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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces 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 (e.g., Zollinger-Ellison syndrome).
* Reduction of risk of NSAID-associated gastric ulcers in patients at risk.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks. For maintenance, 40 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is 40 mg orally twice daily, may be increased to a maximum of 240 mg daily divided into two doses.
* **NSAID-associated gastric ulcers:** 40 mg orally once daily. Duration varies based on healing, typically up to 8 weeks.
*Intravenous (IV) dosing for hospital use:*
* **Erosive esophagitis:** 40 mg IV once daily for up to 7 days.
* **Pathological hypersecretory conditions:** 40 mg IV twice daily, may be increased to 240 mg daily divided into two doses.
## Pediatric Dosing
* **GERD (oral):**
* 1 year and older, 20 kg or less: 10 mg orally once daily.
* 1 year and older, over 20 kg: 20 mg orally once daily.
* Duration typically up to 4 weeks for healing erosive esophagitis.
* **GERD (IV):**
* 5 years and older: 1.1 mg/kg/dose IV once daily, not to exceed 40 mg/dose.
*Dosing for other indications in pediatric patients is not well established.*
## Dose Adjustments
* **Hepatic impairment:** Maximum dose is 40 mg orally once daily.
* **Renal impairment:** No dose adjustment is typically required.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* Common: Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence.
* Long-term use (over 1 year): Increased risk of C. difficile infection, bone fractures (hip, wrist, spine), magnesium deficiency, and potentially vitamin B12 deficiency.
## Key Drug Interactions
* **Clopidogrel:** Reduced antiplatelet effect. Consider alternative PPIs if concomitant use is necessary.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **Drugs dependent on gastric pH for absorption (e.g., ketoconazole, itraconazole, certain HIV protease inhibitors):** May decrease absorption.
## Monitoring
* Monitor for signs and symptoms of C. difficile infection.
* Consider baseline and periodic monitoring of serum magnesium levels, especially with prolonged use or concomitant diuretic use.
* Assess for bone fracture risk in patients with risk factors for osteoporosis.
* Monitor for efficacy and symptom improvement.
## Clinical Pearls
* Administer oral pantoprazole 30-60 minutes before a meal.
* IV administration should be over 15 minutes.
* Do not crush or chew delayed-release formulations.
* For Zollinger-Ellison syndrome, the dose should be individualized based on response.
This information is intended as a quick reference. Always consult the current prescribing information and relevant clinical guidelines for complete details before making prescribing decisions.
