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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production. ## 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 or intravenously once daily for up to 8 weeks. * **Maintenance of healing:** 40 mg orally once daily. For some patients, 20 mg orally once daily may suffice. * **Hypersecretory conditions:** 40 mg orally or intravenously once daily. Doses may be titrated up to 240 mg intravenously or 120 mg orally per day, divided into two doses. ## Pediatric Dosing * **GERD and erosive esophagitis (5-16 years):** 20 mg or 40 mg orally once daily. Dosing is weight-based for intravenous administration if needed, with specific recommendations varying by indication and formulation. Data for younger children is limited. ## Dose Adjustments No dose adjustment is typically required for hepatic or renal impairment. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects Common adverse effects include diarrhea, headache, dizziness, abdominal pain, nausea, and flatulence. Long-term use may be associated with vitamin B12 deficiency, hypomagnesemia, and increased risk of C. difficile infection and bone fractures. ## Key Drug Interactions * Drugs requiring gastric acid for absorption (e.g., certain antifungals like ketoconazole, itraconazole; certain antiretrovirals like rilpivirine, atazanavir): PPIs can decrease absorption. * Methotrexate: PPIs may increase levels of methotrexate. * CYP2C19 substrates: Pantoprazole can inhibit CYP2C19, potentially affecting the metabolism of drugs like clopidogrel. ## Monitoring * Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, arrhythmias). * Monitor for signs of vitamin B12 deficiency with prolonged therapy. * Assess for effectiveness and presence of adverse effects. ## Clinical Pearls * Pantoprazole is generally given 30-60 minutes before a meal. * IV administration may be used when oral intake is not feasible. * Long-term use should be periodically re-evaluated for need. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details.*