pantoprazole

pantoprazole

(pan toe' pray zol)

Pantoloc (CAN), Protonix, Protonix IV

Pregnancy Category B

Drug classes

Antisecretory drug

Proton pump inhibitor

Therapeutic actions

Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Indications

·        Oral: Short-term (< 8 wk) and long-term treatment of GERD

·        Maintenance healing of erosive esophagitis

·        Long-term treatment of pathological hypersecretory conditions

·        IV: Short-term (7–10 days) treatment of GERD in patients unable to continue oral therapy

·        Treatment of pathological hypersecretory conditions associated with Zollinger-Ellison syndrome and other neoplastic conditions

·        Unlabeled uses: Treatment of duodenal ulcer

Contraindications and cautions

·        Contraindicated with hypersensitivity to any proton pump inhibitor or any drug components.

·        Use cautiously with pregnancy, lactation.

Available forms

DR tablet—20, 40 mg; powder for injection—40 mg/vial

Dosages

ADULTS

40 mg PO daily for maintenance healing of erosive esophagitis for < 8 wk. 8-wk course may be repeated if healing has not occurred; give continually for hypersecretory disoders; 40 mg/day IV for 7–10 days. Up to 240 mg/day PO or IV has been used for hypersecretory syndromes.

PEDIATRIC PATIENTS < 18 YR

Safety and efficacy not established.

PATIENTS WITH HEPATIC IMPAIRMENT

Use caution and monitor patient closely.

Pharmacokinetics

Route	Onset	Peak
Oral	1 hr	3–5 hr
IV	Rapid	3–5 hr

Metabolism: Hepatic; T_1/2: 1.5 hr

Distribution: Crosses placenta; may enter breast milk

Excretion: Bile, urine

IV facts

Preparation: Reconstitute with 10 mL 0.9% sodium chloride; may then be further diluted with 100 mL 5% dextrose injection, 0.9% sodium chloride injection or lactated Ringer's, final concentration 0.4 mg/mL; reconstituted solution can be stored 2 hr, dilution up to 12 hr at room temperature.

Infusion: Infuse over at least 15 min using in-line filter.

Incompatibilities: Do not mix with or administer through the same line as other IV solutions.

Adverse effects

·        CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities

·        Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin

·        GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy

·        Respiratory: URI symptoms, cough, epistaxis

·        Other: Cancer in preclinical studies, back pain, fever

Interactions

Drug-drug

·        Fewer drug interactions reported than with other proton pump inhibitors

Nursing considerations

Assessment

·        History: Hypersensitivity to any proton pump inhibitor or any drug components; pregnancy; lactation

·        Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal examination; respiratory auscultation

Interventions

·        Administer once or twice a day. Caution patient to swallow tablets whole; not to cut, chew, or crush them.

·        WARNING: Arrange for further evaluation of patient after 4 wk of therapy for gastroreflux disorders. Symptomatic improvement does not rule out gastric cancer; gastric cancer did occur in preclinical studies.

·        Maintain supportive treatment as appropriate for underlying problem.

·        Switch patients on IV therapy to oral dosage as soon as possible.

·        Provide additional comfort measures to alleviate discomfort from GI effects and headache.

Teaching points

·        Take the drug once or twice a day. Swallow the tablets whole—do not chew, cut, or crush them.

·        Arrange to have regular medical follow-up care while you are using this drug.

·        Maintain all of the usual activities and restrictions that apply to your condition. If this becomes difficult, consult your health care provider.

·        You may experience these side effects: Dizziness (avoid driving a car or performing hazardous tasks); headache (consult your health care provider if these become bothersome, medications may be available to help); nausea, vomiting, diarrhea (proper nutrition is important, consult a dietitian to maintain nutrition; stay near a bathroom); symptoms of upper respiratory tract infection, cough (it may help to know that this is a drug effect, do not self-medicate, consult your health care provider if this becomes uncomfortable).

·        Report severe headache, worsening of symptoms, fever, chills, blurred vision, periorbital pain.

Adverse effects in Italic are most common; those in Bold are life-threatening.