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Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that decreases the amount of acid produced in the stomach. ## Primary Indications * Erosive esophagitis associated with gastroesophageal reflux disease (GERD) * Healing of erosive esophagitis and reduction in associated heartburn * Pathological hypersecretory conditions, including Zollinger-Ellison syndrome ## Adult Dosing * **Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. * **Maintenance of Healing 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. * **Pathological Hypersecretory Conditions:** 40 mg orally or intravenously twice daily, may be increased to a maximum of 120 mg intravenously or orally every 8 hours. ## Pediatric Dosing * **1 month to < 5 years:** 10 mg orally once daily for up to 8 weeks (for GERD). * **5 years to < 17 years:** 20 mg orally once daily for up to 8 weeks (for GERD); 40 mg orally once daily for up to 8 weeks (for erosive esophagitis). * **Intravenous administration in pediatrics is not FDA-approved.** ## Dose Adjustments * **Hepatic Impairment:** Oral: Maximum dose of 40 mg daily. Intravenous: Reduce dose by one-half. * **Renal Impairment:** No dose adjustment needed. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects Common: Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence. Serious: *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine) with long-term use, hypomagnesemia, vitamin B12 deficiency. ## Key Drug Interactions * **Antiretrovirals (e.g., nelfinavir, atazanavir):** Decreased absorption and serum concentrations. * **Methotrexate:** Increased methotrexate levels. * **Drugs dependent on gastric pH for absorption (e.g., ketoconazole, itraconazole, iron salts):** Decreased absorption. ## Monitoring * Monitor for signs and symptoms of *C. difficile*-associated diarrhea. * Consider serum magnesium levels, especially with prolonged therapy (>1 year) or concomitant use of other drugs that lower magnesium. * Monitor for signs of bone fracture. * Monitor vitamin B12 levels if deficiency is suspected. ## Clinical Pearls * Administer oral pantoprazole at least 30 minutes before a meal. * IV infusion should be administered over 15 minutes. * Long-term PPI use has been associated with increased risk of fractures, *C. difficile* infection, hypomagnesemia, and vitamin B12 deficiency. Use the lowest effective dose for the shortest duration necessary. * Consider switching to oral therapy once IV infusion is completed if clinically appropriate. --- **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions. Dosing may vary based on institutional protocols and individual patient factors.