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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, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Healing of Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of Healing of Erosive Esophagitis:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased as clinically indicated. Doses greater than 240 mg once daily must be divided and administered every 12 hours. Maximum dose is 240 mg daily.
## Pediatric Dosing
* **GERD and Erosive Esophagitis (12 years and older):**
* 40 mg orally once daily for up to 8 weeks.
* **GERD and Erosive Esophagitis (Newborn to less than 12 years):** Dosing varies by weight and indication. Consult specific pediatric guidelines or prescribing information for detailed weight-based dosing.
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 40 mg orally once daily.
## Contraindications
* Known hypersensitivity to pantoprazole, other PPIs, or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence.
Long-term use (greater than 1 year) may be associated with an increased risk of:
* Fractures of the hip, wrist, or spine (especially with higher doses and prolonged duration).
* Clostridium difficile-associated diarrhea.
* Vitamin B12 deficiency.
* Hypomagnesemia.
* Fundic gland polyps.
## Key Drug Interactions
* **Antiretrovirals:** Drugs requiring gastric pH for absorption (e.g., nelfinavir, rilpivirine, atazanavir) may have reduced efficacy.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 Substrates:** May affect metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of fracture, C. difficile infection, vitamin B12 deficiency, and hypomagnesemia, especially in patients on long-term therapy or those taking concomitant medications that may increase risk.
* For Zollinger-Ellison syndrome, monitor gastric acid output.
## Clinical Pearls
* Administer pantoprazole delayed-release tablets 30 minutes before a meal.
* Pantoprazole intravenous injection can be given without regard to meals.
* Long-term use should be based on ongoing need, and the lowest effective dose should be used.
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*This information is intended for healthcare professionals and does not substitute for a thorough review of the complete prescribing information or local protocols. Always verify current drug information with a trusted source.*
