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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion by inhibiting the H+/K+-ATPase enzyme system in gastric parietal cells. ## Primary Indications * Erosive esophagitis associated with gastroesophageal reflux disease (GERD). * Maintenance of healing of erosive esophagitis. * Pathological hypersecretory conditions, such as Zollinger-Ellison syndrome. ## Adult Dosing * **Erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. A subsequent 8-week course may be considered for patients who have not healed. * **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily. The safety and efficacy for longer-term use have not been established beyond 12 months. * **Pathological hypersecretory conditions:** 40 mg orally or intravenously twice daily, potentially increased to 80 mg intravenously or orally every 8 hours. Doses >80 mg daily should be administered intravenously as a continuous infusion. ## Pediatric Dosing * **12 to 15 years:** * Erosive esophagitis: 40 mg orally once daily for up to 8 weeks. * **5 to 11 years:** * Erosive esophagitis: 20 mg orally once daily for up to 8 weeks. For more severe esophagitis or patients weighing > 40 kg, 40 mg orally once daily may be used. * Dosing for pediatric patients with pathological hypersecretory conditions is not established. ## Dose Adjustments No dose adjustment is generally required for renal impairment. Caution and potential dose reduction may be considered in severe hepatic impairment. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects Common adverse effects include diarrhea, headache, dizziness, abdominal pain, nausea, and vomiting. Long-term use of PPIs may be associated with an increased risk of *Clostridioides difficile*-associated diarrhea, bone fractures (hip, wrist, or spine), and vitamin B12 deficiency. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** Pantoprazole can decrease absorption of drugs that require an acidic environment (e.g., ketoconazole, itraconazole, iron salts, vitamin B12). * **CYP2C19 substrates:** Pantoprazole may affect the metabolism of drugs metabolized by CYP2C19 (e.g., clopidogrel). Consider alternative therapy if clopidogrel is used concurrently. ## Monitoring * Monitor for signs and symptoms of *C. difficile*-associated diarrhea. * Consider monitoring bone mineral density in patients at risk for osteoporosis. * Consider monitoring vitamin B12 levels with long-term therapy. ## Clinical Pearls * Administer pantoprazole 30 minutes before a meal for optimal efficacy. * Intravenous administration should be done over 15 minutes or as a continuous infusion. * Long-term use should be reserved for patients with a clear indication, and periodic reassessment of the need for therapy is recommended. *** *This information is intended for healthcare professionals. Always verify current prescribing information, including contraindications, warnings, precautions, and adverse reactions, with the most recent official drug labeling or other authoritative sources.*