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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
* Maintenance of healing of erosive esophagitis
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* Adjunct to *H. pylori* eradication
## Adult Dosing
* **Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of Healing:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose 40 mg orally or intravenously twice daily. Doses may be increased as clinically needed. Doses up to 240 mg IV daily have been administered.
* ***H. pylori* Eradication (in combination therapy):** 40 mg orally twice daily for 7-14 days.
## Pediatric Dosing
* **Erosive Esophagitis (12 to 16 years):** 40 mg orally once daily for up to 8 weeks.
* **Note:** Dosing for children younger than 12 years for erosive esophagitis is not established. Dosing for *H. pylori* eradication in pediatrics is not established.
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose of 40 mg orally once daily.
* **Renal Impairment:** No dose adjustment necessary.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* **Common:** Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence.
* **Serious:** Clostridium difficile-associated diarrhea, bone fracture (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, fundic gland polyps.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, iron salts, nelfinavir. Pantoprazole may decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole may affect metabolism of drugs like clopidogrel (though clinical significance is debated).
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, tremors).
* Consider monitoring magnesium levels in patients on long-term therapy, especially if taking other medications that can lower magnesium.
* Monitor for signs of *C. difficile*-associated diarrhea.
## Clinical Pearls
* Administer pantoprazole oral suspension and delayed-release tablets 30 minutes before a meal.
* IV administration may be given over 15 minutes or as an infusion over 2-15 minutes.
* Long-term PPI use has been associated with an increased risk of fractures, *C. difficile* infection, and vitamin B12 deficiency. Consider the shortest duration of therapy needed to treat the condition.
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*Disclaimer: This information is intended for clinical pharmacists and healthcare professionals. Always consult the most current prescribing information and institutional protocols before initiating or modifying drug therapy. The information provided here is not a substitute for professional medical advice.*
