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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
* Reduction of risk of NSAID-induced gastric ulcers in patients at continued risk and requiring continuous NSAID treatment
## 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.
* **Reduction of risk of NSAID-induced gastric ulcers:** 20 mg orally once daily.
* **Zollinger-Ellison Syndrome:** 40 mg orally or intravenously once daily, may be increased to 80 mg intravenously or orally once daily. Doses greater than 80 mg daily should be divided and administered twice daily.
## Pediatric Dosing
* **GERD (erosive esophagitis):**
* 1 year to 5 years: 10 mg orally once daily for up to 8 weeks.
* 5 years to 16 years: 20 mg orally once daily for up to 8 weeks.
* *Note: IV dosing is not established in pediatric patients.*
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 40 mg orally once daily. IV formulation is not recommended.
## Contraindications
* Known hypersensitivity to pantoprazole or any of its components, or other substituted benzimidazoles.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, and flatulence.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** May decrease absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors (e.g., atazanavir, nelfinavir). Separate administration by at least 12 hours.
* **Methotrexate:** PPIs may increase methotrexate levels. Consider a temporary discontinuation of pantoprazole.
* **CYP2C19 Substrates:** Pantoprazole can inhibit CYP2C19, potentially increasing levels of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Long-term use of PPIs may be associated with increased risk of C. difficile-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, and vitamin B12 deficiency.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* If symptoms persist or worsen, evaluate for underlying causes.
* IV pantoprazole is typically reserved for patients who cannot take oral medication.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive patient care decisions.*
