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## 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.
* Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
### Adult Dosing
* **Healing of erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is 40 mg orally or intravenously twice daily. Doses can be increased as needed. Doses up to 240 mg daily have been administered.
### Pediatric Dosing
* **Erosive esophagitis (ages 5 to 16 years):** 40 mg orally once daily for up to 8 weeks.
* **GERD (ages 12 to 16 years):** 20 mg orally once daily for up to 8 weeks.
* *Note: Dosing for pediatric patients is less well-established than for adults. Consult specific pediatric guidelines.*
### Dose Adjustments
* **Hepatic impairment:** Maximum daily dose of 40 mg orally or intravenously.
* **Renal impairment:** No dose adjustment necessary.
### Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
### Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea, bone fractures (hip, wrist, spine) with prolonged use, hypomagnesemia, vitamin B12 deficiency, lupus erythematosus.
### Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, posaconazole, iron salts, mycophenolate mofetil. Pantoprazole can decrease absorption.
* **CYP2C19 substrates:** Warfarin, diazepam, phenytoin. Pantoprazole may increase levels.
### Monitoring
* Magnesium levels (especially with prolonged therapy >3 months, or concomitant diuretic use).
* Vitamin B12 levels (with prolonged therapy).
* Bone mineral density (in patients at risk for osteoporosis).
* Symptoms of *Clostridioides difficile*.
### Clinical Pearls
* Administer pantoprazole delayed-release tablets 30 minutes before a meal.
* For IV administration, reconstitute and dilute according to manufacturer instructions. Do not administer with other medications through the same IV line.
* Long-term PPI use is associated with increased risk of fractures, *C. difficile* infection, and vitamin B12 deficiency. Use the lowest effective dose for the shortest duration necessary.
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**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information with the most recent product monograph or reliable drug compendium.
