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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Healing of erosive esophagitis.
* Maintenance of healing of erosive esophagitis.
* Pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Healing of 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 patients with a history of recurrence, 20 mg orally once daily may be considered.
* **GERD (symptomatic):** 20 mg orally once daily for up to 4 weeks.
* **Pathological Hypersecretory Conditions (e.g., Zollinger-Ellison Syndrome):** Starting dose of 40 mg orally or intravenously twice daily. Doses may be increased as clinically indicated. Doses up to 240 mg daily have been administered intravenously.
## Pediatric Dosing
* **Erosive esophagitis (age 5 to 16 years):** 20 mg orally once daily for up to 8 weeks.
* **GERD (age 5 to 16 years):** 20 mg orally once daily for up to 4 weeks.
* Dosing for pediatric patients younger than 5 years is not established.
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 40 mg orally or intravenously.
* **Renal Impairment:** No dose adjustment is necessary.
## Contraindications
* Known hypersensitivity to pantoprazole or any of its components.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, dizziness, and flatulence. Long-term use of PPIs may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Pantoprazole can decrease absorption of drugs like ketoconazole, itraconazole, and certain antiretrovirals (e.g., atazanavir, nelfinavir).
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole may inhibit CYP2C19, potentially increasing concentrations of drugs metabolized by this enzyme (e.g., clopidogrel - though clinical significance is debated, cilostazol).
* **Warfarin:** Increased risk of bleeding events. Monitor INR.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia, vitamin B12 deficiency, and bone fractures with prolonged use.
* For patients on warfarin, monitor INR.
## Clinical Pearls
* Pantoprazole is available in oral and intravenous formulations.
* Oral pantoprazole is generally taken 30 to 60 minutes before a meal.
* Intravenous administration should be over 15 minutes or longer.
* Long-term use of PPIs should be re-evaluated periodically, and treatment should be discontinued when clinically indicated.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance.*
