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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.
* Treatment of pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome).
## Adult Dosing
* **Healing of erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses can be increased as clinically indicated. Doses up to 240 mg intravenously daily have been administered.
## Pediatric Dosing
* **GERD (erosive esophagitis):**
* **12 years and older:** 40 mg orally once daily for up to 8 weeks.
* **GERD (symptomatic):**
* **5 years to 11 years:** 20 mg orally once daily for up to 8 weeks.
* **12 years and older:** 40 mg orally once daily for up to 8 weeks.
*Note: Dosing in children may vary based on local protocols and specific clinical guidelines.*
## Dose Adjustments
No dose adjustment is generally recommended for patients with hepatic or renal impairment.
## Contraindications
Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** PPIs can decrease absorption of drugs like ketoconazole, itraconazole, iron salts, and vitamin B12.
* **Methotrexate:** Coadministration with PPIs may increase methotrexate levels.
* **CYP2C19 substrates:** Pantoprazole can inhibit CYP2C19, potentially affecting metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for improvement of GERD symptoms.
* Long-term use of PPIs has been associated with an increased risk of C. difficile-associated diarrhea, bone fractures, hypomagnesemia, and vitamin B12 deficiency. Consider the risks and benefits for prolonged therapy.
## Clinical Pearls
* Oral pantoprazole should be taken at least 30 minutes before a meal.
* For IV administration, reconstitute and further dilute as per manufacturer instructions. Administer as a slow infusion.
* Pantoprazole is generally considered less likely to inhibit CYP2C19 compared to omeprazole or esomeprazole, which may be relevant for patients on clopidogrel, though caution is still advised.
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*This information is intended for healthcare professionals. Always verify current prescribing information and local protocols before initiating or adjusting therapy.*
