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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion. ## Primary Indications * Healing of erosive esophagitis * Maintenance of healing of erosive esophagitis * Symptomatic gastroesophageal reflux disease (GERD) * H. pylori eradication (in combination with antibiotics) * Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome) ## Adult Dosing * **Erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. * **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily. * **Symptomatic GERD:** 40 mg orally once daily for up to 4 weeks. * **H. pylori eradication:** 40 mg orally twice daily for 7 to 14 days in combination with amoxicillin and clarithromycin or other antibiotic regimens. * **Pathological hypersecretory conditions:** Starting dose 40 mg orally or intravenously twice daily. Doses can be increased as needed. Doses up to 240 mg IV daily have been administered. ## Pediatric Dosing * **Erosive esophagitis:** * Ages 5 to 11 years: 20 mg orally once daily for up to 8 weeks. * Ages 12 to 17 years: 40 mg orally once daily for up to 8 weeks. * **Symptomatic GERD:** * Ages 5 to 11 years: 20 mg orally once daily for up to 4 weeks. * Ages 12 to 17 years: 40 mg orally once daily for up to 4 weeks. ## Dose Adjustments * **Hepatic impairment:** Maximum dose of 40 mg orally or intravenously once daily. ## Contraindications * Known hypersensitivity to pantoprazole or any component of its formulation. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, flatulence, vomiting, dizziness. * **Serious:** Fractures (hip, wrist, spine) with long-term use, C. difficile-associated diarrhea, hypomagnesemia (can be severe, may be asymptomatic), vitamin B12 deficiency with long-term use, fundic gland polyps. ## Key Drug Interactions * **Certain medications requiring gastric pH for absorption:** Antiretrovirals (e.g., atazanavir, nelfinavir), antifungals (e.g., ketoconazole, itraconazole), iron salts, mycophenolate mofetil. Monitor for loss of efficacy. * **Methotrexate:** PPIs may increase methotrexate levels. Consider PPI discontinuation if used with high-dose methotrexate. * **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. May affect metabolism of drugs like clopidogrel (reduced efficacy) or citalopram (increased levels). ## Monitoring * Monitor for signs and symptoms of C. difficile-associated diarrhea. * Monitor serum magnesium levels, especially with prolonged use or concurrent diuretic use. * Monitor for signs and symptoms of vitamin B12 deficiency with prolonged use. * Monitor bone mineral density if indicated. ## Clinical Pearls * Administer oral pantoprazole 30 to 60 minutes before a meal. * Intravenous formulation should be administered over at least 15 minutes. * Long-term use of PPIs is associated with increased risk of fractures, C. difficile infection, hypomagnesemia, and vitamin B12 deficiency. Use the lowest effective dose for the shortest duration needed. **Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant guidelines before making clinical decisions.