Pantoprazole (Protonix) Dosing
The standard dose of pantoprazole is 40 mg once daily, taken 30 minutes before breakfast on an empty stomach for optimal absorption. 1, 2
Standard Dosing by Indication
Acid-Related Gastric Disorders (GERD, Erosive Esophagitis, Peptic Ulcer)
- 40 mg once daily is the optimal adult oral dose for gastric acid-related disorders 1, 2, 3
- Take 30 minutes before breakfast on an empty stomach for optimal absorption 1, 4
- Treatment duration is typically 4-8 weeks for acute conditions 1, 3
H. pylori Eradication (Triple Therapy)
- 40 mg twice daily as part of combination therapy with antibiotics for 10-14 days 1, 3
- This higher dose is necessary for adequate acid suppression during antimicrobial therapy 1
Maintenance Therapy for GERD
- 20 mg once daily for long-term maintenance after healing (up to 24 months) 3
- Some patients may require 40 mg daily for maintenance 3
Upper GI Bleeding (High-Risk Lesions After Endoscopy)
- 80 mg IV bolus, followed by 8 mg/hour continuous infusion for 72 hours after endoscopic therapy 5, 6
- This represents a class effect of PPIs in reducing rebleeding rates 6
Dose Equivalencies
- 40 mg pantoprazole = 20 mg omeprazole for standard once-daily dosing 4
- 80 mg pantoprazole = 40 mg omeprazole for higher-dose therapy 6, 4
- Pantoprazole has markedly lower relative potency than other PPIs (40 mg pantoprazole = only 9 mg omeprazole in some analyses) 1, 6
Pediatric Dosing (Ages 1-16 Years)
- 20 mg or 40 mg once daily depending on weight and severity for treatment of erosive esophagitis 7, 3
- Safety and effectiveness established for short-term treatment (up to 8 weeks) 7
- Effectiveness not demonstrated in patients less than 1 year of age 7
Critical Dosing Considerations
Administration Timing
- Must be taken 30 minutes before eating or drinking on an empty stomach 1, 4
- Should not be taken with food or other antacids, as this significantly reduces absorption and efficacy 1
- Preferably taken in the morning before breakfast 1, 4
When NOT to Use Twice-Daily Dosing
- Avoid twice-daily dosing initially unless treating H. pylori infection 1
- Twice-daily dosing increases costs and adverse event risk without proven benefit for simple gastritis or uncomplicated GERD 1
Duration of Therapy
- Most patients should be considered for de-prescribing after acute symptoms resolve 1
- Avoid long-term use without clear indication 1
- An 8-week course at appropriate doses is recommended to assess PPI response for most conditions 6
Common Pitfalls to Avoid
- Do not use pantoprazole as first-line for conditions requiring robust acid suppression (e.g., amoxicillin-containing H. pylori regimens), as it has lower relative potency compared to esomeprazole or rabeprazole 1, 6
- Do not prescribe for acute gastritis without confirming diagnosis, as acute gastritis is not a definitive indication for PPI therapy unless H. pylori-related 1
- Do not take with food, as this significantly reduces bioavailability (absolute bioavailability is 77% when taken correctly) 8
- Do not assume dose equivalence across all PPIs, as pantoprazole requires higher doses than other PPIs for equivalent effect 1, 6, 4
Special Populations
Renal Impairment
- No dose adjustment required, as pharmacokinetics are unaltered in patients with renal failure 8
Hepatic Impairment
- In severe liver cirrhosis, half-life increases to 7-9 hours (vs. 1.1 hours normally), but specific dose adjustments are not routinely recommended 8
Elderly
- Half-life is approximately 1.25 hours in the elderly (slightly longer than younger adults), but no routine dose adjustment needed 8