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# 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, such as 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. * **Pathological hypersecretory conditions:** 40 mg orally or intravenously twice daily, may be increased to a maximum of 240 mg daily in divided doses. ## Pediatric Dosing * **Erosive esophagitis (12 to 17 years):** 40 mg orally once daily for up to 8 weeks. * **GERD symptoms (5 to 11 years):** 20 mg to 40 mg orally once daily for up to 8 weeks. (Dose depends on severity and patient weight). * Dosing in children younger than 5 years is not established. ## Dose Adjustments No dose adjustment is typically required for renal impairment. Caution may be advised in severe hepatic impairment. ## Contraindications Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use of PPIs may be associated with an increased risk of bone fractures, Clostridium difficile infection, hypomagnesemia, and vitamin B12 deficiency. ## Key Drug Interactions * **Drugs dependent on gastric pH for absorption:** Pantoprazole can decrease absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors. * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19; caution with drugs like clopidogrel. ## Monitoring * Monitor for efficacy (symptom relief). * Monitor electrolytes (magnesium, calcium) with long-term therapy. * Consider vitamin B12 levels with prolonged use. ## Clinical Pearls * Administer oral pantoprazole 30 minutes before a meal. * For IV administration, reconstitute and infuse over 2 minutes. * Long-term use should be regularly reassessed for ongoing need. *** *Please verify current prescribing information with the manufacturer's package insert or a reliable drug compendium before making any clinical decisions.*