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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 GERD. * Maintenance of healing of erosive esophagitis. * Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome). ## Adult Dosing * **Healing of erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. * **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily. Doses of 20 mg orally once daily may be effective for some patients. * **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be adjusted up to 240 mg intravenously daily or 120 mg orally twice daily depending on patient response. ## Pediatric Dosing * **Erosive esophagitis (ages 5-16 years):** 20 mg orally once daily for up to 8 weeks. * **Erosive esophagitis (ages 1 month to < 5 years):** Dosing varies. Consult specific pediatric guidelines or product information. ## Dose Adjustments * **Hepatic Impairment:** Maximum daily dose of 40 mg orally. Intravenous route is not recommended. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence. * **Serious:** *Clostridioides difficile*-associated diarrhea, bone fractures (hip, wrist, spine) with long-term use, hypomagnesemia, vitamin B12 deficiency, fundic gland polyps. ## Key Drug Interactions * Drugs whose absorption is pH-dependent (e.g., ketoconazole, itraconazole, iron salts, digoxin): Pantoprazole decreases gastric pH, potentially altering absorption. * Methotrexate: PPIs may increase methotrexate levels. * Warfarin: PPIs may increase INR and prothrombin time. Monitor INR closely. * CYP2C19 and CYP3A4 substrates/inhibitors: May affect pantoprazole metabolism. ## Monitoring * Monitor for signs and symptoms of hypomagnesemia (e.g., tremor, muscle cramps, seizures). * Monitor for signs of *C. difficile*-associated diarrhea. * Consider vitamin B12 levels with long-term therapy. * Monitor bone mineral density in patients at risk for osteoporosis with prolonged use. ## Clinical Pearls * Pantoprazole is available as delayed-release oral formulations and as an intravenous preparation. * Oral administration is preferred over intravenous when feasible. * Administer oral pantoprazole 30-60 minutes before a meal. * Do not crush or chew delayed-release tablets. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance. Dosing can vary based on individual patient factors and clinical context.*