Adults

For GERD and erosive esophagitis: 40 mg once daily for up to 8 weeks. For H. pylori eradication: 40 mg twice daily for 7-14 days (with antibiotics). For Zollinger-Ellison Syndrome: Initial 40 mg twice daily, adjusted based on response.

Elderly

No dose adjustment generally necessary, but caution in patients with severe hepatic impairment.

Renal_impairment

No dose adjustment required for renal impairment.

Onset

Onset of acid suppression typically within 2-3 hours.

Excretion

Primarily excreted renally (approximately 71%) as metabolites and to a lesser extent via bile/feces (approximately 18%).

Half life

Plasma elimination half-life is approximately 1 hour, but the duration of action is much longer due to irreversible binding to the proton pump.

Absorption

Rapidly absorbed after oral administration; peak plasma concentrations achieved in approximately 2.0-2.5 hours. Absolute bioavailability is about 77%.

Metabolism

Extensively metabolized in the liver mainly by cytochrome P450 (CYP) system, primarily CYP2C19 and CYP3A4.

Warfarin

Increased INR and prothrombin time have been reported, requiring monitoring.

Clopidogrel

Concomitant use may reduce the antiplatelet effect of clopidogrel. Avoid co-administration.

Methotrexate

May increase and prolong serum levels of methotrexate and/or its metabolite, potentially leading to toxicity. Consider temporary PPI withdrawal.

Drugs requiring acidic pH for absorption (e.g., ketoconazole, itraconazole, atazanavir)

Pantoprazole reduces gastric acidity, which can decrease the absorption and bioavailability of these drugs.