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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
* Zollinger-Ellison syndrome
* Healing of duodenal ulcers
* H. pylori eradication (in combination regimens)
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or intravenously once daily. For severe erosive esophagitis, 40 mg twice daily may be used. Duration of treatment varies based on indication.
* **Zollinger-Ellison Syndrome:** Starting dose 40 mg orally or intravenously twice daily. Doses may be increased to 240 mg daily.
* **H. pylori Eradication:** 40 mg orally twice daily for 7-14 days, in combination with antibiotics (e.g., amoxicillin and clarithromycin or metronidazole and clarithromycin).
## Pediatric Dosing
* **GERD/Erosive Esophagitis:**
* **12 to 17 years:** 40 mg orally once daily.
* **5 to 11 years:** 20 mg orally once daily.
* **1 to 4 years:** 20 mg orally once daily. (Data limited, use based on clinical judgment).
* **< 1 year:** Dosing is not well established and should be individualized based on clinical response and tolerability.
## Dose Adjustments
* **Hepatic Impairment:** Maximum daily dose of 40 mg orally once daily. No dose adjustment needed for IV route.
* **Renal Impairment:** No dose adjustment necessary.
## Contraindications
* Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, vomiting, flatulence, dizziness.
Serious: Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, lupus erythematosus (cutaneous and systemic).
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, posaconazole, iron salts, mycophenolate mofetil. May decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels. Monitor for methotrexate toxicity.
* **CYP2C19 substrates:** May affect metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremor, tetany, seizures, arrhythmias).
* Monitor for potential bone fractures, especially with long-term use.
* Assess for C. difficile-associated diarrhea.
## Clinical Pearls
* Administer oral pantoprazole 30-60 minutes before a meal.
* IV infusion should be administered over 15 minutes.
* Long-term use of PPIs may increase the risk of certain adverse events; use the lowest effective dose for the shortest duration necessary.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your specific condition and to review the most current prescribing information.*
