Please check your internet connection and try again.
# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Erosive esophagitis associated with gastroesophageal reflux disease (GERD)
* Maintenance of healing of erosive esophagitis
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* *Off-label:* Peptic ulcer disease, H. pylori eradication (in combination regimens)
## Adult Dosing
* **Erosive esophagitis:** 40 mg once daily for up to 8 weeks. For maintenance of healing, 40 mg once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg twice daily, may be increased to 80 mg twice daily. Doses above 80 mg daily should be administered in divided doses.
* **H. pylori eradication (combination therapy):** 40 mg twice daily for 7-14 days in combination with antibiotics.
## Pediatric Dosing
* **Erosive esophagitis (12 years and older):** 40 mg once daily for up to 8 weeks.
* Dosing for younger pediatric patients is less established and should be guided by specific clinical guidelines or specialist recommendations.
## Dose Adjustments
No specific dose adjustments are generally required for renal impairment. For severe hepatic impairment, the recommended dose is 20 mg once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
* Concomitant use with rilpivirine.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness.
Less common: Rash, pruritus, insomnia, myalgia, elevated liver enzymes.
Long-term use: Potential for vitamin B12 deficiency, hypomagnesemia, and increased risk of C. difficile-associated diarrhea, bone fractures (hip, wrist, spine).
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, iron salts, and certain antiretrovirals (e.g., rilpivirine) may have reduced absorption.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Caution with drugs like clopidogrel (potential for reduced antiplatelet effect), phenytoin, and methotrexate.
* **Methotrexate:** Concomitant use may increase methotrexate levels.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremors, tetany, seizures) with prolonged use.
* Consider monitoring magnesium levels, especially in patients on diuretics or with other risk factors for hypomagnesemia.
* Monitor for signs of bone fractures, vitamin B12 deficiency, and C. difficile infection with long-term therapy.
## Clinical Pearls
* Administer 30-60 minutes before a meal.
* Pantoprazole capsules should not be crushed or chewed. Delayed-release granules for oral suspension can be mixed with applesauce or apple juice.
* IV formulation is available for patients unable to take oral medication.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before making clinical decisions.*
