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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion. ## Primary Indications * Healing of erosive esophagitis * Maintenance of healing of erosive esophagitis * Gastroesophageal reflux disease (GERD) * Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome) * H. pylori eradication (in combination with antibiotics) ## Adult Dosing * **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. For some patients, 20 mg orally once daily may suffice. * **GERD:** 40 mg orally once daily for up to 4 weeks. * **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased as clinically needed. Doses up to 240 mg intravenously daily have been used. * **H. pylori eradication:** 40 mg orally twice daily for 7 to 14 days in combination with amoxicillin and clarithromycin, or clarithromycin and metronidazole. ## Pediatric Dosing * **GERD and Erosive Esophagitis (1 to 5 years):** 10 mg orally once daily. * **GERD and Erosive Esophagitis (5 to 16 years):** 20 mg orally once daily. * **GERD and Erosive Esophagitis (16 years and older):** Dosing similar to adults (20-40 mg orally once daily). *Note: IV formulation is not generally recommended for pediatric patients due to lack of data.* ## Dose Adjustments No dose adjustment is generally needed for hepatic impairment, although severe impairment may warrant caution. No dose adjustment is typically required for renal impairment. ## Contraindications * Known hypersensitivity to pantoprazole, any component of the formulation, or other substituted benzimidazoles. ## Adverse Effects Common: Headache, diarrhea, nausea, abdominal pain, flatulence, vomiting, dizziness. Serious: Bone fracture (hip, wrist, spine), *Clostridioides difficile*-associated diarrhea, lupus erythematosus, hypomagnesemia, vitamin B12 deficiency. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** Absorption may be decreased (e.g., ketoconazole, itraconazole, posaconazole, iron salts, vitamin B12). * **Methotrexate:** Pantoprazole may increase methotrexate levels. * **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. * **Warfarin:** May increase INR and risk of bleeding. ## Monitoring * Monitor for symptoms of bone fracture, diarrhea (especially *C. difficile*), and signs of hypomagnesemia (e.g., muscle cramps, seizures, arrhythmias) with prolonged use. * Consider periodic serum magnesium levels, especially in patients taking concomitant medications like diuretics or digoxin. * Monitor for vitamin B12 deficiency with long-term therapy. ## Clinical Pearls * Administer orally 30 minutes to 1 hour before a meal. * For oral suspension, instruct patients on proper reconstitution and administration. * Long-term use of PPIs is associated with increased risk of certain adverse events. Use the lowest effective dose for the shortest duration necessary. * Intravenous administration is generally reserved for patients unable to take oral medications. --- *Please verify the current prescribing information for the most up-to-date and complete details.*