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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that decreases gastric acid production. ## Primary Indications * Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD). * Reduction of symptoms of GERD. * Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome). ## Adult Dosing * **Healing of erosive esophagitis:** 40 mg orally once daily for up to 8 weeks. * **Maintenance of healing erosive esophagitis:** 40 mg orally once daily. * **Symptomatic GERD:** 20 mg to 40 mg orally once daily. For patients not healed after 4 weeks, an additional 4 weeks may be given. * **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily. Doses can be increased as clinically indicated. Doses up to 240 mg IV daily have been used. ## Pediatric Dosing * **GERD (erosive esophagitis):** * 1 year and older, weighing 15 kg to 40 kg: 20 mg orally once daily for up to 8 weeks. * 1 year and older, weighing >40 kg: 40 mg orally once daily for up to 8 weeks. * **Symptomatic GERD:** * 5 years and older: 20 mg orally once daily for up to 8 weeks. *Note: Dosing for pediatric patients below 5 years of age is not well-established.* ## Dose Adjustments * **Hepatic Impairment:** Maximum dose of 40 mg orally once daily. * **Renal Impairment:** No dose adjustment necessary. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence. * **Serious:** Bone fracture (hip, wrist, spine) with long-term use, Clostridioides difficile-associated diarrhea, vitamin B12 deficiency, hypomagnesemia (can be severe and prolonged), fundic gland polyps. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** Pantoprazole can decrease absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors. * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. ## Monitoring * Magnesium levels, especially in patients on long-term therapy or concomitant diuretic use. * Bone mineral density in patients at risk for osteoporosis. * Signs and symptoms of C. difficile infection. ## Clinical Pearls * Administer oral pantoprazole 30 minutes before a meal. * IV formulation is available for patients unable to take oral medications. * Long-term use of PPIs is associated with increased risk of fractures and C. difficile infection. Consider lowest effective dose for shortest duration. * Hypomagnesemia can occur, sometimes without symptoms, and may require magnesium supplementation and discontinuation of the PPI. *** *Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information and a qualified healthcare provider for any medical decisions.*