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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Reduction of risk of nonsteroidal anti-inflammatory drug (NSAID)-induced gastric ulcers in patients at risk.
* Pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks. For maintenance of healing: 40 mg orally once daily.
* **NSAID-induced gastric ulcers:** 40 mg orally once daily, typically for up to 8 weeks.
* **Pathological hypersecretory conditions:** Starting dose typically 40 mg orally twice daily; titrate to clinical effect. Doses may exceed 160 mg daily.
## Pediatric Dosing
* **GERD and erosive esophagitis (ages 5 to 16 years):** 20 mg or 40 mg orally once daily, depending on severity. Max dose: 40 mg once daily.
* **GERD and erosive esophagitis (ages 1 month to <5 years):** Oral suspension: 1.0 mg/kg/day to 1.3 mg/kg/day divided once or twice daily, not to exceed 40 mg/day.
* Dosing in children < 1 month has not been established.
## Dose Adjustments
No dose adjustment is typically necessary for hepatic or renal impairment in adults.
## Contraindications
Hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, dizziness.
Long-term use (typically > 1 year) may be associated with an increased risk of:
* Fractures (hip, wrist, spine)
* Clostridium difficile-associated diarrhea
* Vitamin B12 deficiency
* Hypomagnesemia
## Key Drug Interactions
* **Clopidogrel:** Concomitant use may decrease clopidogrel's effectiveness due to CYP2C19 inhibition. Consider alternatives or close monitoring.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **Drugs dependent on gastric pH for absorption:** May alter absorption (e.g., ketoconazole, itraconazole, iron salts, digoxin).
## Monitoring
* Monitor for signs and symptoms of C. difficile infection.
* Monitor magnesium levels with prolonged therapy, especially in patients taking diuretics or digoxin.
* Monitor for signs of bone fracture.
## Clinical Pearls
* Administer oral pantoprazole at least 30 minutes before a meal.
* If using delayed-release tablets and experiencing difficulty swallowing, they can be mixed with 2 tablespoons of applesauce or apple juice and consumed immediately. Do not chew or crush the tablets.
* Intravenous formulation is available for patients unable to take oral medication.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before initiating or modifying therapy.*
