Please check your internet connection and try again.
# 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.
* Pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
* Part of a treatment regimen for *Helicobacter pylori* eradication.
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily. Some patients may be treated with 20 mg orally once daily.
* **Pathological hypersecretory conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased to 240 mg per day (divided into two doses).
* ***H. pylori* eradication:** 40 mg orally twice daily for 7 to 14 days in combination with antibiotics (e.g., amoxicillin and clarithromycin, or clarithromycin and metronidazole).
## Pediatric Dosing
* **Erosive esophagitis (ages 5-16 years):** 40 mg orally once daily for up to 8 weeks.
* **GERD symptoms (ages 5-16 years):** 20 mg orally once daily for up to 8 weeks.
* *Dosing for children under 5 years is not established.*
## Dose Adjustments
* **Hepatic Impairment:** Maximum dose is 40 mg orally once daily.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
* Common: Diarrhea, headache, nausea, abdominal pain, dizziness, flatulence.
* Long-term use (greater than 1 year) is associated with an increased risk of:
* Fractures (hip, wrist, spine)
* Clostridium difficile infection
* Vitamin B12 deficiency
* Hypomagnesemia
## Key Drug Interactions
* **Drugs requiring gastric acid for absorption:** Antiretrovirals (e.g., rilpivirine), antifungals (e.g., ketoconazole, itraconazole). Pantoprazole can decrease absorption.
* **Methotrexate:** PPIs may increase methotrexate levels.
* **CYP2C19 Substrates:** Pantoprazole may affect metabolism of drugs like clopidogrel.
## Monitoring
* Monitor for signs and symptoms of *C. difficile* infection.
* Consider monitoring magnesium levels, especially with prolonged use or concurrent diuretic use.
* Assess for bone fracture risk with long-term therapy.
* Monitor for signs of vitamin B12 deficiency.
## Clinical Pearls
* Administer oral pantoprazole 30 minutes before a meal.
* Intravenous pantoprazole should be administered as an infusion over 2 to 5 minutes or as a continuous infusion.
* Do not crush or chew delayed-release tablets.
***
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete drug information, including indications, contraindications, warnings, precautions, adverse reactions, and drug interactions, before making any clinical decisions. Local protocols may dictate specific dosing regimens.
