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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production.
## Primary Indications
* Gastroesophageal reflux disease (GERD)
* Healing of erosive esophagitis
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
* Duodenal ulcers
* Gastric ulcers
## Adult Dosing
* **GERD/Erosive Esophagitis:** 40 mg orally or intravenously once daily for 4-8 weeks. A maintenance dose of 20-40 mg once daily may be used.
* **Pathological Hypersecretory Conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased as needed. Doses greater than 240 mg daily require divided doses.
* **Duodenal/Gastric Ulcers:** 40 mg orally or intravenously once daily for 4 weeks. For healing resistant ulcers, treatment may be extended.
## Pediatric Dosing
Dosing in pediatric patients is less established and should be individualized based on clinical judgment and available evidence.
* **GERD (Erosive Esophagitis):**
* Ages 5 to 11 years: 20 mg orally once daily for up to 8 weeks.
* Ages 12 to 15 years: 40 mg orally once daily for up to 8 weeks.
* Adolescents (16 years and older): Dosing as per adult guidelines.
* **Note:** Intravenous formulations are generally not recommended for pediatric patients unless oral administration is not feasible.
## Dose Adjustments
* **Hepatic Impairment:** Reduce the daily dose of pantoprazole to 20 mg orally once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or other substituted benzimidazoles.
## Adverse Effects
* **Common:** Diarrhea, headache, abdominal pain, nausea, dizziness.
* **Long-term use concerns:** Increased risk of bone fractures (hip, wrist, spine), Clostridium difficile infection, hypomagnesemia, vitamin B12 deficiency, and possibly kidney disease.
## Key Drug Interactions
* **Drugs Affected by Gastric pH:** May alter absorption of drugs requiring acidic gastric pH (e.g., ketoconazole, itraconazole, some HIV protease inhibitors, iron salts).
* **Methotrexate:** PPIs may increase methotrexate levels, especially at high doses.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. Monitor for increased concentrations of drugs metabolized by this enzyme (e.g., clopidogrel, voriconazole).
## Monitoring
* Electrolytes (especially magnesium), particularly with long-term therapy or concomitant diuretic use.
* Bone mineral density if risk factors are present.
* Renal function.
## Clinical Pearls
* Administer oral pantoprazole at least 30 minutes before a meal.
* IV pantoprazole is often given as a continuous infusion for hypersecretory states, but intermittent dosing is also common.
* Long-term PPI use should be periodically reassessed for continued need.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
