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Pantoprazole is a proton pump inhibitor (PPI) used to decrease stomach acid production. ## Primary Indications * Gastroesophageal reflux disease (GERD) * Erosive esophagitis healing and maintenance * Zollinger-Ellison syndrome * Part of *Helicobacter pylori* eradication regimens ## Adult Dosing * **GERD/Erosive Esophagitis:** 20 mg to 40 mg orally or intravenously once daily. Maximum 40 mg daily for GERD, up to 40 mg daily for erosive esophagitis. * **Zollinger-Ellison Syndrome:** 40 mg orally or intravenously once daily, may be increased to 80 mg daily. * ***H. pylori* Eradication:** 40 mg orally twice daily in combination with antibiotics. ## Pediatric Dosing * **GERD (1 to 11 years):** 10 mg orally once daily for weight < 40 kg, 20 mg orally once daily for weight $\ge$ 40 kg. * **GERD (12 to 17 years):** 20 mg to 40 mg orally once daily. * **Erosive Esophagitis (5 to 11 years):** 10 mg orally once daily for weight < 40 kg, 20 mg orally once daily for weight $\ge$ 40 kg. * **Erosive Esophagitis (12 to 17 years):** 40 mg orally once daily. * Dosing for Zollinger-Ellison syndrome and *H. pylori* eradication in pediatrics is not well-established and should be based on expert consultation or specific protocols. ## Dose Adjustments No dose adjustment is necessary for hepatic impairment. No dose adjustment is necessary for renal impairment. ## Contraindications Known hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation. ## Adverse Effects * **Common:** Diarrhea, headache, nausea, abdominal pain, flatulence, dizziness. * **Serious:** *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine) with prolonged use, hypomagnesemia, vitamin B12 deficiency, lupus erythematosus, fundic gland polyps. ## Key Drug Interactions * **Drugs Dependent on Gastric pH:** May decrease absorption of drugs requiring acidic environment (e.g., ketoconazole, itraconazole, iron salts, vitamin B12). May increase levels of drugs metabolized by CYP2C19 (e.g., clopidogrel, voriconazole). * **Methotrexate:** PPIs may increase methotrexate levels. ## Monitoring * Monitor for signs and symptoms of *C. difficile*-associated diarrhea. * Consider monitoring serum magnesium levels, especially with prolonged therapy or concomitant diuretic use. * Assess for bone fracture risk with long-term therapy. * Monitor for signs of vitamin B12 deficiency with prolonged use. ## Clinical Pearls * Administer oral pantoprazole 30 minutes before a meal. * Intravenous administration: Reconstitute vial with 5 mL sterile water for injection, then further dilute in 50 mL D5W or NS. Infuse over 15 minutes. * Long-term use may increase the risk of certain infections (e.g., pneumonia) and nutrient deficiencies. Consider the lowest effective dose for the shortest duration necessary. *** This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before initiating or modifying therapy.