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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis healing and maintenance
* *Helicobacter pylori* eradication (in combination therapy)
* Zollinger-Ellison syndrome and other pathological hypersecretory conditions
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally once daily for 4-8 weeks.
* **Maintenance of Healing:** 40 mg orally once daily. Some patients may be treated with 20 mg once daily.
* ***H. pylori* Eradication:** 40 mg orally twice daily for 7-14 days in combination with antibiotics (e.g., amoxicillin and clarithromycin).
* **Pathological Hypersecretory Conditions:** Starting dose 40 mg orally twice daily. Doses can be titrated up to 240 mg daily divided into doses.
## Pediatric Dosing
* **GERD/Erosive Esophagitis (12 years and older):** 40 mg orally once daily for up to 8 weeks.
* Dosing for children younger than 12 years for GERD or erosive esophagitis is not well-established and should be guided by specialist recommendations.
## Dose Adjustments
No dose adjustment is generally required for renal impairment. In severe hepatic impairment, consider a dose reduction to 20 mg once daily.
## Contraindications
* Known hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, dizziness, abdominal pain, flatulence.
Less common: Liver enzyme elevations, rash, urticaria, pruritus.
Long-term use risks: *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), vitamin B12 deficiency, hypomagnesemia.
## Key Drug Interactions
* **Certain Antiretrovirals (e.g., rilpivirine, atazanavir):** Reduced absorption due to increased gastric pH. Avoid coadministration or monitor.
* **Methotrexate:** PPIs may increase methotrexate levels. Consider dose reduction or interruption of pantoprazole.
* **Warfarin:** May increase INR and risk of bleeding. Monitor INR closely when initiating or discontinuing pantoprazole.
* **Drugs Dependent on Gastric pH for Absorption (e.g., ketoconazole, itraconazole, iron salts):** Reduced absorption due to increased gastric pH.
## Monitoring
* Clinical improvement of symptoms.
* Electrolytes (magnesium, sodium, potassium) with prolonged therapy or in patients on concomitant diuretics.
* Bone mineral density in patients at risk for osteoporosis with prolonged therapy.
## Clinical Pearls
* Administer 30-60 minutes before a meal.
* Delayed-release tablets should be swallowed whole and not chewed or crushed.
* IV formulation is available for patients unable to take oral medication.
* Long-term PPI use is associated with increased risks, consider the shortest effective duration.
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**Disclaimer:** This information is intended for clinical use and does not replace a thorough review of the most current prescribing information, including full prescribing details, warnings, and precautions, from the drug's official labeling or other authoritative sources. Always verify current drug information before prescribing.
