*Please verify current prescribing information for the most up-to-date details.*
