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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.
* Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks.
* **Maintenance of healing erosive esophagitis:** 40 mg orally once daily.
* **Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome):** Starting dose of 40 mg orally twice daily. Doses may be increased as clinically indicated. Doses up to 240 mg daily have been administered intravenously.
## Pediatric Dosing
* **Erosive esophagitis (ages 5 to 16 years):** 20 mg orally once daily for up to 8 weeks. Doses of 40 mg once daily may be considered for patients who do not heal on 20 mg daily.
## Dose Adjustments
No dose adjustment is generally required for hepatic or renal impairment.
## Contraindications
Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Diarrhea, headache, nausea, abdominal pain, vomiting, dizziness, flatulence.
Serious: Fractures (hip, wrist, spine) with long-term use, *Clostridioides difficile*-associated diarrhea, hypomagnesemia, vitamin B12 deficiency.
## Key Drug Interactions
* **Antiretrovirals (e.g., rilpivirine, nelfinavir):** Reduced absorption due to decreased gastric acidity. Avoid coadministration.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity. Consider dose reduction or interruption of PPI if coadministered.
* **CYP2C19 Substrates (e.g., clopidogrel):** Pantoprazole is a moderate inhibitor of CYP2C19 and may decrease the efficacy of clopidogrel. Consider alternatives or monitor closely.
## Monitoring
* Electrolytes (especially magnesium) with long-term therapy.
* Bone mineral density in patients at risk for osteoporosis.
* Symptoms of *C. difficile* infection.
## Clinical Pearls
* Administer 30 minutes to 1 hour before a meal.
* Pantoprazole delayed-release tablets and granules should be swallowed whole and not crushed or chewed.
* For patients unable to swallow whole tablets, pantoprazole for oral suspension may be an alternative; reconstitute and administer immediately.
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*This information is intended for healthcare professionals and does not substitute for professional medical advice. Always verify current prescribing information with the latest drug monographs, institutional protocols, and available clinical guidelines.*
