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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that decreases stomach acid production. ## Primary Indications * Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD). * Maintenance of healing of erosive esophagitis. * Pathological hypersecretory conditions, including Zollinger-Ellison syndrome. ## Adult Dosing * **Erosive esophagitis healing:** 40 mg once daily for up to 8 weeks. * **Maintenance of healing:** 40 mg once daily. * **Pathological hypersecretory conditions:** Starting dose is typically 40 mg twice daily, but may be increased based on gastric acid output. Usual doses range from 40 mg to 120 mg daily, given in divided doses. Doses > 80 mg daily should be administered via IV infusion. ## Pediatric Dosing * **12 to 17 years:** * Erosive esophagitis healing: 40 mg once daily for 4 to 8 weeks. * **5 to 11 years:** * Erosive esophagitis healing: 20 mg once daily for 4 to 8 weeks. Doses > 20 mg daily should be administered via IV infusion. * **Less than 5 years:** Efficacy and safety not established for IV formulation. For oral formulations, doses of 20-40 mg once daily have been used in children 2 to 11 years for GERD; however, specific indications and dosing are highly dependent on age, weight, and severity of condition, and local protocols should be followed. ## Dose Adjustments No dose adjustment is generally needed for hepatic or renal impairment. ## Contraindications * Known hypersensitivity to pantoprazole, any of its components, or other substituted benzimidazoles. ## Adverse Effects Common adverse effects include diarrhea, headache, dizziness, nausea, abdominal pain, and flatulence. Long-term use of PPIs may be associated with an increased risk of *Clostridioides difficile* infection, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, and kidney problems. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** PPIs can decrease the absorption of drugs such as ketoconazole, itraconazole, and certain HIV protease inhibitors (e.g., atazanavir, nelfinavir). * **Methotrexate:** PPIs may increase serum levels of methotrexate. * **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19, which may increase concentrations of drugs metabolized by this enzyme (e.g., clopidogrel, although clinical significance is debated). ## Monitoring * Monitor for signs and symptoms of *C. difficile*-associated diarrhea. * Consider monitoring serum magnesium levels, especially in patients on long-term therapy or concomitant diuretic use. * Monitor for signs of vitamin B12 deficiency (e.g., fatigue, glossitis, neurological symptoms) if long-term therapy is expected. ## Clinical Pearls * Pantoprazole oral formulations should be taken at least 1 hour before a meal. * Delayed-release tablets should be swallowed whole and not chewed or crushed. * IV pantoprazole is stable in normal saline or dextrose 5% in water. *** *This information is intended for educational purposes and does not substitute for professional medical advice. Always consult current prescribing information and your healthcare provider for any health concerns or before making any decisions related to your health or treatment.*