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Pantoprazole

Classification

Proton pump inhibitor

Indications

CCP: Bleeding peptic ulcer, peptic ulcer prophylaxis in intubated patient, erosive esophagitis, gastroesophageal reflux disease in patients unable to swallow, Zollinger Ellison Syndrome.

PCP: For Interfacility Transport of patients with any of the conditions outlined above.

Contraindications

Hypersensitivity to any components of the medication

Adult dosages

CCP: Bleeding peptic ulcer

80mg IV bolus followed by 8mg/hour infusion for 72 hours

CCP: Patient unable to take oral medications or peptic ulcer prophylaxis

40mg IV once daily to BID

CCP: Zollinger Ellison Syndrome

80mg IV BID

Pediatric Considerations And Dosing

CCP: Acute GI Bleed

5-40kg: 2mg/kg IV bolus once followed by 0.2mg/kg/hour continuous infusion
Greater than 40kg: see adult dosages

CCP: Gerd, esophagitis, ulcers

1-4 years: 0.6 – 1.2 mg/kg/dose PO/IV (Max 20mg)
5 and older and less than 40kg: 20mg PO/IV
5 and over and greater than 40kg: 40mg PO/IV daily

Interfacility Transport

PCP: Bleeding Peptic Ulcer

80mg IV bolus followed by 8mg/hour infusion for 72 hours

PCP: Patient unable to take oral medications or peptic ulcer prophylaxis

40mg IV once daily to BID

PCP: Zollinger Ellison Syndrome

80mg IV BID

Preparation And Administration

Adult and Pediatrics

Reconstitution

Mix 10mL of NS into vial to dissolve powder

Standard solution: 0.4mg/mL

Add reconstituted solution (40mg/10mL) to 100mL bag of NS

How Supplied

Not supplied by BCEHS

40 mg/vial
20 mg tablet
40 mg tablet

Mechanism Of Action

Inhibits gastric parietal cell hydrogen-potassium ATPase. This results in the blocking of acid secretion in the stomach.

Pharmocokinetics

Onset: 15- 30 minutes
Duration: 24 hours

Onset: 2.5 hours
Duration 24 hours

Adverse Effects

Generally well tolerated
Headache
Diarrhea, nausea, flatulence
Hypersensitivity reaction (from minor rash to anaphylaxis or Stevens-Johnson syndrome)
Thrombophlebitis

Warning And Precautions

In short term use, there is limited risk in PPI administration

If possible, avoid in patients with C. Difficile associated diarrhea

Drug Interactions

There are a number of drug interactions with PPI’s however, in short term use, the clinical significance of drug interactions is minimal
Use caution when administering with the following:
- Antiretrovirals for HIV
- Chemotherapy
- Minerals (iron, calcium)
- Levothyroxine