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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases the amount of acid produced in the stomach.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive Esophagitis (Healing):** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Erosive Esophagitis (Maintenance):** 40 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose 40 mg orally or intravenously twice daily. Doses may be increased as needed. Doses up to 240 mg daily have been administered intravenously.
## Pediatric Dosing
* **Erosive Esophagitis (12 to 17 years):** 40 mg orally once daily for up to 8 weeks.
* **Erosive Esophagitis (5 to 11 years):** 20 mg orally once daily for up to 8 weeks. Doses up to 40 mg twice daily can be considered based on clinical response and tolerability.
* **Pathological Hypersecretory Conditions (5 to 17 years):** Dosing is highly individualized and should be determined by a specialist.
## Dose Adjustments
No dose adjustment is generally needed for hepatic or renal impairment in adults.
## Contraindications
Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use of PPIs has been associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** PPIs can alter gastric pH, affecting the absorption of drugs such as ketoconazole, itraconazole, iron salts, and certain antiretrovirals.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Caution is advised when co-administered with substrates where concentration is critical, such as clopidogrel.
## Monitoring
* Monitor for improvement of GERD symptoms.
* Monitor for signs and symptoms of hypomagnesemia (e.g., tremor, muscle spasms, seizures).
* Monitor for signs of bone fracture, especially in patients with osteoporosis risk factors.
* Monitor for signs of vitamin B12 deficiency with prolonged use.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* For IV administration, reconstitute and dilute according to manufacturer instructions.
* Long-term use of PPIs should be re-evaluated regularly.
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*This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information with the manufacturer's product insert or a reliable drug information resource.*
