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Pantoprazole Dosage

Medically reviewed on June 26, 2018.

Applies to the following strengths: 40 mg; 20 mg

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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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