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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 healing and maintenance * Zollinger-Ellison syndrome * H. pylori eradication (in combination regimens) ## Adult Dosing * **GERD/Erosive Esophagitis:** 20 mg to 40 mg once daily orally or intravenously. * **Zollinger-Ellison Syndrome:** Starting dose 40 mg twice daily orally or intravenously; titrate as needed. Maximum daily dose is 240 mg (divided every 8 hours). * **H. pylori Eradication:** 40 mg twice daily orally for 7 to 10 days, in combination with antibiotics. ## Pediatric Dosing * **GERD/Erosive Esophagitis:** * **1 to 5 years:** 10 mg once daily orally. * **5 to 12 years:** 20 mg once daily orally. * **12 to 17 years:** 40 mg once daily orally. Dosing for pediatric H. pylori eradication or Zollinger-Ellison syndrome is not established. ## Dose Adjustments No dose adjustment is typically needed for renal or hepatic impairment, though caution is advised in severe hepatic dysfunction. ## Contraindications * Known hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation. ## Adverse Effects * Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness. * Serious: Clostridium difficile-associated diarrhea, bone fractures (hip, wrist, spine) with long-term use, hypomagnesemia, vitamin B12 deficiency, potential for systemic lupus erythematosus. ## Key Drug Interactions * Drugs dependent on gastric pH for absorption: ketoconazole, itraconazole, posaconazole, iron salts, vitamin B12. * Methotrexate: PPIs may increase methotrexate levels. * CYP2C19 substrates/inhibitors: May affect metabolism of drugs like clopidogrel. ## Monitoring * Monitor for signs and symptoms of C. difficile infection. * Consider serum magnesium levels periodically, especially with prolonged use (>1 year) or concurrent diuretic use. * Monitor for signs of fracture risk if applicable. ## Clinical Pearls * Administer oral pantoprazole at least 30 minutes before a meal. * Intravenous administration requires reconstitution and further dilution. * Long-term use of PPIs is associated with increased risk of adverse events. Use the lowest effective dose for the shortest duration necessary. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before initiating or modifying therapy.*