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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Erosive esophagitis associated with gastroesophageal reflux disease (GERD)
* Maintenance of healing of erosive esophagitis
* Pathological hypersecretory conditions (e.g., 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. For some patients, 20 mg orally once daily may suffice.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased to 240 mg daily.
## Pediatric Dosing
* **12 years and older:**
* Erosive esophagitis: 40 mg orally once daily for up to 8 weeks.
* GERD symptoms: 20 mg to 40 mg orally once daily.
* Dosing for children younger than 12 years is not established.
## Dose Adjustments
No dose adjustment is generally required for hepatic impairment, but caution is advised. No dose adjustment is necessary for renal impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, dizziness.
Serious: *Clostridium difficile*-associated diarrhea, bone fracture (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, systemic lupus erythematosus.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, iron salts, mycophenolate mofetil. Pantoprazole may decrease their absorption.
* **Methotrexate:** Pantoprazole may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole may inhibit CYP2C19, affecting the metabolism of drugs like clopidogrel (though clinical significance is debated).
## Monitoring
* Electrolytes (especially magnesium) with long-term therapy.
* Bone mineral density if indicated.
* For *Clostridium difficile* infection if diarrhea occurs.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* Intravenous administration: Reconstitute and further dilute; administer over at least 2 minutes.
* Long-term PPI use is associated with increased risk of fractures, *C. difficile* infection, and hypomagnesemia. Use the lowest effective dose for the shortest duration necessary.
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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 and up-to-date details before making any treatment decisions.
