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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion.
## Primary Indications
* Erosive esophagitis associated with gastroesophageal reflux disease (GERD)
* Healing of erosive esophagitis
* Maintenance of healing of erosive esophagitis
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **Healing of erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **GERD (symptomatic):** 20 mg orally once daily for up to 4 weeks.
* **Pathological hypersecretory conditions:** Starting dose 40 mg orally or intravenously twice daily. Doses may be adjusted. Doses up to 240 mg IV daily have been administered.
## Pediatric Dosing
* **Erosive esophagitis (age 5 to 15 years):** 40 mg orally once daily for up to 8 weeks.
* **Erosive esophagitis (age 6 months to less than 5 years):** 20 mg orally once daily for up to 8 weeks. Dosing is based on weight:
* 15 kg to < 40 kg: 20 mg once daily.
* ≥ 40 kg: 40 mg once daily.
* **Note:** Safety and efficacy in pediatric patients for other indications have not been established.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose is 40 mg orally once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Diarrhea, headache, dizziness, nausea, abdominal pain, flatulence.
Long-term use: Potential increased risk of *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), vitamin B12 deficiency, hypomagnesemia, and possibly interstitial nephritis.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, iron salts, mycophenolate mofetil. May decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole can inhibit CYP2C19, potentially affecting the metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia, especially with prolonged use (typically > 1 year).
* Monitor for bone fracture risk.
* Consider monitoring vitamin B12 levels with prolonged therapy.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* For intravenous administration, reconstitute and dilute according to manufacturer instructions. Infuse over 15 minutes.
* Do not crush or chew delayed-release tablets.
* Consider switching to oral therapy when clinically appropriate.
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*This information is intended for healthcare professionals. Always refer to the most current prescribing information and institutional protocols for definitive guidance.*
