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Pharmacologic class: Proton pump inhibitor
Therapeutic class: GI agent
Pregnancy risk category B
Reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating protective coating on gastric mucosa
Granules (delayed-release oral suspension): 40 mg
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.
Children ages 5 and older weighing 40 kg (88 lb) or more: 40 mg P.O. daily for up to 8 weeks
Children ages 5 and older weighing 15 kg (33 lb) to less than 40 kg (88 lb): 20 mg P.O. daily for up to 8 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).
• Hypersensitivity to drug or any substituted benzimidazole
Use cautiously in:
• severe hepatic disease
• atrophic gastritis with long-term use
• increased risk of osteoporosis-related hip, wrist, or spine fractures with long-term use or multiple daily doses
• concurrent use of atazanavir, nelfi-navir, or methotrexate
• pregnant or breastfeeding patients
• Be aware that oral granules may be mixed with applesauce or apple juice and given 30 minutes before a meal. Once mixed, give drug within 10 minutes.
• Know that oral granules may be mixed with 10 ml apple juice and administered into nasogastric tube using 60-ml catheter-tip syringe. Rinse syringe with additional apple juice so that no granules remain in syringe.
• 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.
• Be aware that symptomatic response doesn't rule out gastric cancer.
CNS: dizziness, headache
CV: chest pain
GI: vomiting, diarrhea, abdominal pain, dyspepsia
Musculoskeletal: hip, wrist, spine fractures (with long-term daily use)
Skin: rash, pruritus
Other: injection site reaction
Drug-drug. Ampicillin, cyanocobalamin, digoxin, iron salts, ketoconazole: delayed absorption of these drugs Atazanavir, nelfinavir: substantially decreased atazanavir or nelfinavir plasma concentration with loss of therapeutic effect and development of drug resistance
Clarithromycin, diazepam, flurazepam, phenytoin, triazolam: increased panto-prazole blood level
Sucralfate: delayed pantoprazole absorption
Warfarin: increased bleeding
Drug-diagnostic tests. Aspartate aminotransferase, glucose: increased levels
Tetrahydrocannabinol test: false-positive result
• Assess for symptomatic improvement.
• Monitor blood glucose level in diabetic patient.
• 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.