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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases gastric acid production.
## Primary Indications
* Erosive esophagitis associated with GERD
* Gastroesophageal reflux disease (GERD)
* Zollinger-Ellison syndrome
* Part of H. pylori eradication regimens (in combination with antibiotics)
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks.
* **GERD:** 20 mg to 40 mg orally once daily. Treatment duration varies.
* **Zollinger-Ellison syndrome:** 40 mg orally once daily, may be increased to a maximum of 80 mg every 8 hours.
* **H. pylori eradication:** Typically 40 mg orally twice daily for 7-14 days, in combination with antibiotics.
## Pediatric Dosing
* **Erosive esophagitis (1 to 16 years):** 20 mg to 40 mg orally once daily for up to 8 weeks. Dosing based on weight may be considered for children < 40 kg.
* **GERD (5 to 16 years):** 20 mg to 40 mg orally once daily.
* **Neonates and Infants < 1 year:** Dosing is not well established. Use with caution and only if clearly needed.
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 40 mg orally once daily for patients with severe hepatic impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* Common: Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence.
* Long-term use associated with increased risk of *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs affected by gastric pH:** Ketoconazole, itraconazole, iron salts, and others may have decreased absorption.
* **CYP2C19 substrates:** Methotrexate may have increased levels.
* **Warfarin:** May increase INR and risk of bleeding. Monitor INR closely.
* **Certain HIV medications:** Atazanavir, nelfinavir.
## Monitoring
* Magnesium levels, especially with prolonged use (>1 year) or concurrent diuretic/digoxin use.
* Vitamin B12 levels with prolonged therapy.
* Bone mineral density assessment may be considered in patients at risk for osteoporosis.
## Clinical Pearls
* Administer orally 30 minutes before a meal.
* For patients with difficulty swallowing, pantoprazole delayed-release oral suspension is available.
* The 20 mg dose is often sufficient for GERD symptom management.
* Discontinuation of PPIs should be considered gradually to minimize rebound acid hypersecretion.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines for complete and up-to-date information before making any treatment decisions.*
