Please check your internet connection and try again.
# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis
* Healing of duodenal ulcers
* Reduction of risk of NSAID-induced gastric ulcers in patients with a history of these ulcers or risk factors
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **GERD, Erosive Esophagitis, Duodenal Ulcers:** 20 mg to 40 mg orally once daily. For severe erosive esophagitis, 40 mg once daily for up to 8 weeks.
* **NSAID-induced Gastric Ulcers (Prevention):** 20 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose typically 40 mg orally once or twice daily; titrate as needed. Maximum dose: 240 mg daily.
Intravenous (IV) dosing is available and typically follows oral dosing equivalents, with doses often ranging from 20 mg to 40 mg once or twice daily, depending on indication.
## Pediatric Dosing
Dosing varies significantly by age and indication. Consult specific pediatric guidelines.
* **GERD (1 month to 5 years):** 1.1 mg/kg to 1.5 mg/kg once daily, not to exceed 20 mg daily.
* **GERD (5 years to 16 years):** 20 mg once daily for mild to moderate GERD; 40 mg once daily for severe GERD or erosive esophagitis.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 20 mg once daily for moderate to severe hepatic impairment.
* **Renal Impairment:** No dose adjustment generally required.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
* Use of rilpivirine-containing products.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness.
Serious:
* **Long-term use:** Increased risk of bone fractures (hip, wrist, spine), *Clostridium difficile*-associated diarrhea, hypomagnesemia (can be severe), vitamin B12 deficiency.
* Acute interstitial nephritis.
* Systemic lupus erythematosus (cutaneous and systemic).
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, posaconazole, iron salts, erlotinib, mycophenolate mofetil. PPIs can decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates/inhibitors:** Pantoprazole is a moderate inhibitor of CYP2C19 and can affect metabolism of drugs like clopidogrel.
* **Rilpivirine:** Contraindicated due to potential for decreased rilpivirine plasma concentrations.
## Monitoring
* Electrolytes (magnesium, calcium, potassium) with prolonged therapy or concomitant diuretic use.
* Vitamin B12 levels with prolonged therapy.
* Bone mineral density with long-term therapy, especially in patients with risk factors for osteoporosis.
* Signs and symptoms of *Clostridium difficile* infection.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* Do not crush or chew delayed-release tablets.
* Long-term PPI use is associated with significant risks; use the lowest effective dose for the shortest duration necessary.
* Consider concurrent use of antacids for rapid symptom relief if needed.
***
**Disclaimer:** This information is for educational purposes and does not substitute professional medical advice. Always consult the most current prescribing information and your healthcare provider for any medical decisions.
