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 GERD
* Maintenance of healing of erosive esophagitis
* Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome)
## Adult Dosing
* **Healing of erosive esophagitis:** 40 mg orally or intravenously once daily for up to 8 weeks.
* **Maintenance of healing:** 40 mg orally once daily. Doses of 20 mg orally once daily may be adequate for some patients.
* **Pathological hypersecretory conditions:** 40 mg orally or intravenously once daily, may be increased to 80 mg intravenously or orally every 8 hours. Doses greater than 80 mg daily should be administered in divided doses. Maximum dose typically 240 mg daily.
## Pediatric Dosing
* **Erosive esophagitis (ages 5 to 16 years):** 20 mg orally once daily for up to 4 weeks.
* **Erosive esophagitis (ages 16 to 17 years):** 40 mg orally once daily for up to 8 weeks.
* **Note:** Dosing for younger pediatric patients or for other indications in pediatrics is not well-established.
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence.
Serious: _Clostridioides difficile_-associated diarrhea, bone fractures (hip, wrist, spine), hypomagnesemia, vitamin B12 deficiency, lupus erythematosus.
## Key Drug Interactions
* **Antiretrovirals (e.g., nelfinavir, rilpivirine):** May decrease absorption and efficacy.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to toxicity.
* **CYP2C19 substrates (e.g., clopidogrel):** May alter the metabolism of these drugs, though clinical significance is debated.
## Monitoring
* Monitor for signs and symptoms of _C. difficile_-associated diarrhea.
* Consider monitoring serum magnesium levels, especially with prolonged use (≥1 year) or concomitant use of diuretics or digoxin.
* Monitor for bone fracture risk with long-term use.
## Clinical Pearls
* Administer oral pantoprazole at least 30 minutes before a meal.
* Intravenous administration: Reconstitute and dilute as per manufacturer instructions. Infuse over 2 to 5 minutes.
* Long-term use of PPIs is associated with increased risk of certain adverse events; use the lowest effective dose for the shortest duration necessary.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.*
