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## Overview
Pantoprazole is a proton pump inhibitor (PPI) that reduces the amount of acid produced in the stomach.
## Primary Indications
* Gastroesophageal reflux disease (GERD) - symptomatic and erosive esophagitis
* Healing of duodenal ulcers
* Maintenance of healing of erosive esophagitis and duodenal ulcers
* Pathological hypersecretory conditions, including Zollinger-Ellison syndrome
## Adult Dosing
* **GERD (symptomatic):** 20 mg orally once daily.
* **Erosive esophagitis healing:** 40 mg orally once daily for up to 8 weeks.
* **Maintenance of healing of erosive esophagitis:** 40 mg orally once daily.
* **Healing of duodenal ulcers:** 40 mg orally once daily for 4 weeks.
* **Zollinger-Ellison syndrome:** Starting dose is typically 40 mg orally twice daily. Doses may be adjusted based on gastric acid output. Doses up to 240 mg daily have been administered.
## Pediatric Dosing
Dosing in pediatric patients is highly variable and depends on age and indication. Consult specific pediatric guidelines or drug information resources for detailed pediatric dosing.
* **GERD (ages 5-16 years):** 20 mg orally once daily.
* **Erosive esophagitis healing (ages 5-16 years):** 40 mg orally once daily for up to 8 weeks.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, although caution may be advised in severe hepatic impairment.
## Contraindications
* Known hypersensitivity to pantoprazole or any component of the formulation.
* Use of rilpivirine-containing products.
## Adverse Effects
Common: Headache, diarrhea, nausea, abdominal pain, dizziness, flatulence.
Less common: Rash, itching, fatigue, muscle pain, joint pain.
Long-term use: Increased risk of bone fractures (hip, wrist, spine), Clostridium difficile-associated diarrhea, vitamin B12 deficiency, and hypomagnesemia.
## Key Drug Interactions
* **Rilpivirine:** Pantoprazole decreases rilpivirine concentrations, potentially leading to loss of virologic response and resistance. Avoid coadministration.
* **Methotrexate:** PPIs may increase methotrexate levels, potentially leading to methotrexate toxicity. Consider temporarily discontinuing pantoprazole if high-dose methotrexate is administered.
* **Drugs dependent on gastric pH for absorption:** Antiretrovirals (e.g., atazanavir, nelfinavir), certain antifungals (e.g., ketoconazole, itraconazole), and iron salts may have reduced absorption. Separate administration or consider alternatives.
* **CYP2C19 substrates:** Pantoprazole can inhibit CYP2C19, potentially increasing concentrations of drugs metabolized by this enzyme (e.g., clopidogrel, citalopram, sertraline).
## Monitoring
* Monitor for signs and symptoms of C. difficile infection.
* Monitor serum magnesium levels, especially in patients receiving long-term therapy or concomitant medications known to lower magnesium.
* Consider monitoring for vitamin B12 deficiency in patients with prolonged treatment duration.
* Monitor bone mineral density in patients at risk for osteoporosis.
## Clinical Pearls
* Administer pantoprazole orally 30-60 minutes before a meal for optimal efficacy.
* Do not crush or chew delayed-release tablets or capsules.
* If a dose is missed, take it as soon as remembered; however, if it is close to the time of the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double doses.
* Long-term use should be justified by ongoing need and periodically re-evaluated.
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This information is intended for healthcare professionals. Always verify current prescribing information with the official product labeling or a reliable drug information resource before making clinical decisions.
