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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production. ## 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 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 twice daily; may be increased to a maximum of 240 mg daily depending on clinical need. Doses > 80 mg daily should be divided and administered every 12 hours. ## Pediatric Dosing * **GERD (age 5 to 15 years):** 20 mg orally once daily for up to 8 weeks. * **Erosive esophagitis (age 5 to 15 years):** 40 mg orally once daily for up to 8 weeks. * Dosing for younger children or other indications is not well-established. ## Dose Adjustments * No dose adjustment is generally required for hepatic impairment, although caution may be warranted with severe impairment. * No dose adjustment is required for renal impairment. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, flatulence, and dizziness. Long-term use may be associated with increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency. ## Key Drug Interactions * **Drugs Dependent on Gastric pH for Absorption:** PPIs can decrease absorption of drugs like ketoconazole, itraconazole, posaconazole, and certain antiretrovirals. * **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity. * **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Caution may be needed when co-administered with drugs primarily metabolized by this enzyme (e.g., clopidogrel). ## Monitoring * Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, arrhythmias) with prolonged therapy. * Monitor for signs of bone fracture, particularly in patients at risk. * Consider periodic vitamin B12 level monitoring in patients on long-term therapy. ## Clinical Pearls * Administer pantoprazole 30 minutes before a meal. * Delayed-release tablets should be swallowed whole and not chewed or crushed. * The 24-hour intravenous formulation is available for patients who cannot take oral medications. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and guidelines for definitive patient care decisions.