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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Treatment of pathological hypersecretory conditions, such as Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily. Doses may be adjusted as needed, with doses up to 240 mg daily administered intravenously and divided into 3 infusions. Oral doses can be up to 120 mg daily.
## Pediatric Dosing
* **Age 5 to 11 years:**
* **Erosive esophagitis:** 20 mg orally once daily for up to 4 weeks.
* **Alternative for longer treatment:** 40 mg orally once daily for up to 8 weeks.
* **Age 12 to 15 years:**
* **Erosive esophagitis:** 40 mg orally once daily for up to 4 weeks.
* **Alternative for longer treatment:** 40 mg orally once daily for up to 8 weeks.
* **Note:** Dosing for children under 5 years of age is not well-established and should be based on clinical judgment and expert consultation.
## Dose Adjustments
* No dose adjustment is generally required for patients with hepatic impairment, though caution is advised and the lowest effective dose should be used.
* No dose adjustment is necessary for patients with renal impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of its formulation.
## Adverse Effects
* **Common:** Diarrhea, headache, nausea, abdominal pain, vomiting, dizziness, flatulence.
* **Serious:** Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine) with prolonged use, vitamin B12 deficiency, hypomagnesemia, lupus erythematosus.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, posaconazole, iron salts, vitamin B12. Pantoprazole can decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole may affect the metabolism of drugs metabolized by CYP2C19 (e.g., clopidogrel, warfarin).
## Monitoring
* Monitor for signs and symptoms of Clostridium difficile infection.
* Consider monitoring magnesium levels in patients on long-term PPI therapy, especially those taking diuretics or digoxin.
* Monitor for signs of bone fracture.
* Monitor for symptoms of vitamin B12 deficiency.
## Clinical Pearls
* Administer pantoprazole oral suspension and delayed-release tablets 30 minutes before a meal.
* Pantoprazole delayed-release tablets should be swallowed whole and not chewed or crushed.
* Long-term use of PPIs is associated with increased risk of fractures, C. difficile infection, and vitamin B12 deficiency. Consider the risks and benefits for prolonged therapy.
* The use of PPIs for duration longer than necessary should be avoided.
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*This information is intended for clinical use by healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details and to verify dosage and safety prior to patient treatment.*
