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Proton Pump Inhibitor (PPI) Pregnancy: Compatible — omeprazole/pantoprazole data reassuring

Pantoprazole

Brand names: Protium

Adult dose

Dose: Oral: 20–40 mg OD. IV: 40 mg OD (or BD for bleeding peptic ulcer after endoscopy)
Route: Oral or IV infusion
Frequency: Once daily (oral); BD in high-risk peptic ulcer
Max: 80 mg/day
Preferred PPI with clopidogrel (less CYP2C19 interaction vs omeprazole). High-dose IV (80 mg bolus then 8 mg/h) after endoscopic haemostasis for peptic ulcer bleeding.

Paediatric dose

Route: Oral or IV
Frequency: OD
Max: 40 mg OD
Concentration: 4 mg/ml
BNF for Children: weight-banded fixed doses — ≥15 kg to <40 kg: 20 mg OD; ≥40 kg: 40 mg OD. Not recommended <5 years (limited data). Weight-based calculator not applicable. Source: BNF for Children 2024

Dose adjustments

Renal

No dose adjustment required

Hepatic

Maximum 20 mg/day in severe hepatic impairment

Clinical pearls

  • Preferred PPI with clopidogrel due to less CYP2C19 inhibition — use pantoprazole not omeprazole
  • Hypomagnesaemia: check Mg2+ in patients on long-term PPI, especially those also on digoxin or diuretics
  • C. diff risk increases with PPI use — always review appropriateness of ongoing prescribing
  • Intravenous pantoprazole used after endoscopic haemostasis to reduce re-bleeding: 80 mg loading, then 8 mg/h for 72h

Contraindications

  • Concomitant rilpivirine, nelfinavir, or atazanavir (without ritonavir) — reduces antiviral absorption

Side effects

  • Headache
  • Diarrhoea
  • Nausea
  • Hypomagnesaemia (long-term use)
  • C. difficile (long-term use)
  • Interstitial nephritis (rare)
  • Fundic gland polyps

Interactions

  • Clopidogrel — less interaction than omeprazole (preferred PPI with antiplatelet therapy)
  • Methotrexate — PPIs reduce methotrexate clearance (monitor toxicity)
  • Antivirals (atazanavir, rilpivirine) — reduced absorption

Monitoring

  • Magnesium (long-term use)
  • Vitamin B12 (prolonged use)
  • Symptom response
  • Review ongoing indication at each encounter

Reference: BNFc; BNF; NICE CG141 Peptic Ulcer; ESC AFib PPI guidance. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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