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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 and maintenance * Zollinger-Ellison syndrome * H. pylori eradication (in combination therapy) ## Adult Dosing * **GERD and Erosive Esophagitis (Healing):** 20 mg or 40 mg orally once daily for up to 8 weeks. * **GERD (Maintenance):** 20 mg orally once daily. * **Zollinger-Ellison Syndrome:** 40 mg orally or IV every 12 hours, may increase up to 240 mg daily. * **H. pylori Eradication:** 40 mg orally twice daily for 7-14 days as part of a triple or quadruple therapy regimen. ## Pediatric Dosing * **GERD (12 to 16 years):** 20 mg or 40 mg orally once daily for up to 8 weeks. * Dosing for younger children is not well-established and typically requires specialist consultation. ## Dose Adjustments * **Hepatic Impairment:** Maximum daily dose of 40 mg orally for severe hepatic impairment. * **Renal Impairment:** No dose adjustment necessary. ## Contraindications * Hypersensitivity to pantoprazole or other PPIs. ## Adverse Effects Common: Headache, diarrhea, nausea, abdominal pain, flatulence. Long-term use may be associated with: Vitamin B12 deficiency, hypomagnesemia, increased risk of fractures (hip, wrist, spine), C. difficile infection. ## Key Drug Interactions * **Drugs requiring gastric acid for absorption:** Ketoconazole, itraconazole, iron salts, mycophenolate mofetil. Pantoprazole can decrease absorption. * **Methotrexate:** PPIs may increase methotrexate levels. * **CYP2C19 substrates:** Clopidogrel (pantoprazole may reduce its effectiveness). ## Monitoring * Electrolytes (magnesium, sodium, potassium) with long-term therapy. * Bone density screening with prolonged use. * Monitor for signs and symptoms of C. difficile infection. ## Clinical Pearls * Administer 30 minutes before a meal. * IV formulation available for patients unable to take oral medication. * Maximum IV dose for Zollinger-Ellison syndrome is 240 mg/day divided into doses. *** *This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to ensure the information provided is appropriate for your specific circumstances. Verify current prescribing information before making any treatment decisions.*