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Protonix
pantoprazole
Adult Dosing .
Dosage forms: DR TAB: 20 mg, 40 mg; DR GRANULE: 40 mg per packet; INJ: various
GERD
- [non-erosive, symptomatic (off-label)]
- Dose: 40 mg PO qd x4-8wk; Alt: 40 mg IV qd; Info: IV form for short-term tx up to 10 days if unable to take oral regimen; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table
- [erosive esophagitis, short-term tx]
- Dose: 40 mg PO qd x8-16wk; Alt: 40 mg IV qd; Info: IV form for short-term tx up to 10 days if unable to take oral regimen; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table
- [erosive esophagitis, maintenance tx]
- Dose: 40 mg PO qd; Alt: 40 mg IV qd; Info: IV form for short-term tx up to 10 days if unable to take oral regimen; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table
hypersecretory conditions
- [individualize dose PO qd-bid]
- Start: 40 mg PO bid; Alt: 80 mg IV q12h, may incr. dose to 80 mg IV q8h; Info: doses up to 240 mg/day have been used; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table
upper GI bleeding (off-label)
- [8 mg/h IV x72h]
- Start: 80 mg IV x1
H. pylori infection (off-label)
- [40-80 mg PO bid x14 days]
- Info: part of multi-drug regimen, dosing may vary; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table; search 'H. pylori Treatment' for epocrates H. pylori Treatment Regimens decision tool
eosinophilic esophagitis (off-label)
- [80 mg/day PO divided qd-bid x8-12wk, then taper to lowest effective dose]
- Info: do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: DR TAB: 20 mg, 40 mg; DR GRANULE: 40 mg per packet; INJ: various
GERD, erosive esophagitis
- [IV form, 3-11 mo, <12.5 kg]
- Dose: 0.8 mg/kg/dose IV qd; Info: for short-term tx up to 7 days if unable to take oral regimen; consider decr. dose in CYP2C19 poor metabolizers
- [IV form, 3-11 mo, >12.5 kg]
- Dose: 10 mg IV qd; Info: for short-term tx up to 7 days if unable to take oral regimen; consider decr. dose in CYP2C19 poor metabolizers
- [IV form, 1-17 yo, <15 kg]
- Dose: 10 mg IV qd; Info: for short-term tx up to 7 days if unable to take oral regimen; consider decr. dose in CYP2C19 poor metabolizers
- [IV form, 1-17 yo, 15-40 kg]
- Dose: 20 mg IV qd; Info: for short-term tx up to 7 days if unable to take oral regimen; consider decr. dose in CYP2C19 poor metabolizers
- [IV form, 1-17 yo, >40 kg]
- Dose: 40 mg IV qd; Info: for short-term tx up to 7 days if unable to take oral regimen; consider decr. dose in CYP2C19 poor metabolizers
- [PO form, 5 yo and older, 15-39 kg]
- Dose: 20 mg PO qd for up to 8wk; Info: consider decr. dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab
- [PO form, 5 yo and older, >40 kg]
- Dose: 40 mg PO qd for up to 8wk; Info: consider decr. dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table
H. pylori infection (off-label)
- [15-24 kg]
- Dose: 40 mg PO bid x10-14 days; Info: part of multi-drug regimen; consider decr. dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table; search 'H. pylori Treatment' for epocrates H. pylori Treatment Regimens decision tool
- [25-34 kg]
- Dose: 60 mg PO bid x10-14 days; Info: part of multi-drug regimen; consider decr. dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table; search 'H. pylori Treatment' for epocrates H. pylori Treatment Regimens decision tool
- [>35 kg]
- Dose: 80 mg PO bid x10-14 days; Info: part of multi-drug regimen; consider decr. dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab or granules; give granules 30min before meals; see PPI Administration Alternatives table; search 'H. pylori Treatment' for epocrates H. pylori Treatment Regimens decision tool
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: hypersensitivity to substituted benzimidazoles
- caution: CYP2C19 poor metabolizers (peds patients)
- caution: zinc deficiency risk (EDTA-containing form)
- caution: long-term use
- caution: high-dose use
- caution: hypomagnesemia
- caution: hypocalcemia risk
Drug Interactions .
Overview
pantoprazole
PPI
- gastric pH modulator
- hypomagnesemia
Contraindicated
- rilpivirine
Avoid/Use Alternative
- amphetamine
- atazanavir
- bosutinib
- captopril
- cefuroxime axetil
- dacomitinib
- dasatinib
- defactinib
- dextroamphetamine
- erlotinib
- esomeprazole
- ferrous gluconate
- ferrous sulfate
- gefitinib
- ketoconazole
- levoketoconazole
- mefenamic acid
- mesalamine
- methamphetamine
- methylphenidate
- nelfinavir
- neratinib
- nilotinib
- nirogacestat
- omeprazole
- paltusotine
- pazopanib
- pexidartinib
- posaconazole
- rilzabrutinib
- risedronate
- selpercatinib
- sotorasib
- sparsentan
- taletrectinib
- velpatasvir
- vonoprazan
- ziftomenib
Monitor/Modify Tx
- acetazolamide
- amiloride
- amphotericin
- belumosudil
- bumetanide
- carboplatin
- cetuximab
- chlorothiazide
- chlorthalidone
- cyclosporine
- cysteamine
- digoxin
- domperidone
- ethacrynic acid
- foscarnet
- furosemide
- glipizide
- hydrochlorothiazide
- indapamide
- itraconazole
- ledipasvir
- letermovir
- levothyroxine
- mannitol
- methazolamide
- methotrexate
- metolazone
- necitumumab
- octreotide
- pamidronate
- panitumumab
- patiromer
- peppermint
- romidepsin
- sodium polystyrene sulfonate
- spironolactone
- sucralfate
- tacrolimus
- torsemide
- triamterene
- triazolam
- warfarin
Caution Advised
- bisacodyl
- cefpodoxime
- fosinopril
- levodopa
- mycophenolate mofetil
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- erythema multiforme
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- drug reaction with eosinophilia and systemic symptoms
- acute generalized exanthematous pustulosis
- tubulointerstitial nephritis
- renal impairment
- pancreatitis
- rhabdomyolysis
- fractures
- hyponatremia
- hypomagnesemia (long-term use)
- lupus erythematosus
- C. difficile-associated diarrhea
- blood dyscrasia
- hepatic impairment
Common Reactions
- headache
- diarrhea
- thrombophlebitis (IV use)
- abdominal pain
- nausea
- vomiting
- URI symptoms (peds patients)
- fever (peds patients)
- rash (peds patients)
- dizziness
- flatulence
- arthralgia
- ALT or AST elevated
- vitamin B12 deficiency (long-term use)
- fundic gland polyps (long-term use)
Safety/Monitoring .
Monitoring Parameters
consider Mg at baseline, then periodically if long-term tx or hypocalcemia risk; consider Ca at baseline, then periodically if hypocalcemia risk
Look/Sound-Alike Drug Names
Protonix confused with: Lotronex; pancuronium; Paxil; Plavix; Pravachol; Primaxin; protamine sulfate; Proteinex; Topamax
pantoprazole confused with: PARoxetine; Pravachol; pravastatin; propranolol
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; possible risk of teratogenicity based on conflicting human data
Lactation
Clinical Summary
may use while breastfeeding; inadequate human data available, though risk of infant harm not expected based on limited drug excretion into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for pantoprazole: liver extensively; CYP450: 2C19 substrate
Excretion: for pantoprazole: urine 71% (none unchanged), bile/feces 18%; Half-life: 1h
Subclass: H. pylori ; Proton Pump Inhibitors (PPIs)
Mechanism of Action
for pantoprazole: prodrug converted to active sulfenamide form, which inhibits gastric parietal cell hydrogen-potassium ATPase (proton pump inhibitor)
Formulary .
No Formulary Selected
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