Please check your internet connection and try again.
# 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 (e.g., 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 is typically 40 mg orally or intravenously twice daily. Doses may be increased as clinically indicated. Doses greater than 80 mg daily should be administered intravenously in divided doses. Maximum IV dose is 120 mg over 30 minutes.
## Pediatric Dosing
Dosing in pediatric patients is variable and depends on age and indication.
* **Erosive Esophagitis (5 to 16 years):** 20 mg or 40 mg orally once daily for up to 8 weeks.
* Dosing for younger children or other indications may be extrapolated from adult data or based on weight, but definitive recommendations are limited. Consult specific pediatric guidelines.
## Dose Adjustments
No dose adjustment is generally required for hepatic or renal impairment, though caution is advised in severe hepatic impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness.
* **Serious:**
* *Clostridium difficile*-associated diarrhea (CDAD)
* Fracture of the hip, wrist, or spine (associated with prolonged use, typically >1 year)
* Cutaneous and systemic lupus erythematosus
* Hypomagnesemia (can be serious and may lead to hypocalcemia and hypokalemia)
* Vitamin B12 deficiency (associated with prolonged use, typically >3 years)
* Fundic gland polyps (associated with long-term use)
## Key Drug Interactions
* **Antiretrovirals:** May decrease absorption of drugs like atazanavir and nelfinavir.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. May affect metabolism of drugs like clopidogrel and voriconazole.
* **Iron Supplements:** May decrease absorption.
## Monitoring
* Monitor for signs and symptoms of CDAD.
* Consider periodic serum magnesium levels with prolonged therapy, especially if taking concomitant medications like digoxin or diuretics.
* Assess for bone fracture risk with long-term use.
* Monitor for signs of vitamin B12 deficiency with long-term use.
## Clinical Pearls
* Pantoprazole is available in oral and intravenous formulations.
* For oral administration, tablets can be taken with or without food. Delayed-release granules should be sprinkled on applesauce and swallowed immediately, or mixed in a small amount of applesauce or
* *Ensure apple juice is not used for mixing.*
* Long-term use of PPIs is associated with increased risk of certain adverse events. Consider the shortest duration of therapy needed to treat the condition.
***
**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your specific condition and to review the most current prescribing information.
