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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases acid production in the stomach.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis
* Healing of duodenal ulcers
* Reduction of risk of NSAID-associated gastric ulcers
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. Maintenance therapy may be 20 mg once daily.
* **Healing of Duodenal Ulcers:** 40 mg orally once daily for 7 days.
* **NSAID-associated Ulcer Prophylaxis:** 40 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is 40 mg orally or intravenously twice daily, may be increased to 80 mg twice daily. Doses above 80 mg daily should be divided. Maximum dose typically 240 mg daily.
## Pediatric Dosing
* **GERD (12 to 16 years):** 40 mg orally once daily for up to 8 weeks.
* **GERD (5 to 11 years):** 20 mg orally once daily for up to 8 weeks.
There is limited data for use in children younger than 5 years.
## Dose Adjustments
No dose adjustment is typically needed for renal impairment.
For severe hepatic impairment, a dose of 20 mg orally once daily is recommended.
## Contraindications
* Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, dizziness, abdominal pain, flatulence.
* **Serious:** Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine) with long-term use, hypomagnesemia, vitamin B12 deficiency, fundic gland polyps.
## Key Drug Interactions
* **Drugs affected by gastric pH:** Ketoconazole, itraconazole, iron salts, cyanocobalamin, mycophenolate mofetil. Separate administration if possible.
* **CYP2C19 substrates:** May increase concentrations of drugs like clopidogrel. Monitor for efficacy and toxicity.
* **Methotrexate:** PPIs may increase methotrexate levels.
## Monitoring
* Assess for symptom relief.
* Monitor for signs and symptoms of C. difficile infection.
* Consider monitoring magnesium levels with prolonged therapy, especially in patients taking diuretics or digoxin.
* Monitor bone density if risk factors are present for long-term therapy.
## Clinical Pearls
* Administer oral pantoprazole 30 to 60 minutes before a meal.
* Intravenous administration should be over at least 15 minutes.
* Long-term PPI use is associated with increased risk of fractures, hypomagnesemia, and vitamin B12 deficiency.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and relevant clinical guidelines for complete and up-to-date details before making any treatment decisions.*
