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 associated with gastroesophageal reflux disease (GERD)
* Maintenance of healing of erosive esophagitis
* Reduction of risk of NSAID-associated 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.
* **Maintenance of healing erosive esophagitis:** 40 mg orally once daily.
* **Reduction of NSAID-associated gastric ulcers:** 40 mg orally once daily. Duration depends on risk factors and healing.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily. Doses may be increased as needed. Maximum dose usually 240 mg daily divided into doses.
## Pediatric Dosing
* **Erosive esophagitis (5 to 16 years):** 40 mg orally once daily for up to 4 weeks. (Note: Data for this indication and age group may be limited; consult specific guidelines.)
* **GERD symptoms (2 to 16 years):** 20 mg orally once daily for up to 8 weeks. Dosing may be adjusted based on clinical response.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 40 mg once daily.
## Contraindications
* Known hypersensitivity to pantoprazole, any component of the formulation, or other substituted benzimidazoles.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence.
Less Common: Arthralgia, rash, pruritus, fatigue.
Serious: *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, systemic lupus erythematosus.
## Key Drug Interactions
* **Drugs requiring gastric pH for absorption:** Ketoconazole, itraconazole, nelfinavir, atazanavir, iron salts. Concomitant use may decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Clopidogrel. Pantoprazole may inhibit CYP2C19, potentially reducing the efficacy of clopidogrel.
* **Warfarin:** Increased INR and bruising. Monitor INR closely.
## Monitoring
* Clinical signs and symptoms of GERD, erosive esophagitis, or ulcers.
* Magnesium levels, especially in patients on long-term therapy or taking concomitant medications like diuretics.
* Bone mineral density screening may be considered in patients at risk for osteoporosis.
* Vitamin B12 levels with long-term use.
## Clinical Pearls
* Pantoprazole is available as oral and intravenous formulations.
* Oral pantoprazole is generally taken once daily before a meal.
* Long-term PPI use is associated with increased risk of fractures, *C. difficile* infection, and vitamin B12 deficiency. Consider risks versus benefits for long-term therapy.
* For patients with difficulty swallowing, pantoprazole delayed-release tablets can be opened and mixed with applesauce. Do not chew or crush the granules.
---
***Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
