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# Pantoprazole
## Overview
Pantoprazole is a proton pump inhibitor (PPI) that decreases gastric acid production.
## Primary Indications
* Erosive esophagitis (healing and maintenance)
* Symptomatic gastroesophageal reflux disease (GERD)
* Duodenal ulcers
* Gastric ulcers
* *Helicobacter pylori* eradication (in combination with antibiotics)
* Zollinger-Ellison syndrome
## Adult Dosing
* **Erosive esophagitis:** 40 mg orally or IV once daily for up to 8 weeks. Maintenance therapy: 20-40 mg once daily.
* **Symptomatic GERD:** 40 mg orally once daily for up to 4 weeks. If symptoms do not improve, consider retreatment.
* **Duodenal ulcers:** 40 mg orally once daily for 2 to 4 weeks.
* **Gastric ulcers:** 40 mg orally once daily for 4 to 8 weeks.
* ***H. pylori* eradication:** 40 mg orally twice daily for 7-14 days with amoxicillin and clarithromycin, or lansoprazole regimen.
* **Zollinger-Ellison syndrome:** 40 mg orally or IV twice daily. Doses may be increased to 80 mg IV or orally twice daily. Usual maximum daily dose is 160 mg.
## Pediatric Dosing
* **Erosive esophagitis (ages 5-16 years):** 20-40 mg orally once daily for up to 8 weeks.
* **Symptomatic GERD (ages 5-16 years):** 40 mg orally once daily for up to 4 weeks.
* **Note:** Dosing for other indications in pediatric populations is not well established.
## Dose Adjustments
No dose adjustment is typically needed for hepatic or renal impairment.
## Contraindications
Hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence.
Long-term use may be associated with:
* Increased risk of *Clostridium difficile*-associated diarrhea
* Bone fractures (hip, wrist, spine)
* Hypomagnesemia
* Vitamin B12 deficiency
* Kidney disease (acute interstitial nephritis)
## Key Drug Interactions
* **Drugs dependent on gastric pH for absorption:** Antifungals (ketoconazole, itraconazole), certain HIV protease inhibitors (atazanavir, nelfinavir), iron supplements. PPIs can decrease absorption.
* **Methotrexate:** PPIs may increase and prolong serum levels of methotrexate.
* **CYP2C19 substrates:** May inhibit CYP2C19, potentially affecting metabolism of drugs like clopidogrel (though clinical significance debated).
## Monitoring
* Monitor for efficacy (symptom relief).
* Monitor for adverse effects, especially with long-term use (e.g., electrolyte imbalances, bone health).
* Monitor magnesium levels in patients receiving long-term therapy or concomitant diuretic/digoxin use.
## Clinical Pearls
* Administer oral pantoprazole 30-60 minutes before a meal.
* IV formulation is available for patients unable to take oral medication.
* Consider the risks and benefits of long-term PPI use due to potential adverse effects.
**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information and guidelines before making clinical decisions.
