Please check your internet connection and try again.
# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Erosive esophagitis associated with gastroesophageal reflux disease (GERD)
* Maintenance of healing of erosive esophagitis
* Pathological hypersecretory conditions, such as Zollinger-Ellison syndrome
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is 40 mg orally or intravenously twice daily. Doses can be increased as needed. Maximum recommended daily dose is 240 mg.
## Pediatric Dosing
* **Erosive esophagitis (age 5 to 16 years):** 20 mg orally once daily for up to 8 weeks. For more severe esophagitis or if not healed after 4 weeks, consider 40 mg orally once daily.
* Dosing for pediatric patients with pathological hypersecretory conditions is not well-established and requires careful consideration and expert consultation.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 40 mg once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence.
Serious: *Clostridium difficile*-associated diarrhea, bone fracture (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, lupus erythematosus cutaneus subacutus.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, iron salts, and mycophenolate mofetil. Pantoprazole can decrease absorption.
* **Methotrexate:** Concomitant use with PPIs may increase methotrexate levels and toxicity.
## Monitoring
* Monitor for signs and symptoms of *Clostridium difficile*-associated diarrhea.
* Consider monitoring serum magnesium levels periodically, especially with long-term use (>1 year) or concurrent use of digoxin or diuretics.
* Monitor for signs and symptoms of bone fracture.
## Clinical Pearls
* Pantoprazole is generally taken 30-60 minutes before a meal.
* Intravenous administration should be limited to patients unable to take oral medication.
* Long-term PPI use is associated with an increased risk of fractures, *C. difficile* infection, and hypomagnesemia. Use the lowest effective dose for the shortest duration necessary.
***
*Disclaimer: This information is intended for clinical pharmacy use and does not replace comprehensive drug references. Always verify current prescribing information and institutional protocols before making therapeutic decisions.*
