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# Pantoprazole ## Overview Pantoprazole is a proton pump inhibitor (PPI) that decreases the amount of acid produced in the stomach. ## Primary Indications * Healing of erosive esophagitis associated with gastroesophageal reflux disease (GERD). * Maintenance of healing of erosive esophagitis. * Treatment of pathological hypersecretory conditions, such as 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. May consider 20 mg orally once daily for maintenance. * **Pathological Hypersecretory Conditions:** Starting dose is typically 40 mg orally or intravenously twice daily. Doses may be increased as clinically indicated. Usual doses range from 40 mg to 240 mg daily. Doses greater than 160 mg daily should be divided and given every 12 hours. * **IV Maximum:** 40 mg per dose. ## Pediatric Dosing * **Erosive Esophagitis (12 to 17 years):** 40 mg orally once daily for up to 4 weeks. * **GERD (5 to 11 years):** 20 mg orally once daily for up to 8 weeks. * **GERD (12 to 17 years):** 40 mg orally once daily for up to 8 weeks. * **Pathological Hypersecretory Conditions (12 to 17 years):** 40 mg orally or intravenously once daily. Doses may be increased as clinically indicated. ## Dose Adjustments No dose adjustment is typically necessary for patients with hepatic or renal impairment. ## Contraindications Known hypersensitivity to pantoprazole, any component of the formulation, or any substituted benzimidazole. ## Adverse Effects Common: Headache, diarrhea, nausea, abdominal pain, vomiting, dizziness, flatulence. Serious: Clostridium difficile-associated diarrhea, bone fracture (hip, wrist, spine), lupus erythematosus, vitamin B12 deficiency, hypomagnesemia. ## Key Drug Interactions * **Antiretrovirals:** May decrease absorption of drugs like atazanavir and nelfinavir. * **Methotrexate:** PPIs may increase levels of methotrexate. * **CYP2C19 Substrates:** May affect metabolism of drugs like clopidogrel. * **Iron Salts:** May decrease absorption. ## Monitoring * Monitor for signs and symptoms of hypomagnesemia (e.g., muscle cramps, seizures, tremors). * Monitor for bone fracture risk with long-term use. * Consider vitamin B12 levels with prolonged therapy. ## Clinical Pearls * Administer pantoprazole oral suspension at least 30 minutes before a meal. * Do not crush or chew delayed-release tablets. * IV administration should be over 15 minutes or 2-5 minutes for infusion. * Long-term use of PPIs may be associated with increased risk of fracture, C. difficile infection, and vitamin B12 deficiency. *** *Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always verify current prescribing information with the manufacturer's product insert or other reliable resources.*