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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases stomach acid production.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Pathological hypersecretory conditions, including Zollinger-Ellison Syndrome.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks. A subsequent 8-week course may be considered for patients who have not healed.
* **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily.
* **Pathological hypersecretory conditions (e.g., Zollinger-Ellison Syndrome):** 40 mg orally twice daily. The dose may be increased to 80 mg orally twice daily.
Intravenous (IV) dosing is also available for patients unable to take oral medication. Typical IV doses range from 40 mg daily to 40 mg twice daily, depending on the indication and severity.
## Pediatric Dosing
* **Erosive esophagitis (ages 5 to 16 years):** 20 mg orally once daily for up to 8 weeks.
* **Erosive esophagitis (ages 1 month to 5 years):** Dosing is weight-based, typically 0.7 mg/kg to 1.3 mg/kg orally once daily. The maximum dose should not exceed 40 mg once daily. Specific protocols may vary.
## Dose Adjustments
No dose adjustment is generally required for renal or hepatic impairment. However, caution may be advised in severe hepatic impairment.
## Contraindications
Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use of PPIs may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Pantoprazole can decrease absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors.
* **Methotrexate:** Concurrent use with PPIs may increase methotrexate levels.
* **CYP2C19 Substrates:** Pantoprazole can inhibit CYP2C19, potentially increasing levels of drugs metabolized by this enzyme (e.g., clopidogrel, though clinical significance is debated).
## Monitoring
* Monitor for signs and symptoms of *Clostridium difficile* infection.
* Consider monitoring serum magnesium levels, especially with prolonged use (>1 year) or concomitant diuretic use.
* Monitor for bone fracture risk with long-term therapy.
* Assess for signs of vitamin B12 deficiency.
## Clinical Pearls
* Administer 40 mg oral doses 30 minutes before a meal.
* Do not crush or chew delayed-release tablets; administer whole.
* For IV administration, reconstitute and further dilute according to manufacturer instructions.
* Consider the lowest effective dose for the shortest duration necessary to treat the condition.
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*Please verify current prescribing information for the most up-to-date details.*
