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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Erosive esophagitis
* Healing of duodenal ulcers
* Zollinger-Ellison syndrome
## Adult Dosing
* **GERD/Erosive Esophagitis:** 20 mg to 40 mg once daily. For severe cases or healing of erosive esophagitis, 40 mg once daily may be used.
* **Duodenal Ulcer Healing:** 40 mg once daily for up to 4 weeks.
* **Zollinger-Ellison Syndrome:** Initial dose is typically 40 mg twice daily, but can be titrated up to 240 mg per day in divided doses.
## Pediatric Dosing
* **GERD (1 month to 5 years):** 1 mg/kg to 2.5 mg/kg once daily. Maximum dose is 20 mg daily.
* **GERD (5 years to 16 years):** 20 mg to 40 mg once daily.
## Dose Adjustments
No specific dose adjustment is typically required for hepatic impairment, though caution may be advised. No dose adjustment is necessary for renal impairment.
## Contraindications
* Known hypersensitivity to pantoprazole, substituted benzimidazoles, or any component of the formulation.
## Adverse Effects
Common adverse effects include headache, diarrhea, nausea, abdominal pain, and dizziness. Long-term use may be associated with an increased risk of *Clostridioides difficile* infection, bone fractures (hip, wrist, spine), hypomagnesemia, and vitamin B12 deficiency.
## Key Drug Interactions
* **Warfarin:** May increase INR and prothrombin time. Monitor INR closely.
* **Methotrexate:** PPIs may increase methotrexate levels. Consider interruption of pantoprazole if high-dose methotrexate is used.
* **Drugs dependent on gastric pH for absorption:** Absorption may be decreased (e.g., ketoconazole, itraconazole, certain HIV medications like ritonavir).
## Monitoring
* Monitor for signs and symptoms of *C. difficile* infection.
* Monitor serum magnesium levels, especially with prolonged use (typically > 1 year) or concurrent use of other drugs that may cause hypomagnesemia (e.g., diuretics).
* Consider monitoring vitamin B12 levels with prolonged therapy.
## Clinical Pearls
* Administer pantoprazole oral suspension or delayed-release tablets 30 minutes before a meal.
* For IV administration, reconstitute and infuse according to manufacturer instructions.
* Consider the potential for bone fracture risk with prolonged use, especially in older adults or those with other risk factors.
* Hypomagnesemia can be asymptomatic or present with symptoms such as tremors, tetany, seizures, and arrhythmias.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and consider individual patient factors before making clinical decisions.*
