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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). * Reduction of the risk of nonsteroidal anti-inflammatory drug (NSAID)-induced gastric ulcers in patients who are at continued risk and require continuous NSAID treatment. * Pathological hypersecretory conditions, including Zollinger-Ellison syndrome. ## Adult Dosing * **Erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. A subsequent 8-week course may be considered for patients with healing that has not been completed. * **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily. * **GERD without erosive esophagitis:** 20 mg orally once daily. For patients who do not achieve symptom control, an increase to 40 mg orally once daily may be considered. * **NSAID-induced gastric ulcers:** 40 mg orally once daily for up to 8 weeks. * **Zollinger-Ellison syndrome:** 40 mg orally or intravenously twice daily, may be increased to a maximum of 80 mg intravenously or orally twice daily. Dosing should be individualized. ## Pediatric Dosing * **Erosive esophagitis (12 to 17 years):** 40 mg orally once daily for up to 8 weeks. * **GERD (5 to 11 years):** * Weight < 40 kg: 20 mg orally once daily for up to 8 weeks. * Weight ≥ 40 kg: 40 mg orally once daily for up to 8 weeks. * Dosing for pediatric patients under 5 years for erosive esophagitis or under 5 years for GERD is not established. ## Dose Adjustments No dose adjustment is generally required for renal impairment. For severe hepatic impairment, a dose of 20 mg orally once daily is recommended. ## Contraindications * Known hypersensitivity to pantoprazole or any component of its formulation. * Concomitant use with rilpivirine-containing products. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, and flatulence. Long-term use may be associated with an increased risk of fractures (hip, wrist, spine), Clostridium difficile infection, vitamin B12 deficiency, and hypomagnesemia. ## Key Drug Interactions * **Drugs that require gastric acid for absorption:** PPIs can decrease absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors (e.g., atazanavir). * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** Pantoprazole can inhibit CYP2C19, potentially increasing concentrations of drugs metabolized by this enzyme (e.g., clopidogrel, voriconazole). * **Rilpivirine:** Concomitant use is contraindicated due to risk of virologic failure. ## Monitoring * Monitor for symptoms of GERD or erosive esophagitis. * Monitor for signs and symptoms of C. difficile infection (e.g., persistent diarrhea). * Monitor serum magnesium levels, especially with prolonged use or concomitant use of other drugs that can lower magnesium (e.g., diuretics). * Consider monitoring vitamin B12 levels with prolonged therapy. ## Clinical Pearls * Administer pantoprazole oral suspension 30 minutes before a meal. * Pantoprazole delayed-release tablets should be swallowed whole and not chewed, cut, or crushed. * Prophylactic use for stress ulcer bleeding in critically ill patients is generally not recommended. * The risk of bone fractures increases with higher doses and longer duration of use. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date drug information.