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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.
* Reduction of risk of NSAID-associated gastric ulcers in patients at continued risk and requiring NSAID treatment.
* Pathological hypersecretory conditions, including 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.
* **NSAID-associated gastric ulcers:** 40 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is 40 mg orally twice daily, may be increased to 40 mg up to three times daily. Doses up to 240 mg daily have been administered.
## Pediatric Dosing
Dosing varies significantly by indication and age. Consult specific pediatric guidelines or prescribing information.
* **1-5 years (≥15 kg):** 20 mg orally once daily for erosive esophagitis.
* **6-11 years (≥40 kg):** 40 mg orally once daily for erosive esophagitis.
* **Adolescents (12-17 years):** 40 mg orally once daily for erosive esophagitis.
## Dose Adjustments
* **Hepatic impairment:** Maximum dose of 40 mg once daily.
## 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 fracture (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** May decrease absorption of drugs like ketoconazole, itraconazole, atazanavir, nelfinavir.
* **Methotrexate:** May increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 substrates:** May affect metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of *C. difficile*-associated diarrhea.
* Monitor serum magnesium levels, especially with prolonged use (>1 year) or concomitant use of diuretics or digoxin.
* Consider vitamin B12 monitoring with long-term therapy.
* Assess for bone fracture risk.
## Clinical Pearls
* Administer 30-60 minutes before a meal.
* Delayed-release tablets should not be crushed or chewed.
* Long-term PPI use is associated with increased risk of fractures, hypomagnesemia, and vitamin B12 deficiency. Consider risk-benefit for prolonged therapy.
**Disclaimer:** This information is intended for healthcare professionals and does not substitute for the most current prescribing information or professional medical advice. Always consult the official drug monograph and consider individual patient factors before making treatment decisions.
