Pantoprazole

Pantoprazole is a proton pump inhibitor (PPI), similar to omeprazole.The injectable formulation can be used as an alternative to omeprazole. PPIs are often overused in the ICU and there are emerging data linking PPI use with Clostridium difficile infection (Dial S, et al. CMAJ 2004; 171: 33–8).

Uses
Bleeding peptic ulcers,after endoscopic treatment of bleeding (unlicensed)
Continuation of PPI therapy when the PO/NG route is unavailable
Helicobacter pylori eradication

Administration
• Bleeding peptic ulcers, after endoscopic treatment of bleeding
IV: Initial 80 mg IV loading dose given over 1 hour, followed by 8 mg/h IV infusion for 72 hours Reconstitute with either sodium chloride 0.9% or glucose 5%

• Continuation of PPI therapy when the PO/NG route is unavailable
IV: 40 mg daily. Reconstitute 40-mg vial with the 10 ml sodium chloride 0.9%; administer as a slow bolus.Alternatively, add to 100-ml
bag of sodium chloride 0.9% or glucose 5% and administer over 15 min or as a continuous infusion (unlicensed).

Adverse effects
GI disturbances (abdominal pain, diarrhoea, flatulence and constipation)
Headache
Agitation
Liver dysfunction
Leukopenia and thrombocytopenia rarely

Cautions
Severe hepatic disease (risk of encephalopathy)
Pregnancy (toxic in animal studies)
May mask symptoms of gastric cancer
Pantoprazolemay enhance anticoagulant effect ofwarfarin – monitorINR
Pantoprazole may reduce the effectiveness of clopidogrel

Organ failure
Hepatic: reduce 40 mg dose to 20mg
Renal: no dose adjustment is necessary