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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 * **Erosive Esophagitis:** 40 mg orally once daily for up to 8 weeks. * **Maintenance of Healing:** 40 mg orally once daily. * **Pathological Hypersecretory Conditions (e.g., Zollinger-Ellison Syndrome):** Starting dose is typically 40 mg orally twice daily, with dose adjustments based on clinical response. Doses up to 240 mg daily have been administered intravenously. ## Pediatric Dosing * **1-11 years:** * Weight < 40 kg: 20 mg orally once daily for up to 8 weeks for erosive esophagitis. * Weight ≥ 40 kg: 40 mg orally once daily for up to 8 weeks for erosive esophagitis. * **12-17 years:** 40 mg orally once daily for up to 8 weeks for erosive esophagitis. Dosing for other indications in pediatrics is less established and may require specialist consultation. ## Dose Adjustments No dose adjustment is generally required for hepatic or renal impairment in adults. ## Contraindications * Known hypersensitivity to pantoprazole, any component of the formulation, or any other substituted benzimidazole. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, and arthralgia. Long-term use may be associated with increased risk of *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, and renal impairment. ## Key Drug Interactions * **Antiretrovirals:** Pantoprazole can decrease the absorption of drugs that require gastric acidity for absorption (e.g., certain antiretrovirals like rilpivirine, atazanavir). Separate administration by at least 12 hours or consult prescribing information for specific antiretrovirals. * **Methotrexate:** PPIs may increase methotrexate levels. Consider withholding PPIs during methotrexate treatment or use with caution. * **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19 and may increase concentrations of drugs metabolized by this enzyme (e.g., clopidogrel, voriconazole). ## Monitoring * Monitor for symptoms of GI bleeding or malignancy. * Consider monitoring serum magnesium levels with prolonged therapy (>3 months), especially in patients taking concomitant digoxin or diuretics. * Monitor for signs and symptoms of vitamin B12 deficiency with long-term therapy. ## Clinical Pearls * Administer oral pantoprazole at least 30 minutes before a meal. * Oral formulations are available as delayed-release tablets and orally disintegrating tablets. * IV formulations are available for patients unable to take oral medications. * Long-term use of PPIs should be re-evaluated regularly, and the lowest effective dose should be used. *** **Disclaimer:** This information is intended for clinical use and is not exhaustive. Always consult the most current prescribing information and relevant literature for complete details and to verify dosages and safety information before administering any medication.