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## Pantoprazole ### Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion. ### Primary Indications * Gastroesophageal reflux disease (GERD) * Erosive esophagitis * Zollinger-Ellison syndrome * Healing of Duodenal Ulcers * H. pylori eradication (in combination with antibiotics) ### Adult Dosing * **GERD/Erosive Esophagitis:** 20 mg to 40 mg once daily. Maximum dose: 40 mg daily for GERD; 40 mg twice daily for erosive esophagitis. * **Zollinger-Ellison Syndrome:** Starting dose 40 mg twice daily. Doses may be increased to 240 mg daily, administered as 120 mg every 8 hours. * **H. pylori Eradication:** 40 mg twice daily in combination with antibiotics for 7-14 days. ### Pediatric Dosing Dosing varies significantly by age and indication. * **1 month to 5 years:** 10 mg once daily for GERD. * **5 years to 16 years:** 20 mg once daily for GERD and erosive esophagitis. * Doses for Zollinger-Ellison syndrome or H. pylori eradication in children are less established and require careful consideration of available data and local protocols. ### Dose Adjustments No dose adjustment is typically needed for renal impairment. In severe hepatic impairment, the maximum daily dose is 20 mg. ### Contraindications * Known hypersensitivity to pantoprazole or any of its components. * Use of rilpivirine-containing products. ### Adverse Effects * Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence. * Long-term use associated with: increased risk of Clostridium difficile infection, bone fractures (hip, wrist, spine), vitamin B12 deficiency, and hypomagnesemia. ### Key Drug Interactions * Drugs whose absorption is dependent on gastric pH (e.g., ketoconazole, itraconazole, iron salts, digoxin, mycophenolate mofetil). * Potentially affects metabolism of drugs via CYP2C19 (e.g., clopidogrel, warfarin). ### Monitoring * Electrolytes (magnesium, potassium) with prolonged use. * Bone mineral density with long-term therapy. * Monitor for signs and symptoms of C. difficile-associated diarrhea. ### Clinical Pearls * Pantoprazole is available in oral and intravenous formulations. * Oral suspension should not be chewed or crushed. Tablets should be taken at least 1 hour before a meal. * IV infusion should be administered over 15 minutes. * Ensure H. pylori eradication therapy is completed as prescribed. *** **Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making treatment decisions.