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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 or intravenously once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose of 40 mg orally or intravenously twice daily. Doses may be increased as clinically indicated. Doses greater than 240 mg daily must be administered intravenously in divided doses.
## Pediatric Dosing
* **Erosive esophagitis (5-16 years):** 20 mg to 40 mg orally once daily for up to 8 weeks.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 40 mg orally or 20 mg intravenously once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* Common: Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence.
* Serious: Clostridium difficile-associated diarrhea, bone fracture (hip, wrist, spine) with long-term use, hypomagnesemia, vitamin B12 deficiency, systemic lupus erythematosus.
## Key Drug Interactions
* Drugs dependent on gastric pH for absorption: Increased risk of toxicity with digoxin, ketoconazole, itraconazole, and certain other antifungals. Decreased absorption with certain HIV protease inhibitors.
* Methotrexate: May increase and prolong serum levels of methotrexate.
* CYP2C19 substrates (e.g., clopidogrel): May affect clopidogrel efficacy.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremors, muscle cramps, seizures, arrhythmias).
* Consider monitoring magnesium levels, especially in patients on long-term therapy or concomitant medications known to lower magnesium.
* Monitor for bone fracture risk factors.
* Monitor for signs of C. difficile infection.
## Clinical Pearls
* Oral pantoprazole should be taken at least 30 minutes before a meal.
* For intravenous administration, reconstitute and dilute according to manufacturer instructions.
* Long-term use of PPIs may be associated with increased risk of fractures, C. difficile infection, and vitamin B12 deficiency. Discontinue if clinically appropriate.
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*Disclaimer: This information is intended for clinical decision-making support and does not replace comprehensive drug reference materials or institutional protocols. Always verify current prescribing information with the official product monograph or other reliable sources before administering any medication.*
