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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion. It is available in oral and intravenous formulations. ## 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 **Erosive Esophagitis:** * Oral: 40 mg once daily for up to 8 weeks. * Intravenous: 40 mg once daily. **Maintenance of Healing of Erosive Esophagitis:** * Oral: 20 mg once daily. **Pathological Hypersecretory Conditions (e.g., Zollinger-Ellison Syndrome):** * Oral: 40 mg twice daily. Doses may be increased as clinically indicated. Usual maximum oral dose is 240 mg daily. * Intravenous: 80 mg once daily, followed by 8 mg/hour infusion for up to 72 hours. Doses may be adjusted based on clinical response. ## Pediatric Dosing Dosing in pediatric patients varies by indication and age. Consult specific guidelines or product information for detailed pediatric dosing. * **GERD (ages 5-16 years):** * Oral: 20 mg once daily for up to 8 weeks for treatment of symptomatic GERD. * Oral: 40 mg once daily for up to 8 weeks for healing of erosive esophagitis. ## Dose Adjustments * **Hepatic Impairment:** For oral administration, reduce the daily dose to 20 mg in patients with severe hepatic impairment. For intravenous administration, caution is advised. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects Common adverse effects include diarrhea, headache, dizziness, abdominal pain, and nausea. Long-term use of PPIs may be associated with an increased risk of fractures (hip, wrist, spine), Clostridium difficile infection, vitamin B12 deficiency, and hypomagnesemia. ## Key Drug Interactions * **Antiretrovirals:** Pantoprazole can decrease the absorption of certain antiretroviral drugs (e.g., rilpivirine, atazanavir). * **Methotrexate:** PPIs may increase the levels of methotrexate. * **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19 and may affect the metabolism of drugs like clopidogrel. * **Iron Supplements:** Reduced gastric acidity can decrease iron absorption. ## Monitoring * Monitor for signs and symptoms of fractures, C. difficile infection, B12 deficiency, and hypomagnesemia with long-term use. * Monitor electrolytes (magnesium, sodium, potassium) with prolonged therapy. ## Clinical Pearls * Administer oral pantoprazole 30-60 minutes before a meal. * For oral suspension, reconstitute with the provided diluent. * Intravenous pantoprazole is generally reserved for patients who cannot take oral medications. * Consider potential for drug interactions, especially with co-administered medications that rely on gastric pH for absorption or metabolism. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details before making treatment decisions.*