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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production.
## Primary Indications
* Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD).
* Maintenance of healing of erosive esophagitis.
* Reduction of risk of NSAID-associated gastric ulcers in patients at risk.
* Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally once daily for up to 8 weeks. For maintenance, 40 mg orally once daily.
* **NSAID-associated ulcers:** 40 mg orally once daily.
* **Hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily, with subsequent doses adjusted based on gastric acid output. Doses can range from 40 mg to 120 mg daily (divided into two doses if >80 mg/day).
## Pediatric Dosing
* **Erosive esophagitis (ages 5 to 16 years):** 40 mg orally once daily for up to 4 weeks.
* **GERD symptom treatment (ages 5 to 16 years):** 20 mg orally once daily for up to 4 weeks.
* **Note:** Dosing for children under 5 years of age is not established.
## Dose Adjustments
* **Hepatic impairment:** A maximum daily dose of 40 mg is recommended for patients with severe hepatic impairment.
* **Renal impairment:** No dose adjustment is typically required.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, flatulence, dizziness.
Long-term use (over 1 year) may be associated with:
* Increased risk of *Clostridium difficile*-associated diarrhea.
* Increased risk of bone fracture (hip, wrist, spine).
* Hypomagnesemia.
* Vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** PPIs can decrease absorption of drugs such as ketoconazole, itraconazole, posaconazole, iron salts, and vitamin B12.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 substrates/inhibitors:** Pantoprazole is a moderate inhibitor of CYP2C19. Monitor for potential interactions with drugs metabolized by this enzyme (e.g., clopidogrel - though clinical significance is debated, cilostazol).
## Monitoring
* Assess for symptom relief.
* Monitor electrolytes (magnesium, calcium) with long-term therapy.
* Consider monitoring vitamin B12 levels with prolonged use.
## Clinical Pearls
* Administer 30 minutes to 1 hour before a meal.
* If using delayed-release tablets, swallow whole; do not chew or crush.
* If using pantoprazole for injection, follow specific reconstitution and administration guidelines.
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*This information is intended for healthcare professionals. Always verify current prescribing information and local protocols before making clinical decisions.*
