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.
## Adult Dosing
* **Healing of Erosive Esophagitis:** 40 mg orally once daily for up to 8 weeks. A further 8 weeks may be given if needed.
* **Maintenance of Healing of Erosive Esophagitis:** 40 mg orally once daily.
* **Pathological Hypersecretory Conditions:** Starting dose is typically 40 mg orally twice daily. Doses may be increased as clinically indicated. Doses greater than 40 mg twice daily should be administered with caution. The maximum recommended dose is 240 mg daily.
* **Intravenous (IV):** 40 mg IV once daily for the same indications as oral therapy.
## Pediatric Dosing
* **GERD (erosive esophagitis):**
* **5 years to 16 years:** 40 mg orally once daily for up to 8 weeks.
* **<5 years:** Dosing is not well established. Consider risks and benefits.
## Dose Adjustments
* **Hepatic Impairment:** No dose adjustment is typically needed for oral pantoprazole. However, for IV administration, a dose of 20 mg once daily is recommended for patients with severe hepatic impairment.
* **Renal Impairment:** No dose adjustment is typically needed.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of its formulation, or to other substituted benzimidazoles.
## Adverse Effects
Common: Diarrhea, headache, nausea, abdominal pain, flatulence, dizziness.
Less Common: Liver enzyme elevations, rash, pruritus.
Long-term use of PPIs, including pantoprazole, may be associated with an increased risk of:
* Fractures (hip, wrist, spine)
* Clostridium difficile infection
* Vitamin B12 deficiency
* Hypomagnesemia
## Key Drug Interactions
* **Drugs Dependent on Gastric pH for Absorption:** May decrease absorption of drugs like ketoconazole, itraconazole, posaconazole, iron salts, ampicillin esters, and erlotinib.
* **Methotrexate:** PPIs may increase methotrexate levels. Consider withholding pantoprazole during methotrexate administration.
* **CYP2C19 Substrates:** Pantoprazole is a moderate inhibitor of CYP2C19. It can increase the exposure of drugs metabolized by this enzyme (e.g., clopidogrel, voriconazole).
* **Warfarin:** Increased INR and bruising with concurrent use. Monitor INR closely.
## Monitoring
* Monitor for signs and symptoms of C. difficile infection.
* Monitor magnesium levels periodically, especially with prolonged use.
* Monitor for signs of fracture.
* Monitor for efficacy in reducing acid-related symptoms.
## Clinical Pearls
* Pantoprazole is available in oral and IV formulations.
* Oral pantoprazole should be taken at least 1 hour before a meal. Delayed-release tablets should be swallowed whole and not crushed or chewed.
* Consider the risks associated with long-term PPI use.
* When treating erosive esophagitis, healing may not occur in all patients by 8 weeks.
---
This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details and to confirm applicability to your patient's specific situation.
