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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion by inhibiting the H+/K+-ATPase enzyme system. ## 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. Some patients may be treated with 20 mg orally once daily. * **Pathological hypersecretory conditions:** Starting dose typically 40 mg orally or intravenously twice daily. Doses can be titrated up to 240 mg daily. ## Pediatric Dosing * **GERD and erosive esophagitis (1 month to 5 years):** 0.7 mg/kg to 1.5 mg/kg orally once daily. Maximum dose 40 mg daily. * **GERD and erosive esophagitis (5 to 12 years):** 20 mg to 40 mg orally once daily. * **GERD and erosive esophagitis (12 years and older):** 40 mg orally once daily. * *Dosing for pediatric intravenous administration or for pathological hypersecretory conditions in pediatrics is not well established and should be guided by specialist consultation.* ## 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. * Concomitant use with rilpivirine. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use may be associated with an increased risk of *Clostridioides difficile* infection, bone fractures (hip, wrist, spine), hypomagnesemia, and vitamin B12 deficiency. ## Key Drug Interactions * **Drugs dependent on gastric pH for absorption:** Ketoconazole, itraconazole, erlotinib, certain HIV protease inhibitors (e.g., atazanavir, nelfinavir). Monitor for loss of efficacy. * **Methotrexate:** PPIs may increase methotrexate levels. Consider dose reduction or discontinuation. * **CYP2C19 substrates:** Omeprazole, the active metabolite of pantoprazole, inhibits CYP2C19. Pantoprazole has less impact than some other PPIs, but interactions are possible, particularly with drugs like clopidogrel. ## Monitoring * Monitor for symptoms of GERD or esophagitis. * Electrolytes (magnesium, calcium, potassium) with prolonged use. * Vitamin B12 levels with prolonged use. * Bone mineral density with long-term therapy. ## Clinical Pearls * Administer oral pantoprazole at least 30 minutes before a meal. * Intravenous administration should be completed over 15 minutes or infused over 2 hours. * Long-term PPI use should be re-evaluated regularly to determine the need for continued therapy. * Consider the risk of bone fractures, *C. difficile* infection, and hypomagnesemia with chronic use. *** *This information is intended for clinical use and does not replace the need for consulting current prescribing information, specific patient factors, and local protocols before making any treatment decisions.*