Pantop%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520ds

# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that decreases acid production in the stomach. ## Primary Indications * Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD). * Maintenance of healing of erosive esophagitis. * Reduction of risk of NSAID-induced gastric ulcers in patients at continued risk who are on NSAIDs for the treatment of pain or inflammatory conditions. * Pathological hypersecretory conditions, including Zollinger-Ellison Syndrome (ZES). ## Adult Dosing * **Erosive Esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks. * **Maintenance of Healing:** 40 mg orally once daily. * **NSAID-Induced Gastric Ulcers:** 40 mg orally once daily for up to 8 weeks. * **Zollinger-Ellison Syndrome:** Starting dose is typically 40 mg orally or intravenously once daily. Doses may be increased as needed. Doses exceeding 40 mg twice daily should be administered with caution. The maximum recommended dose is 120 mg intravenously every 8 hours or 240 mg intravenously once daily. ## Pediatric Dosing * **Erosive Esophagitis (12 years and older):** 40 mg orally once daily for up to 8 weeks. * **GERD (5 years and older):** 20 mg to 40 mg orally once daily for up to 8 weeks. * **GERD (less than 5 years):** Dosing varies. For patients aged 1 to less than 5 years, 20 mg orally once daily may be used. Data for children younger than 1 year is limited. Local protocol should be consulted. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment, though caution is advised in severe hepatic impairment. ## Contraindications * Known hypersensitivity to pantoprazole or any component of the formulation. * Use with rilpivirine. ## Adverse Effects Common adverse effects include headache, diarrhea, nausea, abdominal pain, dizziness, and flatulence. Long-term use may be associated with an increased risk of bone fractures (hip, wrist, spine), Clostridium difficile-associated diarrhea, vitamin B12 deficiency, and hypomagnesemia. ## Key Drug Interactions * **Rilpivirine:** Pantoprazole decreases rilpivirine plasma concentrations, potentially leading to loss of virologic response and possible resistance. * **Warfarin:** Increased INR and/or bruising. Monitor INR closely. * **Methotrexate:** PPIs may increase methotrexate levels. Consider PPI interruption temporarily in patients receiving high-dose methotrexate. * **Drugs dependent on gastric pH for absorption:** Absorption may be affected (e.g., ketoconazole, itraconazole, posaconazole, iron salts, vitamin B12). ## Monitoring * Monitor for signs and symptoms of hypomagnesemia (e.g., tremors, muscle cramps, seizures, arrhythmias). * Monitor for signs of C. difficile infection. * Monitor bone mineral density with long-term use. * Monitor INR if co-administered with warfarin. ## Clinical Pearls * Pantoprazole is available in oral and intravenous formulations. * Oral pantoprazole is generally taken 30-60 minutes before a meal. * IV infusion should be over 15 minutes or longer. * The risk of long-term adverse effects increases with duration of therapy. Consider the lowest effective dose for the shortest duration necessary. *** *This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant literature before making any treatment decisions.*