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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.
* Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily. Doses may be increased as needed. Doses greater than 240 mg daily require IV administration.
## Pediatric Dosing
Dosing in pediatric patients is weight-based and varies by indication. Consult specific pediatric guidelines for precise dosing.
* **Erosive esophagitis (5 to 16 years):** 20-40 mg orally once daily depending on weight.
* **GERD symptom relief (2 to 16 years):** 20 mg orally once daily.
## Dose Adjustments
No dose adjustment is typically needed for hepatic or renal impairment, though caution may be advised in severe hepatic impairment.
## Contraindications
Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use of PPIs may be associated with increased risk of fractures, hypomagnesemia, and Clostridium difficile infection.
## Key Drug Interactions
* **Clopidogrel:** Pantoprazole may decrease the efficacy of clopidogrel. Consider alternatives or separate administration times if concomitant use is necessary.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **Drugs affected by gastric pH:** Absorption of certain drugs (e.g., ketoconazole, itraconazole, ampicillin esters, iron salts) may be altered.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, arrhythmias).
* Monitor for signs of fracture.
* Monitor for signs of C. difficile infection.
## Clinical Pearls
* Administer oral pantoprazole at least 30 minutes before a meal.
* Do not crush or chew delayed-release formulations.
* IV formulation is available for patients unable to take oral medication.
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*This information is intended for healthcare professionals and does not replace the need to consult the most current prescribing information and institutional protocols.*
