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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Healing of erosive esophagitis
* Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* Peptic ulcer disease (maintenance and treatment of duodenal ulcers)
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of Healing Erosive Esophagitis:** 40 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses can be increased as needed. Maximum dose is generally 240 mg daily.
* **Duodenal Ulcer Treatment:** 40 mg orally once daily for up to 4 weeks.
* **Duodenal Ulcer Maintenance:** 40 mg orally once daily.
**IV Administration:** 40 mg IV daily.
## Pediatric Dosing
Dosing in pediatric populations can vary based on age, weight, and indication. Consult specific pediatric guidelines.
* **GERD/Erosive Esophagitis (6 months to 16 years):** 1.5 mg/kg/day orally once daily, not to exceed 40 mg/day. For more severe cases, 3 mg/kg/day orally once daily, not to exceed 40 mg/day.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose is 20 mg orally or 40 mg IV once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, dizziness, and flatulence. Long-term use may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** PPIs can decrease the absorption of drugs such as ketoconazole, itraconazole, and atazanavir.
* **Methotrexate:** PPIs may increase serum levels of methotrexate.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19 and may affect the metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., muscle spasms, tremors, seizures).
* Monitor for signs of *C. difficile* infection.
* Consider monitoring vitamin B12 levels with prolonged therapy.
## Clinical Pearls
* Administer oral pantoprazole 30-60 minutes before a meal.
* IV pantoprazole should be given as a slow infusion over 15 minutes.
* Do not crush or chew delayed-release tablets.
* Long-term PPI use should be re-evaluated regularly to determine if continued therapy is necessary.
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*This information is for educational purposes and does not substitute for professional medical advice. Always consult the current prescribing information and a qualified healthcare provider for any medical decisions or treatment.*
