Pantop%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520d

# 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 of erosive esophagitis:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily. * **Pathological hypersecretory conditions:** 40 mg orally or intravenously twice daily, then may be increased to a maximum of 240 mg daily. Doses greater than 80 mg daily should be administered intravenously. ## Pediatric Dosing * **GERD and erosive esophagitis (12 years and older):** 40 mg orally once daily for up to 8 weeks. *Note: Dosing in pediatric patients younger than 12 years for GERD and erosive esophagitis is not established.* ## Dose Adjustments * **Hepatic Impairment:** Maximum dose is 40 mg once daily orally. * **Renal Impairment:** No dose adjustment necessary. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, dizziness, abdominal pain. * **Serious:** Fundic gland polyps, *Clostridium difficile*-associated diarrhea, bone fracture (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** Absorption may be decreased (e.g., ketoconazole, itraconazole, posaconazole, iron salts, vitamin B12). Separate administration. * **Methotrexate:** PPIs may increase methotrexate levels. Consider dose interruption if high-dose methotrexate is used. * **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Use with caution with drugs metabolized by this enzyme (e.g., clopidogrel, voriconazole). ## Monitoring * Electrolytes (especially magnesium) with prolonged use. * Bone mineral density with prolonged use. * Vitamin B12 levels with prolonged use. * Monitor for signs and symptoms of *C. difficile*-associated diarrhea. ## Clinical Pearls * For intravenous administration, reconstitute and dilute further according to manufacturer instructions. Do not administer with other medications through the same intravenous line. * Long-term PPI use (greater than 1 year) is associated with an increased risk of fractures, hypomagnesemia, and vitamin B12 deficiency. * Consider discontinuing pantoprazole if *Clostridium difficile*-associated diarrhea is suspected. * Ensure patient understands that pantoprazole is for symptom relief and healing, not a cure for GERD. *** *This information is intended for healthcare professionals. Please verify current prescribing information with the official product monograph or other authoritative sources before making clinical decisions.*