Pantoprazole is often chosen when CYP interactions must be minimized; nonetheless, validate class contraindications and plan for periodic deprescribing discussions.
Absolute contraindications include hypersensitivity to pantoprazole or substituted benzimidazoles, and concomitant use with rilpivirine. Relative issues include chronic therapy without reassessment, hypomagnesemia risk, and infections associated with long-term acid suppression.
Known hypersensitivity to pantoprazole, other substituted benzimidazole PPIs, or formulation excipients
History of severe immediate hypersensitivity (anaphylaxis, angioedema) to proton pump inhibitors
Concomitant use with rilpivirine-containing antiretroviral regimens (marked loss of virologic efficacy)
Need for drugs requiring acidic pH for absorption (atazanavir, erlotinib, ketoconazole)—consider alternatives or therapeutic drug monitoring
Pre-existing hypomagnesemia or long-term diuretic therapy—risk of profound magnesium depletion
High fracture risk or osteoporosis—prolonged PPI use may decrease calcium absorption
History of Clostridioides difficile infection—chronic acid suppression raises recurrence risk