pan·to·pra·zole sodium (p n-t  pr -zl )n. A proton pump inhibitor drug used primarily to treat erosive esophagitis and hypersecretory conditions such as Zollinger-Ellison syndrome. |
pantoprazole sodium
Protium (UK), Protonix, Protonix IV
Pharmacologic class: Proton pump inhibitor
Therapeutic class: GI agent
Pregnancy risk category B
Action
Reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating protective coating on gastric mucosa
Availability
Powder for injection (freeze-dried): 40 mg/vial
Tablets (delayed-release): 20 mg, 40 mg
⊘Indications and dosages
➣ Erosive esophagitis caused by gastroesophageal reflux disease (GERD)
Adults: 40 mg I.V. daily for 7 to 10 days or 40 mg P.O. daily for 8 weeks. May repeat P.O. course for 8 additional weeks.
➣ Erosive esophagitis
Adults: 40 mg P.O. daily
➣ Pathologic hypersecretory conditions
Adults: Initially, 40 mg P.O. b.i.d., increased as needed to maximum of 240 mg P.O. daily; some patients may need up to 2 years of therapy. Alternatively, 80 mg I.V. q 12 hours, to a maximum of 240 mg/day (80 mg q 8 hours).
Contraindications
• Hypersensitivity to drug
Precautions
Use cautiously in:
• severe hepatic disease
• pregnant or breastfeeding patients
• children.
Administration
• For I.V. administration, use in-line filter provided. If Y-site is used, place filter below Y-site closest to patient.
• Dilute I.V. form with 10 ml of normal saline solution; further dilute in dextrose 5% in water, normal saline solution, or lactated Ringer's solution, as directed. Give over 15 minutes at a rate no faster than 3 mg/minute.
• Don't give I.V. form with other I.V. solutions.
• Know that I.V. form is indicated for short-term treatment of GERD in patients with history of erosive esophagitis as alternative to P.O. therapy.
| Route | Onset | Peak | Duration |
| P.O. | Rapid | 2.5 hr | >24 hr |
| I.V. | Rapid | Unknown | >24 hr |
Adverse reactions
CNS: dizziness, headache
CV: chest pain
EENT: rhinitis
GI: vomiting, diarrhea, abdominal pain, dyspepsia
Metabolic: hyperglycemia
Skin: rash, pruritus
Other: injection site reaction
Interactions
Drug-drug. Ampicillin, cyanocobalamin, digoxin, iron salts, ketoconazole: delayed absorption of these drugs
Clarithromycin, diazepam, flurazepam, phenytoin, triazolam: increased pantoprazole blood level
Sucralfate: delayed pantoprazole absorption
Warfarin: increased bleeding
Drug-diagnostic tests. Aspartate aminotransferase, glucose: increased levels
Tetrahydrocannabinol test: false-positive result
Patient monitoring
• Assess for symptomatic improvement.
• Monitor blood glucose level in diabetic patient.
Patient teaching
• Tell patient to swallow delayed-release tablets whole without crushing, chewing, or splitting.
• Tell patient he may take tablets with or without food.
• Explain that antacids don't affect drug absorption.
• Instruct diabetic patients to monitor blood glucose level carefully and stay alert for signs and symptoms of hyperglycemia.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
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