Pantoprazole Dosage

Usual Adult Dose for Erosive Esophagitis

Treatment: 40 mg orally once a day
-Duration of therapy: 8 weeks

Maintenance: 40 mg once daily

Comments:
-If patients are not healed after 8 weeks or erosive esophagitis recurs with the oral formulation, treatment for another 8 weeks may be considered.
-Controlled studies using the oral formulation for maintenance did not extend beyond 12 months.

Uses:
-Short-term treatment in the healing and symptomatic relief of erosive esophagitis
-Maintenance of healing of erosive esophagitis

Usual Adult Dose for Gastroesophageal Reflux Disease

Oral: 40 mg orally once a day
-Duration of therapy: 8 weeks

Parenteral: 40 mg IV once a day, given over at least 2 minutes OR over 15 minutes
-Duration of therapy: 7 to 10 days

Comments:
-IV treatment should be discontinued once the patient is able to take an oral formulation.
-Use of the IV formulation has not been studied for longer than 10 days.
-If patients are not healed after 8 weeks with the oral formulation, treatment for another 8 weeks may be considered.

Uses:
-Short-term treatment of gastroesophageal reflux disease (GERD) in patients with a history of erosive esophagitis
-Reduction of relapse rates of daytime and nighttime heartburn symptoms in adult patients with GERD

Usual Adult Dose for Zollinger-Ellison Syndrome

Oral: 40 mg orally 2 times a day
-Maximum dose: 240 mg/day

Parenteral:
-Initial dose: 80 mg IV every 12 hours, given over at least 2 minutes OR over 15 minutes
-Maintenance dose: 80 mg IV every 8 to 12 hours, given over at least 2 minutes OR over 15 minutes
-Maximum dose: 240 mg/day
-Maximum duration of therapy: 6 days

Comments:
-IV treatment should be discontinued once the patient is able to take an oral formulation.
-Use of the IV formulation for longer than 6 days and/or with doses higher than 240 mg has not been adequately studied.
-Patients may be vulnerable to increased acid production despite a short period of loss of effective inhibition.
-Patients given the oral formulation should be continued on therapy for as long as clinically necessary.

Use: Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome

Usual Pediatric Dose for Erosive Esophagitis

5 years and older:
15 to less than 40 kg: 20 mg orally once a day
40 kg and greater: 40 mg orally once a day
Duration of therapy: Up to 8 weeks

Comment: Safety has not been established in treatment beyond 8 weeks.

Uses:
-Short-term treatment in the healing and symptomatic relief of erosive esophagitis
-Short-term treatment of GERD in patients with a history of erosive esophagitis

Usual Pediatric Dose for Gastroesophageal Reflux Disease

5 years and older:
15 to less than 40 kg: 20 mg orally once a day
40 kg and greater: 40 mg orally once a day
Duration of therapy: Up to 8 weeks

Comment: Safety has not been established in treatment beyond 8 weeks.

Uses:
-Short-term treatment in the healing and symptomatic relief of erosive esophagitis
-Short-term treatment of GERD in patients with a history of erosive esophagitis

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Doses over 40 mg/day have not been studied in patients with liver impairment.

Precautions

Safety and efficacy of oral formulations have not been established in patients younger than 5 years. The IV formulation is not recommended for use in children.

Consult WARNINGS section for additional precautions.

Dialysis

Hemodialysis: No adjustment recommended.
Peritoneal dialysis: Data not available

Other Comments

Administration advice:
-Tablet formulations should be swallowed whole, without crushing/chewing; tablets may be taken with or without food.
-For patients unable to swallow a 40 mg tablet, two 20 mg tablets may be taken.
-Oral suspension/granule formulations should be taken on an empty stomach, preferably 30 to 60 minutes before a meal. The 40 mg packet should not be divided to create 20 mg dosages.
-The granule formulation may be sprinkled into applesauce or mixed into a small volume of either apple juice or orange juice and swallowed immediately. This drug may be mixed with apple juice and administered via nasogastric tube.

Storage requirements: The manufacturer product information should be consulted.

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

IV compatibility: The manufacturer product information should be consulted.

General:
-This drug may be used concomitantly with antacids without affecting the absorption.
-Reflux symptoms may take 2 to 3 days to improve after initiation.
-Rapid acid control may be achieved within an hour at an IV dose of 160 mg.

Monitoring:
-Magnesium levels, especially in patients taking other drugs that could result in hypomagnesemia or those on long-term therapy
-Vitamin B12 levels, especially in patients on long-term therapy
-Bone fractures, especially in patients at high-risk for osteoporosis-related events
-Liver function tests, especially in patients with impaired liver function
-Renal function tests

Patient advice:
-Advise patients to avoid taking concomitant proton pump inhibitors and/or H2 antagonists during treatment.
-If using this drug to treat H pylori, tell patients that it is important to complete the full regimen.
-Instruct patients to seek medical attention if signs/symptoms of hypersensitivity, Clostridium difficile, or systemic cutaneous lupus erythematosus occur.
-Patients should be told that treatment may not provide immediate relief and that they should not take this drug for prophylaxis. Symptomatic relief may occur after 1 day of treatment, but patients should continue treatment for the full duration to achieve complete symptom control.
-Inform patients that this drug may cause dizziness or blurred vision, and they should avoid driving or operating machinery if these side effects occur.
-Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.