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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion.
## Primary Indications
* Erosive esophagitis associated with GERD
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* Treatment of duodenal ulcers
* Maintenance of healing of erosive esophagitis
* *Helicobacter pylori* eradication (in combination with antibiotics)
## Adult Dosing
* **Erosive esophagitis, GERD:** 40 mg orally once daily. May be increased to 80 mg orally once daily for severe cases.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally twice daily. Dose adjusted based on gastric acid output. Maximum dose is 80 mg orally twice daily.
* **Duodenal ulcers:** 40 mg orally once daily.
* **Maintenance of healing:** 40 mg orally once daily.
* ***H. pylori* eradication:** 40 mg orally twice daily for 7-14 days in combination with clarithromycin and amoxicillin or clarithromycin and metronidazole.
## Pediatric Dosing
Dosing varies significantly by indication and age/weight. Consult specific pediatric guidelines.
* **GERD (patients 5 to 16 years):** 20 mg to 40 mg orally once daily.
## Dose Adjustments
No specific dose adjustment is necessary for renal impairment.
For hepatic impairment, reduce the daily dose to 20 mg once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* Common: Headache, diarrhea, nausea, abdominal pain, dizziness.
* Long-term use may be associated with an increased risk of *Clostridium difficile*-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** PPIs can decrease absorption of drugs like ketoconazole, itraconazole, and certain HIV protease inhibitors (e.g., atazanavir, nelfinavir).
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19, potentially increasing plasma concentrations of drugs metabolized by this enzyme (e.g., clopidogrel).
## Monitoring
* Monitor for signs and symptoms of *Clostridium difficile*-associated diarrhea.
* Monitor serum magnesium levels periodically, especially with prolonged use (>1 year) or concurrent use of diuretics or digoxin.
* Monitor for signs of bone fracture.
* Assess for vitamin B12 deficiency symptoms.
## Clinical Pearls
* Administer oral pantoprazole 30-60 minutes before a meal.
* For IV administration, reconstitute and further dilute per manufacturer instructions.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to verify dosage and safety information.*
