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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Healing of erosive esophagitis
* Maintenance of healing of erosive esophagitis
* Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* Gastroesophageal reflux disease (GERD)
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing erosive esophagitis:** 40 mg orally once daily.
* **GERD:** 20 mg orally once daily for up to 4 weeks.
* **Pathological hypersecretory conditions:** Starting dose is 40 mg orally or intravenously twice daily. Doses may be adjusted based on clinical response. Maximum recommended daily dose is 120 mg intravenously or 240 mg orally.
## Pediatric Dosing
* **Erosive esophagitis (ages 5 to 16 years):** 20 mg orally once daily for up to 8 weeks.
* **GERD (ages 5 to 16 years):** 20 mg orally once daily for up to 4 weeks.
* Dosing for pediatric patients with pathological hypersecretory conditions is not established.
## 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 the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, and rash. Long-term use of PPIs may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric pH for absorption:** Pantoprazole can decrease the absorption of drugs such as ketoconazole, itraconazole, and certain HIV protease inhibitors.
* **Methotrexate:** Concomitant use with PPIs may increase methotrexate levels.
* **CYP2C19 Substrates:** Pantoprazole can inhibit CYP2C19, potentially increasing exposure to drugs metabolized by this enzyme (e.g., clopidogrel, although clinical significance is debated).
## Monitoring
Monitor for improvement in GERD symptoms, healing of esophagitis, and signs of adverse effects (e.g., electrolyte abnormalities, bone pain, diarrhea).
## Clinical Pearls
* Administer pantoprazole 30 minutes before a meal.
* For intravenous administration, reconstitute and further dilute as per manufacturer instructions. Infuse over at least 15 minutes.
* Consider the potential for drug interactions, especially with agents whose absorption is pH-dependent or those metabolized by CYP2C19.
* Long-term therapy should be individualized and periodically reassessed.
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*This information is intended for healthcare professionals. Please verify current prescribing information and local protocols before initiating therapy.*
