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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion. ## Primary Indications * Gastroesophageal reflux disease (GERD) - erosive esophagitis and symptom relief * Healing of erosive esophagitis * Zollinger-Ellison syndrome * H. pylori eradication (in combination with antibiotics) ## Adult Dosing * **GERD/Erosive Esophagitis:** 40 mg orally or IV once daily. May increase to 80 mg once daily for severe cases or treatment of severe erosive esophagitis. * **Zollinger-Ellison Syndrome:** Starting dose 40 mg orally or IV twice daily. Titrate to gastric acid output; doses up to 240 mg daily have been administered. * **H. pylori Eradication:** 40 mg orally twice daily (in combination with clarithromycin and amoxicillin or clarithromycin and metronidazole) for 7-14 days. ## Pediatric Dosing * **GERD/Erosive Esophagitis:** * **1-5 years:** 20 mg orally once daily. * **5-12 years:** 20-40 mg orally once daily. * **12 years and older:** 40 mg orally or IV once daily. * *Note: Dosing for <1 year is not well established. Safety and efficacy in this age group have not been fully evaluated.* ## Dose Adjustments * **Hepatic Impairment:** Maximum dose is 40 mg orally or IV once daily. * **Renal Impairment:** No dose adjustment generally needed. ## Contraindications * Hypersensitivity to pantoprazole, other benzimidazoles, or any component of the formulation. ## Adverse Effects * **Common:** Headache, diarrhea, nausea, abdominal pain, flatulence. * **Serious:** Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine) with long-term use, hypomagnesemia, Vitamin B12 deficiency with long-term use, fundic gland polyps. ## Key Drug Interactions * Drugs affected by gastric pH: Ketoconazole, itraconazole, iron salts, mycophenolate mofetil, dasatinib. * CYP2C19 and CYP3A4 substrates: Monitor for altered concentrations of drugs like warfarin, clopidogrel, phenytoin, diazepam. ## Monitoring * Electrolytes (magnesium, potassium, calcium) with prolonged therapy. * Bone mineral density in patients at risk for osteoporosis with prolonged therapy. * For patients on long-term therapy, assess for Vitamin B12 deficiency. ## Clinical Pearls * Administer oral pantoprazole 30 minutes before a meal. * IV formulation should be reconstituted and diluted further before administration. Do not mix with other drugs. * Long-term PPI use is associated with increased risk of fractures, C. difficile infection, and hypomagnesemia. Re-evaluate need for continued therapy periodically. *** *Please verify current prescribing information and institutional protocols for the most up-to-date and specific guidance.*