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(pan-toe-pra-zole) ,

Panto IV

(trade name),


(trade name),


(trade name),

Protonix IV

(trade name),


(trade name)


Therapeutic: antiulcer agents
Pharmacologic: proton pump inhibitors
Pregnancy Category: B


Erosive esophagitis associated with GERD.Decrease relapse rates of daytime and nighttime heartburn symptoms on patients with GERD.Pathologic gastric hypersecretory conditions.Adjunctive treatment of duodenal ulcers associated with Helicobacter pylori.


Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

Therapeutic effects

Diminished accumulation of acid in the gastric lumen, with lessened acid reflux.
Healing of duodenal ulcers and esophagitis.
Decreased acid secretion in hypersecretory conditions.


Absorption: Tablet is enteric-coated; absorption occurs only after tablet leaves the stomach.
Distribution: Unknown.
Protein Binding: 98%.
Metabolism and Excretion: Mostly metabolized by the liver via the cytochrome P450 (CYP) system (primarily CYP2C19 isoenzyme, but also the CYP3A4 isoenzyme) (the CYP2C19 enzyme system exhibits genetic polymorphism; genetic implication 15–20% of Asian patients and 3–5% of Caucasian and Black patients may be poor metabolizers and may have significantly ↑ pantoprazole concentrations and an ↑ risk of adverse effects); inactive metabolites are excreted in urine (71%) and feces (18%).
Half-life: 1 hr.

Time/action profile (effect on acid secretion)

PO 2.5 hrunknown1 wk
IV15–30 min2 hrunknown
†Onset = 51% inhibition; duration = return to normal following discontinuation


Contraindicated in: Hypersensitivity; Obstetric: Should be used during pregnancy only if clearly needed; Lactation: Discontinue breast feeding due to potential for serious adverse reactions in infants.
Use Cautiously in: Patients using high-doses for >1 year (↑ risk of hip, wrist, or spine fractures); Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • headache


  • pseudomembranous colitis (life-threatening)
  • abdominal pain
  • diarrhea
  • eructation
  • flatulence


  • hyperglycemia

Fluid and Electrolyte

  • hypomagnesemia (especially if treatment duration ≥3 mo)


  • bone fracture


Drug-Drug interaction

May ↓ absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavir, ampicillin esters, and iron salts.May ↑ risk of bleeding with warfarin (monitor INR/PT).Hypomagnesemia ↑ risk of digoxin toxicity.May ↑ methotrexate levels



Oral (Adults) 40 mg once daily.
Oral (Children ≥5 yr) 15–39 kg–20 mg once daily for up to 8 wk; ≥40 kg–40 mg once daily for up to 8 wk.
Intravenous (Adults) 40 mg once daily for 7–10 days.

Gastric Hypersecretory Conditions

Oral (Adults) 40 mg twice daily, up to 120 mg twice daily.
Intravenous (Adults) 80 mg q 12 hr (up to 240 mg/day).

Availability (generic available)

Delayed-release tablets: 20 mg, 40 mg Cost: Generic — All strengths $368.22 / 90
Powder for injection: 40 mg/vial
Delayed-release oral suspension: 40 mg/packet Cost: $7.60 / 1 pkt

Nursing implications

Nursing assessment

  • Assess patient routinely for epigastric or abdominal pain and for frank or occult blood in stool, emesis, or gastric aspirate.
  • Lab Test Considerations: May cause abnormal liver function tests, including ↑ AST, ALT, alkaline phosphatase, and bilirubin.
    • May cause hypomagnesemia. Monitor serum magnesium prior to and periodically during therapy.

Potential Nursing Diagnoses

Acute pain (Indications)


  • Do not confuse Protonix (pantoprazole) with Lotronex (alosetron) or protamine.
  • Patients receiving pantoprazole IV should be converted to PO dosing as soon as possible.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Oral: May be administered with or without food. Do not break, crush, or chew tablets.
    • Antacids may be used concurrently.
  • Intravenous Administration
  • Intravenous: Reconstitute each vial with 10 mL of 0.9% NaCl. Reconstituted solution is stable for 6 hr at room temperature.
  • Diluent: Administer undiluted.Concentration: 4 mg/mL.
  • Rate: Administer over at least 2 min.
  • Intermittent Infusion: Diluent: Dilute further with D5W, 0.9% NaCl, or LR.Concentration: 0.4–0.8 mg/mL. Diluted solution is stable for 24 hr at room temperature.
  • Rate: Administer over 15 min at a rate of <3 mg/min.
  • Y-Site Compatibility: allopurinol, alprostadil, amifostine, aminocaproic acid, amikacin, aminophylline, amphotericin B lipid complex, amphotericin B liposome, ampicillin, amipcillin/sulbactam, anidulafungin, argatroban, azithromycin, bleomycin, bumetanide, carboplatin, carmustine, ceftaroline, ceftriaxone, cyclophosphamide, cytarabine, docetaxel, doripenem, doxorubicin liposome, doxycycline, ertapenem, fluorouracil, foscarnet, fosphenytoin, ganciclovir, granisetron, imipenem/cilastatin, irinotecan., mesna, methyldopate, paclitaxel, penicillin G sodium, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, potassium chloride, procainamide, rifampin, succinylcholine, sufentanyl, telavancin, teniposide, theophylline, ticarcillin/clavulanate, tigecycline, tirofiban, vasopressin, zidovudine, zoledronic acid
  • Y-Site Incompatibility: alemtuzumab, alfentanil, amphotericin B colloidal, atropine, aztreonam, buprenorphine, butorphanol, calcium acetate, calcium chloride, cefepime, cefoperazone, cefotaxime, cefotetan, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, dacarbazine, dactinomycin, dantrolene, daptomycin, daunorubicin hydrochloride, dexamethasone, dexmedetomidine, dexrazoxane, diazepam, diltiazem, diphenhydramine, dobutamine, dolasetron, doxorubicin hydrochloride, droperidol, ephedrine, epirubicin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, furosemide, gemcitabine, glycopyrrolate, haloperidol, heparin, hydralazine, hydromorphone, hydroxyzine, idarubicin, ifosfamide, insulin/regular, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, lorazepam, mechlorethamine, melphalan, meperidine, meropenem, methotrexate, methylprednisolone, metoprolol, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, mycophenolate, nalbuphine, naloxone, nesiritide, nicardipine, norepinephrine, ondansetron, palonosetron, pancuronium, pemetrexed, pentamidine, phenytoin, potassium acetate, potassium phosphates, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate, sodium phosphates, streptozocin, thiotepa, tolazoline, topotecan, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, solutions containing zinc

Patient/Family Teaching

  • Instruct patient to take medication as directed for the full course of therapy, even if feeling better.
  • Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
  • Advise patient to report onset of black, tarry stools; diarrhea; or abdominal pain to health care professional promptly. Instruct patient to notify health care professional immediately if rash, diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professional.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decrease in abdominal pain heartburn, gastric irritation and bleeding in patients with GERD; may require up to 4 wk of therapy.
  • Healing in patients with erosive esophagitis. Therapy is continued for up to 8 wk.


Notation for the gene for DFNA12 and DFNB21.


Plural of tectum.
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