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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. * Pathological hypersecretory conditions, such as Zollinger-Ellison syndrome. ## Adult Dosing * **Healing of Erosive Esophagitis:** 40 mg once daily for up to 8 weeks. * **Maintenance of Healing:** 40 mg once daily. * **Pathological Hypersecretory Conditions:** Starting dose is 40 mg twice daily, titrate as needed. Doses up to 240 mg daily have been administered. ## Pediatric Dosing * **Erosive Esophagitis (1-17 years):** 20 mg or 40 mg once daily depending on body weight. * 1-5 years (15 kg to <25 kg): 20 mg once daily. * 5-12 years (25 kg to <40 kg): 20 mg once daily. * 12-17 years (<40 kg): 20 mg once daily. * 12-17 years (≥40 kg): 40 mg once daily. * **Note:** Dosing for GERD without erosive esophagitis in pediatric patients is not well-established. ## Dose Adjustments * **Hepatic Impairment:** Maximum dose of 20 mg once daily for patients with severe hepatic impairment. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness. * **Serious:** *Clostridium difficile*-associated diarrhea, bone fracture (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, acute interstitial nephritis, lupus erythematosus. ## Key Drug Interactions * **Drugs Dependent on Gastric pH for Absorption:** May decrease absorption of drugs such as ketoconazole, itraconazole, posaconazole, nelfinavir, and erlotinib. * **Methotrexate:** May increase methotrexate levels. * **CYP2C19 Inhibitors/Inducers:** May alter pantoprazole levels (though clinical significance is debated). ## Monitoring * Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, tremor). * Monitor for signs of *C. difficile* infection. * Consider monitoring vitamin B12 levels with long-term therapy. * Monitor bone mineral density in patients at risk for osteoporosis. ## Clinical Pearls * Administer 30 minutes prior to a meal. * Do not crush or chew delayed-release formulations. * Long-term use of PPIs is associated with increased risk of fractures, *C. difficile*, hypomagnesemia, and vitamin B12 deficiency. *** *This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your specific condition. Verify current prescribing information before making any treatment decisions.*