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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production. ## Primary Indications * Gastroesophageal reflux disease (GERD) - symptomatic relief and healing of erosive esophagitis. * Healing of NSAID-associated gastric ulcers. * H. pylori eradication (in combination with antibiotics). * Zollinger-Ellison syndrome. ## Adult Dosing * **GERD/Erosive Esophagitis:** 40 mg orally or IV once daily for up to 8 weeks. Maintenance therapy may be 20 mg once daily. * **Healing Gastric Ulcers:** 40 mg orally or IV once daily for 4 to 8 weeks. * **H. pylori Eradication:** 40 mg orally twice daily for 7 to 14 days in combination with specific antibiotics. * **Zollinger-Ellison Syndrome:** Starting dose 40 mg orally or IV twice daily; titrate as needed. Maximum daily dose is 240 mg. ## Pediatric Dosing * **GERD (1 month to 16 years):** * **Oral:** 1.25 mg/kg/day once daily, not to exceed 40 mg/day. * **IV:** 1 mg/kg/day once daily, not to exceed 40 mg/day. * *Note: Dosing for neonates and infants less than 1 month is not established.* ## Dose Adjustments * **Hepatic Impairment:** Maximum oral dose is 20 mg once daily. IV dosing not recommended. * **Renal Impairment:** No dosage adjustment necessary. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. ## Adverse Effects * **Common:** Diarrhea, headache, dizziness, nausea, abdominal pain, flatulence. * **Serious:** * Long-term use is associated with increased risk of bone fractures (hip, wrist, spine), C. difficile infection, vitamin B12 deficiency, and hypomagnesemia. * Acute interstitial nephritis. * Fundic gland polyps. ## Key Drug Interactions * **Clopidogrel:** Pantoprazole may decrease the efficacy of clopidogrel due to CYP2C19 inhibition. Avoid concurrent use if possible or monitor for thrombotic events. * **Methotrexate:** PPIs may increase methotrexate levels. Consider temporary PPI discontinuation if high-dose methotrexate is used. * **Drugs dependent on gastric pH for absorption:** May alter absorption of ketoconazole, itraconazole, posaconazole, iron salts, and certain antiretrovirals (e.g., rilpivirine, atazanavir). ## Monitoring * Monitor for clinical improvement of symptoms. * Assess for signs and symptoms of C. difficile infection. * Monitor magnesium levels with prolonged therapy, especially in patients taking diuretics or digoxin. * Consider bone mineral density screening in patients at risk for osteoporosis with long-term therapy. * Monitor for signs of vitamin B12 deficiency with prolonged therapy. ## Clinical Pearls * Administer oral pantoprazole 30 minutes before a meal. * IV administration: Reconstitute with 5 mL of 0.9% Sodium Chloride Injection, USP. Further dilute in 100 mL of 0.9% Sodium Chloride Injection, USP, or 5% Dextrose Injection, USP. Infuse over 15 minutes. * Do not crush or chew delayed-release tablets. * If symptoms persist or recur after completing treatment, further evaluation is recommended. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.