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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of Healing:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased as clinically indicated. Doses up to 240 mg intravenously daily have been administered.
## Pediatric Dosing
* **Erosive Esophagitis (5 to 16 years):** 20 mg to 40 mg orally once daily.
* **Gastroesophageal Reflux Disease (GERD) (less than 5 years):** Dosing is not well established in this age group and should be based on clinical judgment and physician guidance.
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose is 40 mg orally or intravenously.
* **Renal Impairment:** No dose adjustment is typically required.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, vomiting, flatulence, dizziness.
* **Serious:** Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, systemic lupus erythematosus (cutaneous and systemic).
## Key Drug Interactions
* **Drugs Dependent on Gastric pH for Absorption:** Ketoconazole, itraconazole, iron salts, and certain antiretrovirals (e.g., rilpivirine, atazanavir). Pantoprazole may decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 Substrates:** Potential for altered levels of drugs like clopidogrel.
## Monitoring
* Electrolytes (especially magnesium) with prolonged use.
* Bone mineral density with long-term therapy.
* Signs and symptoms of C. difficile infection.
## Clinical Pearls
* Administer pantoprazole delayed-release tablets 30 minutes before a meal.
* Intravenous administration can be given as a bolus or infusion.
* Long-term use of PPIs is associated with increased risk of fractures, C. difficile infection, and vitamin B12 deficiency. Consider periodic reassessment of the need for continued therapy.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details. This summary does not replace professional clinical judgment.*
