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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases the amount of acid produced in the stomach.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Reduction of risk of NSAID-associated gastric ulcers in patients at risk.
* 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.
* **NSAID-associated ulcers:** 40 mg orally once daily for up to 8 weeks.
* **Zollinger-Ellison syndrome:** 40 mg orally or intravenously twice daily, may be increased to a maximum of 240 mg daily.
## Pediatric Dosing
* **GERD and erosive esophagitis (ages 5-16 years):** 20 mg orally once daily for up to 8 weeks. Dosing may be weight-based (0.5 mg/kg/day) up to a maximum of 40 mg/day.
* **GERD and erosive esophagitis (ages 1 month to <5 years):** Dosing is not well established and may depend on institutional protocol. Generally, 0.5 mg/kg/day orally divided into two doses is used, with a maximum of 20 mg/day.
## Dose Adjustments
No dose adjustment is necessary for hepatic or renal impairment.
## Contraindications
Hypersensitivity to pantoprazole or any of its components.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, and rash. Long-term use may be associated with C. difficile infection, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Certain Antiretrovirals:** PPIs can decrease serum concentrations of antiretrovirals (e.g., rilpivirine, atazanavir). Avoid coadministration.
* **Methotrexate:** PPIs may increase serum concentrations of methotrexate. Consider temporary discontinuation of pantoprazole.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Monitor for potential increased exposure of drugs metabolized by this enzyme (e.g., clopidogrel, voriconazole).
## Monitoring
Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, arrhythmias) with prolonged use. Monitor for bone fracture risk with long-term therapy.
## Clinical Pearls
* Administer orally 30 minutes before a meal.
* Intravenous administration should be over 15 minutes.
* Do not crush or chew delayed-release formulations.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for complete details before initiating or modifying therapy.*
