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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion.
## Primary Indications
* Erosive esophagitis associated with gastroesophageal reflux disease (GERD)
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* Maintenance of healing of erosive esophagitis
* Treatment of duodenal ulcers, gastric ulcers, and GERD symptoms
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily.
* **GERD symptoms:** 20 mg to 40 mg orally once daily.
* **Pathological hypersecretory conditions:** 40 mg orally or intravenously once daily, may be increased to a maximum of 240 mg intravenously or 400 mg orally per day divided into two doses.
## Pediatric Dosing
* **Erosive esophagitis (12 to 17 years):** 40 mg orally once daily for up to 8 weeks.
* **GERD symptoms (5 to 17 years):** 20 mg orally once daily for up to 8 weeks.
* Dosing for children under 5 years for GERD or erosive esophagitis is not well-established.
## Dose Adjustments
No dose adjustment is generally required for hepatic or renal impairment, though caution may be advised in severe hepatic impairment.
## Contraindications
Hypersensitivity to pantoprazole, its components, or other benzimidazoles.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use may be associated with an increased risk of bone fractures (hip, wrist, spine), Clostridium difficile infection, hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Pantoprazole can decrease absorption of drugs like ketoconazole, itraconazole, and certain antiretrovirals (e.g., rilpivirine, atazanavir).
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 Substrates:** May affect metabolism of drugs like clopidogrel (reduced efficacy) and warfarin (increased INR).
## Monitoring
* Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, arrhythmias), especially with prolonged use.
* Monitor for signs of C. difficile-associated diarrhea.
* Consider vitamin B12 levels with long-term therapy.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* IV administration is an option when oral route is not feasible.
* Long-term use of PPIs should be for the shortest duration necessary.
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*Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider and refer to the most current prescribing information for definitive guidance.*
