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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production.
## Primary Indications
* Healing of erosive esophagitis
* Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* Maintenance of healing of erosive esophagitis
* Gastroesophageal reflux disease (GERD)
## Adult Dosing
* **Erosive Esophagitis:** 40 mg orally once daily for up to 8 weeks. For maintenance of healing, 40 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is typically 40 mg orally twice daily, but may be increased as clinically needed. Doses up to 240 mg daily have been used.
* **GERD (symptomatic treatment):** 20 mg orally once daily. If symptoms are not controlled after 4 weeks, consider further evaluation.
## Pediatric Dosing
* **Erosive Esophagitis:**
* 1-11 years: 20 mg orally once daily for up to 8 weeks.
* 12-16 years: 40 mg orally once daily for up to 8 weeks.
* **GERD (symptomatic treatment):**
* 5-16 years: 20 mg orally once daily.
*Note: Dosing in younger children (<1 year) is not well established and requires careful consideration.*
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment.
## Contraindications
* Known hypersensitivity to pantoprazole, any component of the formulation, or other substituted benzimidazoles.
## Adverse Effects
* Common: Headache, diarrhea, nausea, abdominal pain, vomiting, flatulence, dizziness.
* Long-term use may be associated with:
* Increased risk of *Clostridium difficile*-associated diarrhea
* Fractures (hip, wrist, spine)
* Hypomagnesemia
* Vitamin B12 deficiency
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, iron salts, digoxin, mycophenolate mofetil. Pantoprazole can decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** May interact with drugs metabolized by CYP2C19 (e.g., clopidogrel, voriconazole), though clinical significance is variable.
## Monitoring
* Monitor for effectiveness in symptom control.
* Monitor for adverse effects, particularly with long-term use (e.g., magnesium levels, vitamin B12 levels, bone density if indicated).
* Monitor for *Clostridium difficile* infection.
## Clinical Pearls
* Administer 30-60 minutes before a meal.
* Oral formulations can be taken with or without food.
* For delayed-release tablets, do not crush or chew.
* IV formulation is available for patients unable to take oral medication.
* Consider the lowest effective dose for the shortest duration necessary.
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*Disclaimer: This information is intended for clinical pharmacists and should not replace a thorough review of the most current prescribing information and clinical guidelines. Always verify drug information with primary sources before making clinical decisions.*
