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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Treatment of pathological hypersecretory conditions, such as Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive Esophagitis:** 40 mg once daily for up to 8 weeks. A second 8-week course may be considered for patients who have not healed.
* **Maintenance of Healing:** 40 mg once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is 40 mg twice daily. Doses can be titrated up to 240 mg daily. Doses greater than 80 mg daily should be divided and administered twice daily.
## Pediatric Dosing
* **GERD (1 month to 5 years):** 1.1 mg/kg to 2.2 mg/kg once daily. Maximum daily dose is 40 mg.
* **GERD (5 years to 16 years):** 20 mg to 40 mg once daily. Maximum daily dose is 40 mg.
* *Note: Dosing for pediatric patients may vary based on local protocol and clinical judgment.*
## Dose Adjustments
* **Hepatic Impairment:** Reduce the daily dose to 20 mg once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any of its components.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness.
Less Common/Serious: Bone fractures (hip, wrist, spine), Clostridium difficile-associated diarrhea, hypomagnesemia (can be serious and lead to arrhythmias, seizures, tetany), vitamin B12 deficiency (with prolonged use).
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** PPIs can decrease absorption of drugs like ketoconazole, itraconazole, posaconazole, iron salts, and cyanocobalamin.
* **Methotrexate:** Concomitant use may increase methotrexate levels and toxicity.
* **Warfarin:** May increase INR and prothrombin time. Monitor INR closely.
* **Certain HIV medications:** Antiretroviral drugs such as nelfinavir, atazanavir, and rilpivirine may have reduced efficacy due to increased gastric pH.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremors, muscle cramps, seizures, arrhythmias).
* Consider monitoring vitamin B12 levels with prolonged therapy.
* For patients on warfarin, monitor INR.
## Clinical Pearls
* Administer pantoprazole orally 30 minutes before a meal.
* Do not crush or chew delayed-release tablets; they should be swallowed whole.
* If a dose is missed, take it as soon as remembered. However, if it is almost time for the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double doses.
* Long-term use of PPIs has been associated with an increased risk of fractures, C. difficile infection, and hypomagnesemia.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.*
