Please check your internet connection and try again.
# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Healing of erosive esophagitis
* Treatment of gastroesophageal reflux disease (GERD)
* Reduction of risk of NSAID-induced gastric ulcers
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally or IV once daily for up to 8 weeks. Maintenance: 20 mg orally once daily.
* **GERD:** 20 mg to 40 mg orally once daily for up to 4 weeks.
* **NSAID-induced ulcers:** 40 mg orally once daily for up to 8 weeks.
* **Pathological hypersecretory conditions:** 40 mg orally or IV twice daily; may be increased to 80 mg orally or IV twice daily. Doses >80 mg/day should be divided. Maximum dose not established but typically capped around 240 mg/day.
## Pediatric Dosing
* **Erosive esophagitis (age 5 to 16 years):** 20 mg to 40 mg orally once daily for up to 4 weeks.
* **GERD (age 5 to 16 years):** 15 mg orally once daily for up to 8 weeks.
* Dosing for pediatric patients under 5 years is not established.
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 40 mg orally or IV.
## Contraindications
* Known hypersensitivity to pantoprazole, other PPIs, or any component of the formulation.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness.
* **Serious:** Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine) with long-term use, hypomagnesemia, vitamin B12 deficiency, fundic gland polyps.
## Key Drug Interactions
* **CYP2C19 substrates:** May increase concentrations of drugs metabolized by CYP2C19 (e.g., clopidogrel, voriconazole).
* **Drugs dependent on gastric pH:** May decrease absorption of drugs requiring acidic gastric pH (e.g., ketoconazole, itraconazole, iron salts, vitamin B12).
* **Methotrexate:** May increase methotrexate levels.
## Monitoring
* Electrolytes (especially magnesium) with prolonged use.
* Bone mineral density in patients at risk for osteoporosis.
* Signs and symptoms of C. difficile infection.
## Clinical Pearls
* Administer 30-60 minutes before a meal.
* IV formulation should be reconstituted and diluted according to manufacturer instructions.
* Long-term use is associated with increased risk of fractures, C. difficile infection, and vitamin B12 deficiency. Consider intermittent therapy or lowest effective dose for maintenance.
***
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.
