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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion. ## Primary Indications * Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD). * Maintenance of healing of erosive esophagitis. * Pathological hypersecretory conditions, including 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. May be continued as needed. * **Pathological hypersecretory conditions:** 40 mg orally or intravenously twice daily. Doses may be increased to 80 mg intravenously or orally every 8 hours as needed. ## Pediatric Dosing * **Gastroesophageal reflux disease (GERD):** * 1 year and older: 15 mg orally once daily for erosive esophagitis; 10 mg orally once daily for symptoms of GERD. * Doses can be increased to 40 mg once daily if needed. ## Dose Adjustments No dose adjustment is typically required for hepatic or renal impairment. ## Contraindications Hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation. ## Adverse Effects Common: Headache, diarrhea, nausea, abdominal pain, vomiting, flatulence, dizziness. Long-term use may be associated with increased risk of *Clostridium difficile*-associated diarrhea, bone fractures, hypomagnesemia, vitamin B12 deficiency, and nephritis. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** Antiretrovirals (e.g., rilpivirine, atazanavir), antifungals (e.g., ketoconazole, itraconazole), certain tyrosine kinase inhibitors (e.g., erlotinib, gefitinib). Absorption may be decreased. * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. May affect metabolism of drugs like clopidogrel, citalopram, escitalopram, diazepam, and phenytoin. ## Monitoring * Monitor for signs and symptoms of *Clostridium difficile* infection. * Monitor magnesium levels, especially with prolonged use or concomitant use of diuretics or digoxin. * Monitor for signs of bone fracture. * Monitor for vitamin B12 deficiency. ## Clinical Pearls * Administer 30 minutes before a meal. * For IV administration, reconstitute with 5 mL of 0.9% sodium chloride injection, then further dilute in 50 mL or 100 mL of 0.9% sodium chloride, 5% dextrose, or lactated Ringer's injection. * Intermittent intravenous infusion over 15 minutes. * Consider transitioning to oral therapy when clinically appropriate. * Long-term PPI use should be reserved for patients with a clear indication. *** **Disclaimer:** This information is intended for healthcare professionals and does not replace a thorough review of the official prescribing information or local institutional protocols. Always verify current prescribing information before making clinical decisions.