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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces the amount of acid produced in the stomach.
## 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 healing:** 40 mg orally once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily. For some patients, 20 mg orally once daily may be adequate.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily. Doses may be increased as needed. Doses above 100 mg daily should be administered as 100 mg every day or 50 mg twice daily.
## Pediatric Dosing
* **Erosive esophagitis (age 5 to 16 years):** 40 mg orally once daily for up to 4 weeks.
* **GERD symptom relief (age 5 to 16 years):** 20 mg orally once daily for up to 4 weeks.
## Dose Adjustments
No specific dose adjustments are typically required for patients with renal or hepatic impairment, though caution is advised. For hepatic impairment, the maximum daily dose is 40 mg.
## Contraindications
Known hypersensitivity to pantoprazole or any of its components.
## Adverse Effects
Common adverse effects include diarrhea, headache, dizziness, nausea, abdominal pain, and flatulence. Long-term PPI use may be associated with an increased risk of:
* Fractures (hip, wrist, spine)
* Clostridium difficile infection
* Hypomagnesemia
* Vitamin B12 deficiency
* Gastric cancer (rare)
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Pantoprazole may decrease absorption of drugs like ketoconazole, itraconazole, posaconazole, and certain protease inhibitors (e.g., atazanavir).
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19 and may increase concentrations of drugs metabolized by this enzyme (e.g., clopidogrel, though clinical significance is debated).
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia, especially with prolonged use (>1 year) or concomitant use of other drugs that lower magnesium (e.g., diuretics).
* Monitor for signs of fracture risk.
* Consider B12 levels with prolonged use.
* Monitor for signs of C. difficile infection.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* Do not crush or chew delayed-release capsules; swallow whole.
* For patients unable to swallow capsules, the contents can be sprinkled on applesauce and consumed immediately.
* IV formulation is available for patients unable to take oral medications.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to ensure patient safety. Dosing may vary based on specific patient factors and local protocols.*
