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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases gastric acid production.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome).
## Adult Dosing
* **Erosive esophagitis healing:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses can be increased as needed. The maximum recommended dose is 120 mg intravenously every 8 hours or 240 mg intravenously once daily.
## Pediatric Dosing
* **Erosive esophagitis (1 to 5 years):** 10 mg orally once daily for up to 8 weeks.
* **Erosive esophagitis (5 to 16 years):** 20 mg orally once daily for up to 8 weeks.
* **GERD (1 month to 5 years):** 10 mg orally once daily.
* **GERD (5 to 16 years):** 20 mg orally once daily.
* **Note:** Dosing in children is weight-based and depends on the specific indication. Consult specific pediatric guidelines for precise dosing and weight considerations. Intravenous formulations are not typically recommended in children younger than 5 years.
## Dose Adjustments
No dose adjustment is generally required for hepatic or renal impairment.
## Contraindications
Known hypersensitivity to pantoprazole or any of its components, or to other substituted benzimidazoles.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness.
Less Common: Arthralgia, fatigue, rash, myalgia.
## Key Drug Interactions
* **Clopidogrel:** Pantoprazole may decrease the antiplatelet effect of clopidogrel. Consider alternative PPIs or avoid concurrent use if possible.
* **Methotrexate:** PPIs can increase methotrexate levels, potentially leading to toxicity. Monitor closely and consider dose reduction or temporary discontinuation.
* **Drugs dependent on gastric pH for absorption:** Pantoprazole can alter gastric pH, affecting the absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors.
## Monitoring
* Monitor for signs and symptoms of *Clostridium difficile*-associated diarrhea.
* Long-term use of PPIs is associated with an increased risk of fractures (hip, wrist, spine), *Clostridium difficile* infection, and vitamin B12 deficiency. Consider the lowest effective dose for the shortest duration necessary.
* Monitor electrolytes (magnesium, sodium, potassium) in patients on long-term therapy, especially those taking concomitant diuretics.
## Clinical Pearls
* For optimal absorption, pantoprazole delayed-release tablets should be taken at least 1 hour before a meal.
* Pantoprazole formulations should not be crushed or chewed.
* IV pantoprazole should be administered over at least 2 minutes.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any therapeutic decisions.*
