Please check your internet connection and try again.
# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Healing of erosive esophagitis
* Reduction of risk of NSAID-associated gastric ulcers
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **GERD and Erosive Esophagitis Healing:** 40 mg orally or intravenously (IV) once daily for up to 8 weeks. For maintenance therapy in GERD, 20 mg orally once daily may be used.
* **NSAID-associated Ulcer Prophylaxis:** 20 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Initiate with 40 mg orally or IV twice daily. Doses may be increased as clinically indicated. Typical doses range from 40 mg twice daily to 240 mg daily.
## Pediatric Dosing
* **GERD (4 weeks to 16 years):**
* **Weight < 40 kg:** 10 mg orally once daily.
* **Weight ≥ 40 kg:** 20 mg orally once daily.
* *Note:* Dosing for healing of erosive esophagitis in children varies; consult specific pediatric guidelines. IV dosing in pediatrics is not well-established.
## Dose Adjustments
* **Hepatic Impairment:** For severe hepatic impairment, a maximum dose of 20 mg orally once daily is recommended. No dose adjustment is typically needed for renal impairment.
## Contraindications
* Known hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation.
## Adverse Effects
Common: Diarrhea, headache, nausea, abdominal pain, dizziness.
Long-term use may be associated with:
* Bone fractures (hip, wrist, spine)
* Clostridium difficile infection
* Hypomagnesemia
* Vitamin B12 deficiency
## Key Drug Interactions
* **Drugs Dependent on Gastric pH:** May decrease absorption of drugs requiring acidic environment (e.g., ketoconazole, itraconazole, certain HIV protease inhibitors).
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19 and may increase levels of drugs metabolized by this enzyme (e.g., clopidogrel).
## Monitoring
* Monitor for signs and symptoms of C. difficile infection.
* Consider magnesium levels, especially in patients on long-term therapy or concomitant diuretic use.
* Monitor for bone fracture risk factors.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* IV pantoprazole should be administered over at least 15 minutes.
* For IV administration, reconstitute and dilute according to manufacturer instructions.
* Consider the potential for rebound acid hypersecretion when discontinuing therapy. Tapering may be considered.
---
*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for definitive patient care decisions.*
