Pantoprazole

pantoprazole (pan toe' pray zol) Pantoloc (CAN), Protonix, Protonix IV Pregnancy Category B Drug classes

Antisecretory agent 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

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Oral: Short-term (< 8 wk) and long-term treatment of GERD (gastric esophageal reflux disease) IV: Short-term (7–10 days) treatment of GERD in patients unable to continue oral therapy Treatment of pathological hypersecretory conditions associated with ZollingerEllison syndrome and other neoplastic conditions Unlabeled uses: Treatment of peptic ulcer

Contraindications and cautions

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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 to bid for < 8 wk for erosive esophagitis. 8-wk course may be repeated if healing has not occurred; 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 Oral IV

Onset 1 hr Rapid

Peak 3–5 hr 3–5 hr

Metabolism: Hepatic; T1/2: 1.5 hr Distribution: Crosses placenta; may enter breast milk Excretion: Urine and bile 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

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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

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History: Hypersensitivity to any proton pump inhibitor or any drug components; pregnancy; lactation Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal exam; respiratory auscultation

Interventions

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

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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 while you are using this drug. Maintain all of the usual activities and restrictions that apply to your condition. If this becomes difficult, consult with your nurse or physician. These side effects may occur: Dizziness (avoid driving a car or performing hazardous tasks); headache (consult with your nurse if these become bothersome, medications may be available to help); nausea, vomiting, diarrhea (proper nutrition is important, consult with your dietitian to maintain nutrition; ensure ready access to bathroom facilities); symptoms of URI, cough (it may help to know that this is a drug effect, do not self-medicate, consult with your nurse or physician 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.