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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, such as Zollinger-Ellison syndrome. ## Adult Dosing * **Healing of erosive esophagitis:** 40 mg orally once daily for up to 8 weeks. * **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily. * **Pathological hypersecretory conditions:** Start with 40 mg orally twice daily. Doses may be increased as needed. Doses up to 240 mg daily have been administered. ## Pediatric Dosing * **GERD:** * 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. * Higher doses may be necessary based on clinical response and patient factors. ## Dose Adjustments * No dose adjustment is generally required for patients with hepatic impairment. However, caution may be advised with severe hepatic impairment. * No dose adjustment is needed for patients with renal impairment. ## Contraindications * Known hypersensitivity to pantoprazole or any of its components. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness. * **Serious:** Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia (can be severe and lead to QT prolongation, arrhythmias, seizures), vitamin B12 deficiency, fundic gland polyps. ## Key Drug Interactions * **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, posaconazole, iron salts, and vitamin B12. Pantoprazole can decrease absorption. * **Methotrexate:** PPIs may increase methotrexate levels, potentially causing toxicity. * **CYP2C19 substrates:** Pantoprazole can inhibit CYP2C19, potentially affecting the metabolism of drugs like clopidogrel (though clinical significance is debated). ## Monitoring * Monitor for signs and symptoms of hypomagnesemia (e.g., tremors, muscle cramps, seizures, arrhythmias). * Monitor for signs of C. difficile infection. * Long-term use: Consider monitoring vitamin B12 levels and bone mineral density. ## Clinical Pearls * Administer 30 minutes to 1 hour before a meal. * For oral suspension, reconstitute with 10 mL of water and shake well. Administer immediately. Do not mix with other liquids. * IV pantoprazole is available for patients unable to take oral medications. * While generally safe, long-term PPI use is associated with potential risks, and therapy should be periodically reassessed. *** *Please verify current prescribing information for the most up-to-date details and consider individual patient factors.*